Benzodiazepines on trial.
Benzodiazepines on trial.
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苯二氮卓类药物正在试验中。
DOI：
10.1136/bmj.288.6424.1101
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发表时间：
1984
期刊：
影响因子：
--
通讯作者：
P. Tyrer
中科院分区：
文献类型：
--
作者：
P. Tyrer
任何相信药物治疗可以将联合收割机良好的疗效与任何不良反应结合起来的人，都一定会摔得很惨。苯二氮卓类药物是极好的抗焦虑药物和催眠药，2其疗效上级于其他抗焦虑药物，包括巴比妥类药物，3 4，而且无疑更安全。5苯二氮卓类药物一经上市，处方量就稳步上升，在1965年超过了巴比妥类药物，在20世纪70年代继续急剧攀升。它们的流行引起了一些关注，6但仔细的调查表明，这些药物的处方或多或少是负责任的，7尽管患者倾向于接受它们过长的时间。8随着中枢神经系统中苯二氮卓类药物特异性结合位点的发现，其在焦虑中特异性的原因变得清楚。9在焦虑中必须关注结构与苯二氮卓类药物相似的内源性物质。焦虑的生理控制：也许，他们的支持者声称，外源性苯二氮卓类药物只是模仿了一个自然过程。然而，近年来，批准的钟摆已经戏剧性地摆向了苯二氮卓类药物。Ashton的仔细研究（第1135页）是几项研究中最新的一项，这些研究明确表明苯二氮卓类药物在治疗剂量下可能产生药理学依赖性。0-14药物依赖综合征的典型模式，即药物寻求行为、快速耐受性和剂量增加，是罕见的（根据Marks的计算，每500万患者月中有一人处于“危险”5），但治疗剂量后依赖的发生更频繁，更令人担忧。这种危险已经认识到了几年，但直到最近，临床医生一直不愿意接受服用苯二氮卓类药物的患者中出现的问题构成真正的药物依赖-部分原因是依赖主要表现为药物剂量减少或治疗停止后发生的戒断综合征。大部分困难源于戒断的早期症状是焦虑，因此，当患者在戒断苯二氮卓类药物后变得焦虑时，这可能会被简单地误认为是先前存在的焦虑的恢复。退缩的全部特征--包括特殊形式的知觉障碍（阿什顿的例子很好地说明了这一点
Anyone who believes that a drug treatment can combine sound efficacy with no adverse effects whatsoever must be due for a nasty fall. The benzodiazepines are excellent antianxiety drugs and hypnotics,' 2 superior in efficacy to other antianxiety drugs, including the barbiturates,3 4 and indubitably safer.5 As soon as they became available prescriptions for benzodiazepines rose steadily, exceeding those for barbiturates in 1965, and they continued to climb dramatically during the 1970s. Their popularity provoked some concern,6 but careful investigations suggested that the drugs were being prescribed more or less responsibly,7 though patients tended to receive them for unduly long periods.8 With the discovery of specific binding sites for benzodiazepines in the central nervous system the reasons for their specificity in anxiety became clear.9 An endogenous substance similar in structure to the benzodiazepines must be concerned in the physiological control of anxiety: perhaps, their supporters claimed, exogenous benzodiazepines only mimicked a natural process. In recent years, however, the pendulum of approval has swung dramatically against the benzodiazepines. Ashton's careful study (p 1135) is the latest of several investigations that have shown quite unequivocally that benzodiazepines may produce pharmacological dependence in therapeutic dosage.'0-14 The typical pattern of a drug dependence syndrome, with drug seeking behaviour, rapid tolerance, and escalation of dosage, is rare (according to Marks's calculations, one in every 5 million patient months "at risk"'5) but the occurrence of dependence after therapeutic dosage is more frequent and more alarming. This danger has been recognised for several years,'6 but until recently clinicians have been reluctant to accept that the problems seen in patients taking benzodiazepines constitute true pharmacological dependence -partly because the dependence is manifested primarily by an abstinence syndrome occurring after the dose of the drug is reduced or treatment is stopped. Muchofthe difficulty stems from the earlysymptoms ofwithdrawal being those of anxiety, so that when a patient becomes anxious after withdrawal of benzodiazepines this may be mistaken simply for a return of pre-existing anxiety. The full constellation of withdrawal features-including peculiar forms of perceptual disturbance (well exemplified by Ashton's