Does medication work for rapid reduction of anxiety? This review finds some surprising answers. 

Benzodiazepines are highly beneficial for managing anxiety and agitation in psychiatric inpatient settings, but we must be cautious about prescribing them to patients with substance use disorders (SUDs). Here we review strategies to reduce the risk of benzodiazepine misuse and discuss alternative medication options, including second-generation antipsychotics, antidepressants, gabapentin, and pregabalin.

Dr. Ponce Martinez highlights the need to identify and manage alcohol withdrawal in psychiatric settings, underscoring the use of the CIWA-Ar scale for monitoring symptom progression. While benzodiazepines remain the primary treatment, she reviews alternative treatment strategies and tells us which patients are so high risk that they must be transferred to a medical unit for care.

Despite their risks, benzodiazepines remain a widely prescribed class of medication. In the prescriber right hands, benzodiazepines can help many patients cope with a variety of psychiatric issues. Here, Dr. Park reviews how to evaluate patients prior to starting benzodiazepines and reviews strategies to ensure that prescriptions are done safely.

Benzodiazepines are widely prescribed but carry significant risks. The best course of action for many patients is to have their benzodiazepine prescription discontinued, but physiologic dependence can make stopping benzodiazepines a big challenge. Dr. Abeillera teaches us how to identify those who might benefit from a taper and covers all the details on how to do it as safely and effectively as possible. 

It’s a dilemma that will challenge the most seasoned psychopharmacologist: “My Adderall spilled down the sink.” We clarify how to respond in the post-lockdown landscape.