Suddenly, putting patients to sleep is all the rage in psychiatry. Over the last year, two new hypnotics have been approved by the FDA – Lunesta (eszopiclone) in December 2004 and Rozerem (ramelteon) in July 2005. Indiplon (the generic name) is on the launching pad for approval in early 2006.

Tapering patients off benzos (BZs) is certainly more art than science, but TCR has unearthed a surprising number of studies that help bring more science into the process. These studies are, by modern standards, ancient, because research follows the money, and there’s no longer much money to be made in benzodiazepines. So file these studies under “oldies but goodies”!

Whether one should prescribe BZs to patients with a history of alcoholism is a controversial question, and one that tends to polarize psychiatrists into the “purists” versus the “realists.” Most alcoholics take BZs at some point in the course of their disorder, sometimes illegitimately, but often as part of a bona fide treatment program.

Dr. Talmadge, in your practice, do you ever prescribe benzodiazepines to people with substance abuse histories?

My standard practice in treating patients with very frequent panic attacks had always been to start both a benzo and an antidepressant, with the expectation of eventually tapering the benzo. But I noticed, both with my patients and those I inherited from other psychopharmacologists, that hardly anyone ever seemed to get off benzos despite my preparing the patient for this plan.