Do benzodiazepines still deserve a major role in the treatment of psychiatric disorders? A critical reappraisal

Eur Psychiatry. 2013 Jan;28(1):7-20. doi: 10.1016/j.eurpsy.2011.11.003. Epub 2012 Apr 20.


Discovered in the late 1950s by Leo Sternbach, the first benzodiazepine (BZD) chlordiazepoxide was followed by several congeners, which rapidly constituted one of the largest and most widely prescribed classes of psychotropic compounds. After 50 years, BZDs are still routinely utilized not only in psychiatry but, more generally, in the whole of medicine. Despite their high therapeutic index which makes BZDs safer than other compounds like barbiturates, as well as their rapidity of onset, psychiatrists and family physicians are well aware about the controversy that surrounds the wide use - often not adequately based on scientific evidence - of BZDs in many psychiatric disorders. In this overview of international treatment guidelines, systematic reviews and randomized clinical trials, the aim was to provide a critical appraisal of the current use and role of BZDs in psychiatric disorders and their disadvantages, with specific emphasis on anxiety and affective disorders, sleep disorders, alcohol withdrawal, violent and aggressive behaviours in psychoses, and neuroleptic-induced disorders. In addition, specific emphasis has been given to the extent of usage of BZDs and its appropriateness through the assessment of available international surveys. Finally, the entire spectrum of BZD-related adverse effects including psychomotor effects, use in the elderly, paradoxical reactions, tolerance and rebound, teratologic risk, dependence, withdrawal and abuse issues was examined in detail.

Publication types

  • Review

MeSH terms

  • Anti-Anxiety Agents / therapeutic use*
  • Benzodiazepines / therapeutic use*
  • GABA Modulators / therapeutic use*
  • Humans
  • Hypnotics and Sedatives / therapeutic use*
  • Mental Disorders / drug therapy*
  • Sleep Initiation and Maintenance Disorders / drug therapy*


  • Anti-Anxiety Agents
  • GABA Modulators
  • Hypnotics and Sedatives
  • Benzodiazepines