ZAŠTO SU BENZODIAZEPINI JOŠ UVIJEK U ŠIROKOJ PRIMJENI? - VLASTELICA, MIRELA; Private Psychiatric Oice, Split, School of Medicine, University of Split, Split, Croatia; JELASKA, MARIN; Health Center of Split-Dalmatia County, Split, Croatia (Academy of Medical Sciences of Croatia; amzh@zg.t-com.hr, 2013)
Benzodiazepini su se u povijesti dokazali kao miorelaksansi i antikonvulzivi u neurologiji, kao anksiolitici u psihijatriji, uz hipnotičko djelovanje u terapiji izbora za insomniju, a takđ er i u odvikavanju od alkoholne ovisnosti. Također su opravdali svoju široku primjenu u anesteziologiji i drugim kliničkim granama. Vremenom su se u psihijatrijskoj primjeni benzodiazepina pojavile kontroverze koje je pokrenula mogućnost zloporabe, štetnog djelovanja, intoksikacija, te ovisnosti. S druge strane revolucionarna pojava selektivnih inhibitora ponovne pohrane serotonina (SIPPS) benzodiazepine je pomaknula u sjenu. Uz to su se pojavile preporuke raznih znanstvenih i stručnih institucija kojima je uporaba benzodiazepina ili isključena ili reducirana ili svedena na kratkotrajnu mjeru liječenja. Klinička nam iskustva međutim pokazuju da se benzodiazepini i dalje često rabe u dugotrajnom tretmanu i to iz više razloga: zbog same tradicije propisivanja; zbog toga što ih sami pacijenti preferiraju; zbog poteškoća koje se javljaju kod prekida uzimanja čak i onda kad su uzimane niske doze; zbog brzog djelovanja i dobre učinkovitosti a s vrlo malo početnih nuspojava. Drugi lijekovi, odnosno alternativa benzodijazepinima - SIPPS, nemaju brzo očekivani odgovor, a nuspojave su im puno neugodnije. Stoga neki autori smatraju da je razlog prelaska s benzodiazepina na SIPPS u mnogim preporučenim slučajevima često nedostatno opravdan. The advent of benzodiazepines in the 1960s provided their wide use in neurology and psychiatry. They proved to be myorelaxant and anticonvulsive therapy in neurology; their anxiolytic and hypnotic properties have made them the treatment of choice for insomnia and anxiety problems; they have also been used in alcohol withdrawal and in anesthesia, and for a wide range of treatments in other clinical branches. However, reports giving rise to a prescription controversy including abuse, harmful effects, intoxication and dependence toward addiction appeared soon. On the other hand, the revolutionary appearance of selective serotonin reuptake inhibitors (SSRIs) overshadowed benzodiazepines. According to recommendations of many scientiic and professional institutions, the use of benzodiazepines has been gradually excluded or reduced or limited to short-term use. However, clinical experience showed that benzodiazepines are frequently used for long-term treatment, and there are many reasons for this, e.g., prescribing tradition, patient preference, dificulties associated with benzodiazepine withdrawal (even in patients taking low doses) because they have a rapid clinical onset of action, and good eficacy with few initial adverse effects. Moreover, SSRIs as alternative drugs are associated with incomplete therapeutic response and more uncomfortable adverse effects. Some authors therefore point out that the rationale for the shift from benzodiazepines to SSRIs is inappropriate.