FOR PATIENTS for whom the potential short-term benefits of insomnia relief by benzodiazepine therapy are offset by their specific vulnerability to both acute and long-term adverse effects or dependency, the study by Garfinkel and colleagues1 using melatonin therapy for discontinuation offers a hopeful adjunct in the weaning process and a sleep-maintenance alternative to benzodiazepine therapy. Alternatives such as melatonin therapy can be also helpful in maintaining a therapeutic alliance by offering a treatment enabling focus instead of a do-or-die crisislike atmosphere that can surround the encounter between a concerned clinician and a vulnerable, anxious patient seeking or already dependent on benzodiazepines. Thus, for clinicians who treat patients who are benzodiazepine-dependent and suffer from insomnia, an informed consent process that offers melatonin therapy as an alternative to benzodiazepine dependence integrates good clinical care with effective risk management by carefully navigating between the Scylla of addiction and the Charybdis of abandonment.
Bursztajn HJ. Melatonin Therapy: From Benzodiazepine-Dependent Insomnia to Authenticity and Autonomy. Arch Intern Med. 1999;159(20):2393–2395. doi:10.1001/archinte.159.20.2393
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