Effectiveness and safety of long-term benzodiazepine use in anxiety disorders: A systematic review and meta-analysis

Masaki Shinfuku, Taishiro Kishimoto, Hiroyuki Uchida, Takefumi Suzuki, Masaru Mimura, Toshiaki Kikuchi

Research output: Contribution to journalReview articlepeer-review

21 Citations (Scopus)


Long-term benzodiazepines (BZDs) use is not endorsed in the treatment guidelines for anxiety disorders, but is prevalent in the real-world clinical settings. A systematic literature review was performed by using PubMed (last search: May 2019) to identify randomized controlled trials (RCTs) or maintenance studies following RCT that examined the effectiveness of BZDs in patients with anxiety disorders for a duration of 13 weeks or more. Meta-analyses were then conducted regarding changes in the Hamilton Anxiety Rating Scale (HAM-A) scores from baseline through endpoint, all-cause discontinuation, side effects, and the numbers of panic attacks at endpoint. Eight studies were identified (N = 1228). There were no significant differences in all outcomes between BZDs and antidepressants after the initial 8-week treatment. While no significant difference was noted in the HAM-A score changes between BZDs and placebo, BZDs resulted in a lower discontinuation rate and more frequent constipation and dry mouth than placebo. Our study indicates that for those who respond to an initial 8-week treatment, continuing BZDs is equivalent to antidepressants in efficacy and safety. However, the limited number of studies warranted further investigations of the long-term effectiveness and safety of BZDs.

Original languageEnglish
Pages (from-to)211-221
Number of pages11
JournalInternational clinical psychopharmacology
Issue number5
Publication statusPublished - 2019 Sept 1


  • anxiety disorders
  • benzodiazepines
  • long-term effects
  • meta-analysis
  • side effects

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Pharmacology (medical)


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