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It must be pointed out from the onset that perceptions of the risk/benefit ratio of the benzodiazepines vary substantially from country to country. Unfortunately, close evaluation of the available data shows even this efficacy to be surprisingly limited.

One meta-analysis from Australia examined 81 studies mainly of benzodiazepines in anxiety, as compared to a placebo, and in some studies, to no treatment at all.(3) Useful therapeutic effects were apparent in the meta-analysis but half of this improvement was placebo-related, i.e. A large number of short-term trials (up to 28 nights) attest to the effectiveness of benzodiazepines in the treatment of insomnia.(4) Thus, they shorten time to sleep onset, usually prolong sleep time, and reduce the number of arousals in the night.

More recently, the unwanted effects of the benzodiazepines have become more obvious.

They comprise psychomotor/cognitive impairment and more serious neuropsychiatric reactions such as amnesic and aggressive episodes. Anxiety disorders are commonly found in the general population.

The effects generally wane beyond 28 nights and even before that time.

Whether these unequivocal short-term benefits as anxiolytic and hypnotic agents continue into the long-term remains a subject of controversy.

The panics may be spontaneous (PD) or occur in agoraphobic situations.A further complication is the problem of relapse on discontinuation, which could be interpreted as continued efficacy.This must be distinguished from rebound or withdrawal, evidence that the benzodiazepines were acting merely to suppress discontinuation effects.(5) Of course, apparent long-term efficacy might be, and in many cases probably is, a combination of them both.This demonstrates the mis-match between subjective and objective measures.In fact, patients given a benzodiazepine overestimate their sleep duration by an average of 72 minutes as compared with the EEG recordings.(12) The benzodiazepine was then abruptly withdrawn, and patients slept poorly but underestimated their duration of sleep by about an hour.

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