Guidelines warn against benzodiazepines after trauma, yet a short course after the October 7 attacks didn’t raise PTSD risk
STUDY: Rahamim O et al, J Clin Psychiatry 2026
STUDY TYPE: Cohort study
FUNDING: Independent
Background
PTSD guidelines discourage benzodiazepines after trauma, as some studies suggest they disrupt fear extinction. That caution rests on animal studies, two tiny trials, and observational data in which sicker patients got the benzos. After the October 7, 2023 attacks, first-time benzodiazepine prescriptions in Israel rose 10-fold.
This study, though unrandomized, looks at the difference in outcomes.
The Study
- 15,570 Israeli adults with no benzodiazepine use in 3 years, newly prescribed lorazepam, clonazepam, diazepam, or oxazepam within 30 days of October 7.
- Compared those who filled the prescription early (within 7 days) or later (8 to 30 days) with those who never filled it. Because all were prescribed, the groups started out similarly distressed.
- Main outcome: a PTSD diagnosis over 12 months.
Results
PTSD rates were about the same: 5.2% in nonfillers, 4.7% in early fillers, and 5.0% in later fillers (adjusted hazard ratios 0.98 and 1.11).
Among 238 people living near the Gaza border, PTSD was far more common, and those who filled benzos had lower rates of PTSD than nonfillers (31% to 35% vs 53%, unadjusted).
However, the 8% who refilled their benzo during their first supply had higher PTSD risk (hazard ratios 1.60 and 2.07). Those who stopped after one fill had no added risk. This may reflect indication bias, as those who refill likely had higher symptoms.
Limitations
The data are observational, fills don’t confirm the pills were taken, and diagnoses came from routine charts.
Practice Implications
- Observational data like this doesn’t disprove the controlled data, but it reminds us the benzo-PTSD link is not absolute.
- Avoid alcohol after a trauma, which is linked to higher rates of PTSD.
- Don’t reflexively taper benzos after a trauma. Withdrawal could be harmful on its own, and the studies that warn against them involved starting a new benzo,
—Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
