Original Article

대한불안의학회지 (21권2호 74-80)

Benzodiazepine Tapering and Discontinuation in Panic Disorder and Generalized Anxiety Disorder: An Expert Survey

공황장애와 범불안장애 치료 시 벤조디아제핀 감량 및 중단: 전문가 설문조사

Jun Ho Seo1, Eunsoo Moon2, Min-Kyoung Kim3, Yoon Young Chang4, Hyeon-Ah Lee5, Myung Hee Ahn6, Ho-Jun Seo7, Won Kim4, Ho-Suk Suh8, Kyoung-Uk Lee9, and Kang Soo Lee10

1Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju, 2Department of Psychiatry, Pusan National University School of Medicine, Yangsan, 3Department of Psychiatry, CHA Ilsan Medical Center, CHA University, Ilsan, 4Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, 5Department of Psychiatry, College of Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, 6Division of Psychiatry, Health Screening and Promotion Center, Asan Medical Center, Seoul, 7Department of Psychiatry, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Suwon, 8Suh Hosuk Yonsei Psychiatry Clinic for Healthy Mind, Seoul, 9Department of Psychiatry, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, College of Medicine, Uijeongbu, 10Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Korea

Abstract

Objective : We aimed to evaluate the clinical experiences of benzodiazepine (BDZ) tapering and discon tinuation in the treatment of panic disorder (PD) and generalized anxiety disorder (GAD) and to identify fac tors associated with these experiences through a survey of domestic experts.

Methods : A web-based survey of psychiatrists in the Korean Academy of Anxiety Disorders yielded 105 responses for PD and 99 for GAD, respectively. Data included physician demographics, BDZ prescribing pat terns, and experiences with BDZ tapering and discontinuation. Group differences were analyzed with χ2 tests, and correlates of tapering difficulty were assessed with Spearman’s correlations.

Results : Tapering most often began eight weeks after acute stabilization, with no difference between two disorders. Tapering was perceived as moderately difficult in PD, but more often difficult in GAD. Clini cians most often estimated that 21%-40% of their patients experienced tapering difficulties, mainly due to psychological dependence, resistance, and relapse fears. Longer BDZ use, polypharmacy, and maintenance phase combinations correlated with greater difficulty, while lower-dose maintenance facilitated tapering. In GAD, both PRN prescribing and higher BDZ combination rates during the acute phase were also associat ed with greater tapering difficulty.

Conclusion : Psychiatrists perceived BDZ tapering as more difficult in GAD than in PD. Long-term use, polypharmacy, and combination therapy were key barriers, with PRN prescriptions adding risk in GAD. Conversely, proactive dose reduction after the acute phase facilitated BDZ discontinuation. These findings highlight that psychological dependence is a major obstacle, underscoring the need for early planning, cau tious prescribing, and integration of psychosocial interventions to support successful BDZ discontinuation. (Anxiety and Mood 2025;21(2):74-80)

Keywords

Panic disorder; Generalized anxiety disorder; Benzodiazepine; Tapering; Discontinuation.

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