May 1988

Long-term Treatment of Anxiety and Risk of WithdrawalProspective Comparison of Clorazepate and Buspirone

Author Affiliations

From the Department of Psychiatry, Psychopharmacology Research and Treatment Unit, University of Pennsylvania, Philadelphia.

Arch Gen Psychiatry. 1988;45(5):444-450. doi:10.1001/archpsyc.1988.01800290060008

• Risk of withdrawal was investigated in a prospective, double-blind comparison of clorazepate dipotassium, a benzodiazepine with a long half-life, and the nonbenzodiazepine buspirone hydrochloride in the long-term treatment of anxious outpatients. Patients were treated with therapeutic doses of clorazepate dipotassium (15 to 60 mg/d) or buspirone hydrochloride (10 to 40 mg/d) for six continuous months before their tranquilizer therapy was blindly and abruptly stopped. There was a significant increase in symptom severity consistent with a withdrawal reaction for the clorazepate group but not the buspirone group. For the clorazepate group, there was a suggestion that previous discontinuous exposure to benzodiazepines might sensitize patients to subsequent withdrawal effects. For the buspirone group, a higher dropout rate raised questions about patient satisfaction with therapy in this rather chronically anxious population.