The use of benzodiazepines in bipolar disorders

INTRODUCTION: Benzodiazepines are widely prescribed for patients with bipolar disorders, especially in episodes of mood disturbances. However, comorbid anxiety, sleep problems and substance abuse are frequent in these patients, and may lead to more prescription of benzodiazepines in inter-critic period. DISCUSSION: While acute anxiety/sleep problems and substance withdrawal syndromes are potential indications for short-term benzodiazepines use, the long-term use may aggravate the outcome of bipolar disorders, clinically and functionally, and lead to poor prognosis in general. The lack of studies about the management strategies, in patients coming with bipolar disorders and one of these particular situations, is the reason why the use of benzodiazepines may still be a solution for many practitioners, but that must be done with a lot of caution. This situation highlights the need to explore more deeply this important question. CONCLUSION: Although benzodiazepines have many benefits for patients with bipolar disorders, their use must be very cautious, because of the associated risk of misuse and other possible consequences, especially in some particular clinical situations. Concerns remain about efficacious alternatives to manage comorbid anxiety, sleep disturbances and substance use disorders. Despite the clinical importance of that issue, there is a lack of randomized studies. Due to ethical reasons, this situation highlights the need to explore more deeply this question, by naturalistic studies and neurobiological research, to better understand the role of BZD and GABAergic mechanisms in the pathophysiology of BD, anxiety and sleep disturbances.