Requests for Benzodiazepines for Anxiety & Phobias

Benzodiazepines for Situational Anxiety and Phobias

Patients may sometimes ask their GP or nurse to prescribe diazepam, lorazepam, temazepam, clonazepam or similar medicines to help them manage anxiety or fear associated with a particular situation or appointment.

Examples include:

• fear of flying
• dental appointments or dental treatment
• MRI or other scans
• injections, blood tests or procedures
• hospital or outpatient appointments
• driving tests
• public speaking or examinations
• other specific phobias or situations that cause anxiety.

Brockwood Medical Practice does not routinely prescribe benzodiazepines solely to manage situational anxiety or a specific phobia.

This includes requests for a single or occasional dose before an appointment or event.

Why are these medicines not routinely prescribed?

There are several reasons why diazepam and similar medicines are not considered appropriate for most situational anxiety or phobias.

1. They can impair alertness and coordination

Benzodiazepines can cause drowsiness and impair:

• concentration
• memory
• coordination
• judgement
• reaction times
• awareness of surroundings.

This can create safety concerns, particularly where the patient needs to travel independently, drive, operate machinery or participate in an activity requiring concentration.

Patients should not drive or undertake activities requiring alertness if impaired by these medicines.

2. They can have unpredictable effects

Although benzodiazepines are intended to reduce anxiety, some people can experience an unexpected reaction, including:

• agitation
• disinhibition
• confusion
• irritability
• aggression.

These reactions can be particularly problematic in clinical environments or when travelling to and from an appointment.

3. They can cause dependence

Benzodiazepines can lead to physical and psychological dependence, particularly with repeated use.

They can also cause tolerance, meaning that the same dose may become less effective over time.

Withdrawal following regular use can cause significant symptoms and, in some circumstances, can be serious.

For this reason, benzodiazepines are generally intended for short-term use in carefully selected clinical circumstances, rather than as a routine treatment for specific phobias.

4. They do not treat the underlying phobia

A benzodiazepine may temporarily reduce feelings of anxiety, but it does not treat the underlying cause of a phobia.

Repeatedly relying on medication to get through a feared situation may prevent a person from developing their own coping strategies and can reinforce the belief that the situation cannot be managed without medication.

For specific phobias, psychological approaches such as cognitive behavioural therapy (CBT) and graded exposure are generally more appropriate longer-term approaches.

5. Additional safety considerations

The effects of benzodiazepines can be increased when combined with other medicines or substances that cause sedation, particularly alcohol and opioid medicines.

Patients who have been prescribed a benzodiazepine should follow the instructions provided by their clinician and should not take additional doses because they feel anxious.

What can I do instead?

If you experience significant anxiety about a particular situation or appointment, there may be other ways to manage this.

Depending on the situation, you may benefit from:

• discussing your concerns with the healthcare professional or organisation you are attending
• asking whether reasonable adjustments can be made to the appointment
• relaxation and breathing techniques
• preparation and reassurance before the appointment
• psychological support
• CBT
• graded exposure or other treatment specifically aimed at the phobia.

For example, if you have a fear of dental treatment, you should discuss this directly with your dentist. They may be able to offer additional support, adapt the appointment or consider appropriate options for managing dental anxiety.

Our prescribing approach

Brockwood Medical Practice recognises that anxiety associated with specific situations can be distressing. However, diazepam and similar benzodiazepines will not routinely be prescribed solely for situational anxiety, specific phobias or to enable a patient to attend an appointment or procedure.

This includes requests for medication before dental appointments, flights, scans, procedures, examinations or other anxiety-provoking situations.

Where there is a separate clinical indication for a benzodiazepine, the clinician will assess this on an individual basis and prescribe in accordance with current prescribing guidance.

Patients who are already taking a benzodiazepine regularly should not stop taking it suddenly and should discuss any concerns about their medication with their usual clinician.