Which property of benzodiazepines most strongly limits their use as long-term monotherapy in panic disorder?

• A Absolute contraindication with all antidepressant drugs
• B Inability to suppress anticipatory anxiety between attacks
• C Delayed onset of therapeutic action of several weeks
• D Development of tolerance and physiological dependence with discontinuation reactions ✓

Explanation

Benzodiazepines act within days and are effective against both panic attacks and anticipatory anxiety, so options B and C are factually wrong. Their limitation is tolerance, physiological dependence, and potentially severe withdrawal or rebound anxiety on discontinuation, which is why guidelines restrict them to short-term bridging while an SSRI takes effect. They can be safely combined with antidepressants under supervision, so option A is incorrect.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

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