Cognitive mechanisms of diazepam administration: a healthy volunteer model of emotional processing.

A Pringle,J Gottwald,C J Harmer,P J Cowen,M Warren

doi:10.1007/s00213-016-4269-y

A Pringle, J Gottwald + Show 3 more

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https://doi.org/10.1007/s00213-016-4269-y

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Abstract

RationaleBenzodiazepine drugs continue to be prescribed relatively frequently for anxiety disorders, especially where other treatments have failed or when rapid alleviation of anxiety is imperative. The neuropsychological mechanism by which these drugs act to relieve symptoms, however, remains underspecified. Cognitive accounts of anxiety disorders emphasise hypervigilance for threat in the maintenance of the disorders.Objective and methodsThe current study examined the effects of 7- or 8-day administration of diazepam in healthy participants (n = 36) on a well-validated battery of tasks measuring emotional processing, including measures of vigilance for threat and physiological responses to threat.ResultsCompared to placebo, diazepam reduced vigilant–avoidant patterns of emotional attention (p < 0.01) and reduced general startle responses (p < .05). Diazepam administration had limited effects on emotional processing, enhancing the response to positive vs negative words in the emotional categorisation task (p < .05), modulating emotional memory in terms of false accuracy (p < .05) and slowing the recognition of all facial expressions of emotion (p = .01).ConclusionsThese results have implications for our understanding of the cognitive mechanisms of benzodiazepine treatment. The data reported here suggests that diazepam modulates emotional attention, an effect which may be involved in its therapeutic actions in anxiety.

Highlights

Benzodiazepine drugs were introduced in the 1960s and were widely used for the treatment of generalised anxiety and panic disorder
Current guidelines suggest that pharmacological treatment of anxiety disorders is best provided by antidepressant drugs such as selective serotonin re-uptake inhibitors (SSRIs), because patients with anxiety frequently suffer from co-morbid depressive symptomatology and there is no evidence that benzodiazepines have clinically important antidepressant effects when used as monotherapy (Baldwin et al 2014)
Vigilance–avoidance accounts of anxiety emphasise early orienting to threatening stimuli followed by later avoidance of threat (Mogg and Bradley 1998). Both stages are hypothesised to contribute to anxious symptoms; the initial orienting leads to an increased probability of attending to threat, while avoidance in the later stages prevents disconfirmation of the significance of the threat

Summary

Introduction

Benzodiazepine drugs were introduced in the 1960s and were widely used for the treatment of generalised anxiety and panic disorder. Despite concerns about tolerance and dependence, benzodiazepines continue to be prescribed quite frequently. Current guidelines suggest that pharmacological treatment of anxiety disorders is best provided by antidepressant drugs such as selective serotonin re-uptake inhibitors (SSRIs), because patients with anxiety frequently suffer from co-morbid depressive symptomatology and there is no evidence that benzodiazepines have clinically important antidepressant effects when used as monotherapy (Baldwin et al 2014). Benzodiazepines can be helpful in anxious patients unresponsive to antidepressant treatment, and unlike antidepressant treatment, benzodiazepine administration produces a rapid alleviation of anxiety apparent from the first doses of treatment (Burrows and Norman 1999; Baldwin et al 2011)

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