The devil is in the detail: a critique of nine editorials published by the International Task Force on Benzodiazepines

Abstract

SUMMARY Since 2018, the International Task Force on Benzodiazepines (ITFB), a group of academic psychiatrists and academic psychologists, has advocated that clinical guidelines should change to promote benzodiazepines from second- to first-line treatment for anxiety disorders, accept their use as maintenance treatment for anxiety conditions (in particular, panic disorder) and increase their use in gastrointestinal disorders. There is merit in much of what the ITFB argues, but in this article I analyse four major claims it has made in opinion editorials that I believe are not fully supported by the available evidence.

Re-evaluating benzodiazepines for anxiety disorders – déjà-vu all over again?

“…Have guidelines got the wrong balance between benefits and risks, resulting in them being overly restrictive about the longer-term use of benzodiazepines for anxiety disorders? For me there are two additional aspects that warrant caution in addition to the ones addressed by Brandt (2022). First, anxiety is an extremely common symptom, and anxiety disorders are a heterogeneous and comorbid classificatory 'jungle' treated almost exclusively in primary care, so that even if indications for firstline and long-term use were specific (e.g.…”

“…The clinical value of benzodiazepines has continued to be debated, with periodic calls for re-evaluation arguing for a more central role in the longer-term management of anxiety disorders. The editorials from the International Task Force on Benzodiazepines, critiqued in this issue (Brandt 2022), can be viewed as part of this periodic cycle, but are perhaps more strident than before about what they feel is scientific bias and unjustified propaganda against benzodiazepines, arguing that 'they have come to be stigmatized by a fear narrative that has precluded evidence-based reasoning' (Silberman 2022).…”

Prescribing and deprescribing guidance for benzodiazepine and benzodiazepine receptor agonist use in adults with depression, anxiety, and insomnia: an international scoping review

“…Since the 2000's in particular, vigorous debate in the literature amongst psychiatrists and other health professionals practising within the bounds of clinical psychopharmacology has resulted in a continued division of competing perspectives about BZD related benefits and harms for different clinical circumstances. 17 , 18 , 19 The perspective that various guidelines on BZD prescribing have been largely concordant with one another for common mental health and sleep concerns, while commonly held among clinicians and academics, has not yet been subject to rigorous scrutiny to examine differences between recommendations and guidance from these differing groups of experts. 20 We sought to characterise parameters relevant to BZD and BZRA prescribing and de-prescribing, in clinical practice guidelines and prescribing guidance documents, for adult patients with anxiety disorders and insomnia.…”