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Research

Benzodiazepine use and risk of Alzheimer’s disease: case-control study

BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g5205 (Published 09 September 2014) Cite this as: BMJ 2014;349:g5205

Rapid Response:

The British Medical Journal; g5205 "Benzodiazepine use and the risk of Alzheimer's disease: case - control study" is an example of purgorative reporting regarding benzodiazepines. Benzodiazepines have been around since the 1960s and are a safe and effective treatment for anxiety disorders according to the "APA Task Force Report on Benzodiazepines" 1991. I am not aware of any studies repudiating this report.

Benzodiazepines have two main side effects - sedation and memory loss. Both are dose related and go away when dose is lowered. They are abused by 1-2% of the population who are also abusing alcohol and street drugs at the same time. Although the researchers themselves stated in their article that the "dose-effect relation between benzodiazepine use and increased rise of Alzheimer's disease might not be causal. The nature of the link cannot be definitely established because the nature of the link...might also be an early marker of a condition associated with an increased risk of dementia." These statements were under "Discussion" and "What this Study Adds" toward the end of the article. Many physicians and the media only read the headlines and draw false conclusions from them. I have had several worried patients ask about this. The researchers missed the mark by not adding that anxiety is often associated with any progressive Organic Brain Syndrome in its early stages.

In my 39 years of private practice psychiatry, I have treated thousands of patients with benzodiazepines. General Anxiety Disorder usually starts in childhood and Panic Disorder usually starts in the mid to late 20s. Patients with anxiety starting in their 50s to 60s without a concomitant physical, psychological or environmental stressor are very often due to a developing Organic Brain Syndrome which includes Alzheimer's. This anxiety is easily treated with benzos. The dose should be lowered as the OBS progresses because confusion and memory loss from a deteriorating brain from the OBS can be exaggerated by the benzo. While research in all areas of psychopharmacology is appropriate, clinical correlation should play a role in coming to speculative conclusions that might be false. When the underlying disease finally shows up claiming the medication may have caused it is overlooking the prodrome of that disease.

Stating this correlation as causative in that article exploits the negatively biased view of the benzos n the medical literature and lay news. This perpetuates the myth of benzodiazepines being dangerous. The media pounces on the headlines further exaggerating them. This frightens the public from taking them and frightens physicians from prescribing them.

Competing interests: No competing interests

12 January 2015
Abbot Granoff
md psychiatrist
private practice
Norfolk, VA 23502 USA