“Can I get something to take the edge off?”

You’ve heard it. Maybe this morning. Maybe just after you explained the SSRI will take two weeks to work.

And then, the quiet pause.

You both know that they’re asking for a benzo.

We’re still working our way through our A to Z guide on switching psych meds, drawn from the upcoming 8th edition of The Medication Fact Book for Psychiatric Practice (available Black Friday, Nov 28).

So far we’ve covered: 

→ ADHD meds 

→ Antidepressants 

→ Antipsychotics

Next up, alphabetically: Anxiolytics.

We’re breaking it into two parts:

→ Part 1 (today): What to prescribe and when.

→ Part 2 (next): How to switch from Drug A to Drug B when something isn’t working—or is causing new problems.

Psychiatry has a long, ambivalent history with benzos.

They work. Quickly. Reliably.

But they also come with potential problems:

Misuse. Dependence. Withdrawal. Stigma.

The real challenge isn’t deciding whether to use them—it’s knowing how to use them wisely.

Here’s what we recommend in MFB8e:

▸ Start with long-acting agents like clonazepam. Less of a “kick” means lower misuse potential. 

▸ Use short-acting benzos like alprazolam or lorazepam only as PRNs—and sparingly. 

▸ When starting an SSRI, consider a short benzo bridge—just two weeks. Frame it clearly: “You’ll stop this once the SSRI kicks in.” 

▸ Try buspirone, especially for GAD. Low risk, modest efficacy. 

▸ Use propranolol when physical symptoms dominate—racing heart, shaking hands, shortness of breath. 

▸ Think clonidine or prazosin for anxiety + insomnia. Prazosin may help PTSD nightmares, though data is mixed. 

▸ Hydroxyzine is a good PRN for patients with SUD history or risk. 

▸ Avoid benzos in anyone with sleep apnea, respiratory disease, or opioid use. 

▸ In older adults, start low, go slow. Monitor closely for falls, sedation, and confusion.

And finally:

▸ Try to keep benzo use under four weeks. And if they've been on benzos for a long time, taper slowly—over weeks to months—not days.

We don’t need to banish benzos.

We need to bring clinical clarity back to their use.

How do you navigate benzo prescribing in your practice?

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