Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives.

Benzodiazepines I: Upping the Care on Downers: The Evidence of Risks, Benefits and Alternatives.
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DOI:
10.3390/jcm7020017
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发表时间:
2018-01-30
影响因子:
3.9
通讯作者:
Merrill B
Merrill B
中科院分区:
医学2区
文献类型:
--
作者:
Guina J;Merrill B

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苯二氮卓类药物是世界上最常用的处方药之一。这些镇静催眠药可以快速缓解焦虑和失眠等症状,但也与各种不良反应有关(无论是长期使用,短期使用还是根据需要使用)。许多患者长期服用苯二氮卓类药物,但从未接受过循证一线治疗(例如,心理治疗、放松技术、睡眠卫生教育、肾上腺素能药物)。本综述讨论了苯二氮卓类药物的风险和益处以及苯二氮卓类药物的替代品。我们讨论了循证的适应症和禁忌症,以及有效性、无效性和危害的理论生物心理社会基础。总结了潜在的不良反应和药物相互作用。最后,讨论了焦虑和/或失眠的快速/急性和延迟作用/慢性替代治疗。无论是苯二氮卓类药物、其他药物还是心理治疗,治疗反应都应该根据功能恢复而不仅仅是镇静来确定。
Benzodiazepines are some of the most commonly prescribed medications in the world. These sedative-hypnotics can provide rapid relief for symptoms like anxiety and insomnia, but are also linked to a variety of adverse effects (whether used long-term, short-term, or as needed). Many patients take benzodiazepines long-term without ever receiving evidence-based first-line treatments (e.g., psychotherapy, relaxation techniques, sleep hygiene education, serotonergic agents). This review discusses the risks and benefits of, and alternatives to benzodiazepines. We discuss evidence-based indications and contraindications, and the theoretical biopsychosocial bases for effectiveness, ineffectiveness and harm. Potential adverse effects and drug-drug interactions are summarized. Finally, both fast-acting/acute and delayed-action/chronic alternative treatments for anxiety and/or insomnia are discussed. Response to treatment—whether benzodiazepines, other pharmacological agents, or psychotherapy—should be determined based on functional recovery and not merely sedation.
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