Value of prazepam drops in the brief treatment of anxiety disorders

In order to assess the clinical usefulness of benzodiazepine brief therapy with planned tapering, prazepam as drops was administered to 40 psychiatric outpatients suffering from generalized anxiety disorder. After a one-week placebo period, the patients received prazepam 40 mg daily (i.e., 10 drops in the morning, 10 drops at noon and 20 drops in the evening) during 3 weeks, with the possibility to adjust the doses after one week. The doses were then tapered at 4 mg/d (i.e., 1 drop in the morning, 1 drop at noon and 2 drops in the evening) until complete suppression of the treatment. The assessments, performed before the placebo period, at inclusion, after 1 and 3 weeks of active treatment, and after 1 and 2 weeks of tapering, included the Hamilton anxiety scale, the Lader tranquillizer withdrawal rating scale, and the collection of side effects; moreover, the patients completed daily a visual analogue scale. Results showed a very marked anxiolytic effect of prazepam with an already very significant decrease in the scores on the various scales after 1 week of treatment when the daily dose was significantly reduced. Three quarters of the patients were able to take part in the tapering of prazepam doses without exhibiting any reappearance of anxious symptomatology, rebound anxiety, or withdrawal symptoms. The tolerance of the treatment was rated as good or very good in 91.9% of the patients. This study demonstrates the possibility of a brief anxiolytic treatment followed by tapering in a majority of patients with generalized anxiety disorders. For this strategy, the availability of a drop form represents an obvious advantage.