Overuse of Benzodiazepines for Generalized Anxiety Disorder: A Growing Concern in Pakistan

Abstract

Generalised anxiety disorder (GAD) affects a significant proportion of the global population, and its treatment may presuppose the use of drugs as well as psychotherapy. Traditionally, benzodiazepines (BZDs) were prescribed to relieve anxiety symptoms in the short run because of the rapid onset of action. Nevertheless, evidence shows that their overuse, particularly in countries like Pakistan, is causing grave concerns relating to dependence, cognitive and negative social impacts.

Although the recommended guidelines favour selective serotonin reuptake inhibitors (SSRIs) or cognitive-behavioural therapy as first-line treatments and emphasise that benzodiazepines should be used carefully and for a limited period in the management of GAD [1, 2]. Recent research found that a significant proportion of benzodiazepine users continue prescribed treatment beyond recommended guidelines, which puts them at risk of dependence and withdrawal [3].

The problem in Pakistan is worsened by the cultural stigma of mental health, lack of access to special psychiatric treatment, and absence of strict prescription monitoring, which all contribute to the increasing cases of abuse and adverse events [4]. The easy access to benzodiazepines in local pharmacies without a prescription is another factor contributing to the problem.

The solution to benzodiazepine overuse is complex and should consider three aspects: better education of physicians on the evidence-based methods of anxiety management, greater regulatory control, and more awareness of the dangers of long-term use of benzodiazepines among the population. The use of benzodiazepines can be minimised by incorporating mental health in primary care and encouraging non-pharmacological treatment options.

To sum up, although benzodiazepines still play a useful role in addressing the symptoms of anxiety in the short term, their excessive use in Pakistan, especially to manage GAD, poses a serious public health challenge that needs to be addressed immediately.