With the advent of benzodiazepine tranquilizers in the 1960s, a psychopharmacological revolution was completed. To a few earlier antipsychotics and antidepressants, a group of tranquilizers was added, which allowed mental health professionals to form a wide arsenal of medicines for the treatment of mental disorders. The study of the properties of such drugs began in a number of leading clinics around the world. Already the first studies involving a significant number of patients (143 patients) convincingly showed that the drug had a fast (3-5 days) and a pronounced ability to reduce anxiety, fear, various sleep disorders, vegetative disorders, senesto-hypochondriac and obsessive-compulsive syndromes. Thus, the discovery of benzodiazepine tranquilizers has significantly increased the possibilities for treatment, especially in the field of small psychiatry (neuroses, obsessive-compulsive disorder, post-stress disorders, etc.).
However, after decades of widespread and successful use of benzodiazepines in world psychiatry, problems associated with the use of this group of drugs began to arise. Thus, the uncontrolled, often unjustified use of this group of drugs led to their abuse and the formation of dependence in a number of patients.
The tragic fate of benzodiazepine tranquilizers lies in the fact that in addition to a powerful and rapid pharmacotherapeutic effect, these drugs also have some addictive potential. The ability of benzodiazepine derivatives to induce the formation of drug dependence is widely described in the literature. However, a balanced assessment of this effect is still to be made.
Currently, much work has been done to determine the duration of courses of therapy with benzodiazepines, since the main problem leading to the formation of dependence is the unreasonably long reception of this group of tranquilizers. Thus, the widely known study of M.B. Balter showed that in the USA by 1979, more than 15% of patients taking benzodiazepines received them for more than 1 year, and by 1990, this number had increased to a quarter of all those taking anxiolytics. When conducting pharmacoepidemic study of outpatients, it was revealed that among patients taking benzodiazepine derivatives, only 5.6% took them less than half a year, and the rest received them for longer periods. The data convincingly showed that the problem of abuse of drugs in this group is associated primarily with unreasonably long courses of treatment.
Since the 1990s, in connection with the described problems, the majority of international and domestic recommendations suggest dramatically limiting the duration of treatment with benzodiazepine tranquilizers up to 1 month or even 1-2 weeks for the relief of acute symptoms. A number of measures have been carried out to limit the frequency of appointments that led to controversial results. So, the program, which was conducted in the State of New York from 1988 to 1990, limiting the prescription of tranquilizers, led to a decrease in their intake by 57% but the use of other psychoactive substances, primarily barbiturates and alcohol, increased in parallel. At the same time, despite the emergence of new highly effective psychotropic drugs, first of all, antidepressants of the latest generations (selective serotonin reuptake inhibitors, selective serotonin, and noradrenaline reuptake inhibitors), the spectrum of benzodiazepine tranquilizers remains wide and covers practically all nosological forms. In the field of small psychiatry, benzodiazepines, especially such as Ativan and other alike drugs from pharmacies, remain indispensable.