No Role for Benzodiazepines in Posttraumatic Stress Disorder Until Supported by Evidence

Starcevic argues the evidence is insufficient to demonstrate ineffectiveness/harm definitively, therefore benzodiazepine use in posttraumatic stress disorder (PTSD) should continue until more negative well-designed studies arise. Practice guidelines and our meta-analysis2 note insufficient evidence of efficacy and suggest harm (most of which is PTSD specific). Therefore, we contend the best practice is to avoid potential harm when there is no evidence of realistic long-term gain (no positive well-designed studies). Though the evidence may be scarce, we believe the burden of proof is on those claiming benzodiazepines are safe/effective. That burden was lower when options were limited, but with dozens of proven psychotherapeutic/biomedical treatments, benzodiazepines are rarely – if ever – the best option. With 30–74% of PTSD patients taking benzodiazepines,2 clinicians are likely prescribing them first-/second-line rather than only for those failing multiple safer, more efficacious treatments.