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Gale and Oakley-Brown (1) provide a useful summary of the treatment
of anxiety disorder. While they indicate that benzodiazepines and
buspirone cause marked somnolence they have not considered several
important issues. Andrews et al (2) consider concomitant use of
anxiolytics an absolute bar to psychological programmes for treating
anxiety disorders. A three year study by Barbone et al (3) found that the
relative risk of having a first road traffic accident for drivers on
anxiolytics was 1.62 (95% CI [1.24-2.12]). An alternative, zopiclone, also
significantly impairs driving ability (4). The Driver and Vehicle
Licensing Agency advises that 'regular use of, or dependency on…'
benzodiazepines 'will lead to license refusal or revocation for a minimum
period of one year' (5). European countries have already introduced
mandatory roadside testing for psychoactive drugs in all cases of RTA's
(3). In light of these issues Doctors should consider whether the
benefits of anxiolytics outweigh the risks when treating anxiety
disorders.
M E Jan Wise Specialist Registrar in Adult Psychiatry
Paterson Centre for Mental Health, 20 South Wharf Rd, London W2 1NY
1 Gale C., and Oakley-Brown, M. Anxiety Disorder BMJ 2000; 321: 1204-
7 (11Nov.)
2 Andrews G, Crino R, Hunt C, Lampe L, and Page E. (1994) The
Treatment of Anxiety Disorders. Cambridge University Press, Cambridge, UK.
3 Barbone F, McMahon AD, Davey PG, et al. Association of road
traffic accidents with benzodiazepine use. The Lancet; 352: 1331-6, 1998.
4 Vermeeren A, Danjou PE, O'Hanlon JF. Residual effects of evening
amid middle-of -the-night administration of Zaleplon 10 and 20 mg on
memory and actual driving performance. Human Psychopharmacology; 13: s98-
s107, 1998.
5 Drivers Medical Group (2000). At A Glance Guide To The Current
Medical Standards of Fitness to Drive. DVLA, Swansea.
The Intervnetions table listed mirtazapine as an antidepressant for
anxiety, but there was no disucssion of mirtazpine in the text or in the
references.
Treatment of anxiety disorder
Editor-
Gale and Oakley-Brown (1) provide a useful summary of the treatment
of anxiety disorder. While they indicate that benzodiazepines and
buspirone cause marked somnolence they have not considered several
important issues. Andrews et al (2) consider concomitant use of
anxiolytics an absolute bar to psychological programmes for treating
anxiety disorders. A three year study by Barbone et al (3) found that the
relative risk of having a first road traffic accident for drivers on
anxiolytics was 1.62 (95% CI [1.24-2.12]). An alternative, zopiclone, also
significantly impairs driving ability (4). The Driver and Vehicle
Licensing Agency advises that 'regular use of, or dependency on…'
benzodiazepines 'will lead to license refusal or revocation for a minimum
period of one year' (5). European countries have already introduced
mandatory roadside testing for psychoactive drugs in all cases of RTA's
(3). In light of these issues Doctors should consider whether the
benefits of anxiolytics outweigh the risks when treating anxiety
disorders.
M E Jan Wise
Specialist Registrar in Adult Psychiatry
Paterson Centre for Mental Health, 20 South Wharf Rd, London W2 1NY
1 Gale C., and Oakley-Brown, M. Anxiety Disorder BMJ 2000; 321: 1204-
7 (11Nov.)
2 Andrews G, Crino R, Hunt C, Lampe L, and Page E. (1994) The
Treatment of Anxiety Disorders. Cambridge University Press, Cambridge, UK.
3 Barbone F, McMahon AD, Davey PG, et al. Association of road
traffic accidents with benzodiazepine use. The Lancet; 352: 1331-6, 1998.
4 Vermeeren A, Danjou PE, O'Hanlon JF. Residual effects of evening
amid middle-of -the-night administration of Zaleplon 10 and 20 mg on
memory and actual driving performance. Human Psychopharmacology; 13: s98-
s107, 1998.
5 Drivers Medical Group (2000). At A Glance Guide To The Current
Medical Standards of Fitness to Drive. DVLA, Swansea.
Competing interests: No competing interests