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Letter to the Editor
The Lancet
October 1, 1960


A new tranquillising drug, 7-chloro-2methyl-amino-5-phenyl-3H-1, 4 benzodiazepine-4-oxide hydrochloride ('Librium'), is now available commercially. It has been widely advertised in terms of its taming effect on wild animals and claims have been made that it is of special value in controlling phobic and obsessional symptoms in psychoneurosis although the published evidence for this is slight.*

Nine outpatients with phobic anxiety states and six with obsessional neuroses have been treated with this substance for three weeks. The dosage given was 10mg thrice daily for the first week and 25mg thrice daily thereafter. Only three of the nine phobic patients and one of the six obsessional neurotics felt any subjective improvement.

Side-effects were seen in over half the patients. Two felt drowsy on the smaller dose, five on the larger. Two felt fatigued and apathetic, and dizziness and constipation were reported. One patient felt more energetic and two complained of severe irritability. After taking the drug for a week a schoolteacher struck his wife for the first time in the twenty years of their marriage. Of the fifteen patients, three had to stop work because of the side-effects and two others refused to continue taking the drug after two weeks.

Although the number treated is small and the findings uncontrolled, the results are disappointing enough and the side-effects sufficiently troublesome to deserve attention. Other side-effects reported in trials in the United States have included dissociative reactions, hyperactivity, and ataxia.†

We feel justified in suggesting that the drug should be used with circumspection and scepticism until the results of controlled trials are available.

I.M. Ingram, Gerald C. Timbury
Southern General Hospital, Glasgow

*Breitner C, Die Nerv Syst. 1960, 21 (suppl 3), 31.
†Tobin JM, Bird I F, Boyle DE, ibid. p11

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