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As with GAD, discontinuation of the benzodiazepine can be stormy with the panics reappearing often with rebound to higher levels than experienced before, and/or with withdrawal phenomena.
Direct comparisons with other effective anti-panic agents such as imipramine, an SSRI, indicates that such withdrawal after months is often an important problem requiring clinical resources for its management.
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Some elucidation of these issues is afforded by study of the long-term efficacy of the hypnotic benzodiazepines because of the availability of objective sleep recordings (polysomnogram, PSG).
Fairly consistently, sleep EEG measures of hypnotic effect revert to pre-treatment values after 1-4 weeks.(11) Despite this, most patients claim that some benefit remains and many wish to continue medication.
These effects can be seen both with objective EEG recordings in the sleep laboratory and subjectively with rating scales completed each morning.
Although these two sets of data correlate at a notoriously low level, the rating of "a good night's sleep" usually reflects infrequent nocturnal arousals.
They were then transferred to placebo for 18, 10 and 2 weeks respectively.(6) In some patients, the switch to placebo was accompanied by withdrawal reactions.
The incidence ranged from 43% in patients who had been taking a benzodiazepine for more than a year before entering the study to only 5% in the short-term users.
Furthermore, in those patients who did not develop withdrawal reactions, the switch to placebo was usually attended by a worsening of anxiety symptoms.
The variability between patients is high but these data can be interpreted as showing that long-term use, although probably maintaining some efficacy, also involves an appreciable risk of inducing dependence.
Thus, the frequent observation that many long-term benzodiazepine users claim continuing benefit cannot be taken at its face value.Tags: Adult Dating, affair dating, sex dating