According to the National Institute of Mental Health, anxiety disorders affect about one-fifth of the adult population in the United States. There are several different treatment modalities commonly used, including therapy and several types of medication. Benzodiazepines are widely prescribed to treat both acute and chronic anxiety. They have a potential for abuse and are classified as a controlled substance by the DEA, the Drug Enforcement Agency. They are teratogenic, which means they can cause birth defects, and should not be used during pregnancy.
Diazepam
Diazepam, or Valium, is one of the oldest benzodiazepines and has been one of the most widely prescribed medication of any type. As of 2010, it is not as popular as it once was, but is still widely used. It has a very long half life, meaning its effects last in the body for a long time. The dose used for anxiety depends on several factors. Individual response to any given dose varies greatly. First time use usually has a stronger effect. Elderly patients should be given lower doses. People with liver problems should be given lower doses if given valium at all, since it's metabolized by the liver and can accumulate in patients with liver disease. With all that in mind, the typical dose ranges from 2 to 10 mg, taken twice to four times daily.
Clonazepam
As of 2010, clonazepam is the benzodiazepine most favored by psychiatrists to treat anxiety, as it is both potent and has a long half life. This makes it somewhat less addictive than some of the other benzodiazepines. Doses range from 0.5 mg to 1 mg, given two to three times a day. Doses above 4 mg are unusual. Clonazepam can be taken on a regular basis, several times a day, or on an as needed basis.
Alprazolam
Alprazolam is considered by some psychiatrists to be the most effective antianxiety medication. However, it also has a greater potential for abuse than other benzodiazepines. Due to this, it's used more often as an occasional medication for panic attacks, and less commonly for chronic anxiety. The normal dose range is 0.25 mg to 1 mg, taken as needed, or three times daily.
Lorazepam
Lorazepam, or ativan, is intermediate in both its potency and half life. The typical dose is 0.5 mg to 2 mg, given 3 times a day. Dosage should not exceed 10 mg a day. Lorazepam can be given intravenously, and is often used in intensive care settings, including as a replacement for patients who are on long term oral benzodiazepines for chronic anxiety.
References
- "Kaplan and Sadock's Comprehensive Textbook of Psychiatry"; Virginia Sadock and Pedro Ruiz (editors); 2009
- "Tarascon Pocket Pharmacopoeia"; Ricahrd Hamilton M.D. ed. in chief; 2010
