Psychopharmacology and Psychiatry Updates Clinical Pearls for Selecting the Right Benzodiazepine
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Apr 21, 2025 In this engaging discussion, Alexis Ritvo, a board-certified addiction psychiatrist and fellowship program director, sheds light on the intricate world of benzodiazepines. The conversation emphasizes the unique addiction risks associated with alprazolam compared to other options. Ritvo highlights evidence-based practices for selecting the right medication, stressing the importance of informed decisions for patient safety. They explore benzodiazepines' appropriate uses, including managing anxiety and withdrawal, while navigating the complexities of treatment selection.
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Executive's Panic and Medication Request
- A 45-year-old executive experiences panic during meetings and specifically asks for alprazolam after researching online.
- This illustrates common clinical dilemmas balancing immediate relief and long-term risks with benzodiazepines.
Alprazolam's Unique Dopamine Effect
- Alprazolam uniquely increases extracellular dopamine in the striatum, enhancing its addictive potential.
- This dopamine effect is not seen with other benzodiazepines, explaining differential addiction risks.
First- and Second-Line Uses
- Use benzodiazepines first-line for withdrawal, status epilepticus, acute anxiety without psychosis, and movement disorders like catatonia.
- Reserve short courses for acute insomnia or stress-related anxiety while arranging therapy or awaiting antidepressants.