How do you approach anxiety management for patients who have been on long-term (years or more) daily benzodiazepines?  

For patients that I have been seeing for several years, and who have been taking a benzodiazepine for several years, every 1-2 years I inquire as to their thoughts about their medication. After they (almost always) say they want to continue, when they get up in age I advise them of the risks of cont...

I did a literature review for long-term benzodiazepine use and found that studies show little evidence for dosage escalation or loss of effectiveness in patients who are at low risk for abuse and addiction. I think many patients can stay on them and don’t need to be taken off of them.

I agree that there are times when tapering benzodiazepines is not necessary, particularly in younger stable patients. But I warn people that there will inevitably come a time when falling or cognitive slippage begins to occur, and the attribution will be these drugs. Also as a patient ages, their ch...

Have been able to successfully reduce benzodiazepine (BZ) doses in long-term patients, when necessary. Essentially, we used gradual reductions, as tolerated by the patient, at a pace they find comfortable. They will sometimes choose a quicker pace and greater reduction than I would have, but they ha...

What I usually do is if the patient is on short-acting benzodiazepines, e.g., Xanax or Ativan, I will ask the patient to change to long-acting benzodiazepines, e.g., clonazepam. It is then easier to taper. Tapering is usually gradual (6-12 months). It is always good to consider the risk-benefit pro...

If the patient is stable, has benefitted from the treatment, and is on a relatively low dose, I approach the topic of tapering nonjudgmentally and collaboratively with the patient. If the patient is apprehensive, emphasizing the option of staying on the low-dose therapy will alleviate the adversaria...

Tapering down benzodiazepines requires patient’s trust. I definitely employ switching short acting to long acting, and use additional tools such as Buspirone, Propranolol or Metoprolol, Hydroxyzine, and Gabapentin. At times L- theanine is helpful for mild anxiety. I find Duloxetine helpful as ...