By NICHOLAS BAKALAR

Published: February 22, 2005


Among famous inventors, Leo H. Sternbach may not immediately leap to mind.

But this May in Akron, Ohio, Dr. Sternbach, who is 96, will be inducted into the National Inventors Hall of Fame. He holds more than 240 patents, but perhaps his most famous invention, in collaboration with colleagues, is a chemical compound called diazepam, better known by its brand name, Valium.

One of the earliest benzodiazepines, Valium was approved by the Food and Drug Administration in 1963 as a treatment for anxiety, and it would become not only the country's best-selling drug, but an American cultural icon.

Referred to knowingly in Woody Allen movies, enshrined as "Mother's Little Helper" in the Rolling Stones song, condemned as poisonous in best-selling books, Valium reached the height of its popularity in 1978, a year when Americans consumed 2.3 billion of the little yellow pills.

But by the 1980's its reputation for creating abuse and withdrawal problems was well known, and the new selective serotonin reuptake inhibitors like Prozac were widely considered better treatments for anxiety and panic disorders.

Still, the benzodiazepines - there are now more than a dozen others available besides Valium - never disappeared. They are still widely prescribed and, in the view of many doctors, extremely effective in treating not only anxiety and panic disorder, but bipolar illness, insomnia, catatonia and alcohol and drug withdrawal.

"The key is to use them correctly," said Dr. Eric Hollander, director of clinical psychopharmacology at Mount Sinai School of Medicine in New York.

Using them correctly is not so simple. Benzodiazepines cause sedation, which can be either therapeutic or a side effect, depending on the patient's ailment. Dr. Steven Roose, professor of clinical psychiatry at Columbia University, said that for anxiety the "S.S.R.I.'s are still the first-line treatment, but they can initially cause an exaggeration of anxiety symptoms."

"Pretreating with benzos can prevent this," Dr. Roose continued, citing Ativan, which "can be used for the sleep problems that S.S.R.I.'s can cause, although it should be used only for a brief term."

The use of benzodiazepines in drug withdrawal may seem paradoxical, since they can be addictive themselves.

But the newer longer-acting benzodiazepines like Klonopin may have fewer withdrawal problems than the older drugs because they are metabolized more slowly and leave the body gradually.

Even though they don't usually induce euphoria, benzopiazepines can become street drugs of abuse for their sedating effect, and some cocaine users like them to "chill out."

The benzodiazepines can also impair motor function, especially during the first weeks of treatment, and cause temporary memory impairment. The drugs do not help with depression, so those with both anxiety and depression, a common combination, may be better off with the double effect of the S.S.R.I.'s.

People who use alcohol as self-medication for anxiety are not good candidates for benzodiazepines, which can be deadly when combined with drinking.

Perhaps most notoriously, there is the danger of addiction, but some believe that may be exaggerated.

"My view is that the risk of dependency and tolerance is overblown," said Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard and editor in chief of The Harvard Mental Health Letter. "People being treated for anxiety are not looking for a high; they're looking for relief from their anxiety symptoms, and if benzos give it to them, that's good."

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