The Risks Associated with Benzodiazepines
When seeking medical advice to treat mental health conditions, benzodiazepines (benzos) can be part of the conversation with your healthcare provider. Yet, there is much to consider before taking benzodiazepines. While benzos may be an effective treatment option, side effects, and serious risks must be recognized.
At Levelheaded Mind, we know that education is the key to working with your healthcare provider to make wise mental health decisions. Helping you make informed choices is our goal. Therefore, in this article, you will find the following:
What are Benzodiazepines?
The History of Benzodiazepines
Side Effects and Risk of Benzodiazepines
Withdrawal Issues
Safe Uses for Benzodiazepines
Helpful Information and Next Steps
What are Benzodiazepines?
Benzodiazepines are a prescription drug classification used to treat anxiety, anxiety disorder, and panic attacks. Benzos may also be used as antidepressants and prescribed to treat muscle spasms and insomnia.
There are many benzo medications available. Here is a list of some common benzodiazepines and brand names.
Lorazepam (Ativan)
Clonazepam (Klonopin)
Clorazepate (Tranxene)
Alprazolam (Xanax)
Diazepam (Valium)
temazepam (Restoril).
oxazepam (Serax)
flurazepam (Dalmane)
midazolam (Versed)
Triazolam (Halcion)
Estazolam (Prosom)
The History of Benzodiazepines
In 1959 the first benzodiazepine medication, Chlordiazepoxide, was marketed under the brand name Librium. It was highly touted by healthcare providers as a replacement for barbiturates. Barbiturates have a high risk of life-threatening medical emergencies. This includes an increased risk of death by overdose.
Prescribing benzodiazepines provided a safer alternative. Yet, at the time, the long-acting side effects of benzodiazepines were not understood. Both short-term and long-term side effects and risks have now become a concern.
Side Effects and Risks of Benzodiazepines
Short-term side effects: Short-term use can produce side effects, including decreased alertness, drowsiness and sleepiness, impaired psychomotor performance, and memory dysfunction. This decrease in alertness can become a danger with activities such as driving. It can lead to accidents or a DUI.
Long-term side effects: Long-term use is defined as taking benzos for longer than one year. This long-term use leads to a risk of cognitive impairment. Cognitive impairment is a broad term that encompasses several symptoms of central nervous system toxicity, such as recent memory, expressive language, sedation, drowsiness, motor impairment, inattentiveness, and impaired coordination. Elderly patients have a higher risk of experiencing these symptoms because of normal metabolic changes associated with aging.
Risk of dependence: With long-term use, the body adjusts to the lower doses leading to the medication becoming ineffective at that dose. This leads to continual increases in dosage. Once a high dose is reached, drug dependence is a risk.
Rebound anxiety: With high doses of benzodiazepines, there is a risk of rebound anxiety. This is a condition when the previous anxiety levels return and can even be worse than before starting benzos. At this point, the patient may be suffering high anxiety levels while dependent on the benzo medication.
Risk of drug abuse and misuse: More than one out of twenty people in the U.S. fill a benzo prescription each year. Benzodiazepines are the third most misused illicit or prescription substance among adults and adolescents in the U.S., affecting approximately 2.2 percent of the population. Reasons contributing to this misuse are:
Earlier age of prescription initiation (Austic et al., 2015; McLarnon et al., 2011)
Longer duration of prescription use (Boyd et al., 2015)
Greater frequency of prescription use (McCabe et al., 2011a)
Risk of overdose: Benzodiazepines increase the risk of heart rate and respiratory depression when taken with opioids or alcohol, increasing the risk of overdose. Benzodiazepines were involved in nearly 30% of opioid overdose deaths in 2015.
Withdrawal Issues
Once you begin to understand the side effects of benzodiazepines and the potential risk, you may consider stopping your benzo use. It is not safe to stop your benzodiazepine use rapidly or cold turkey. Benzodiazepine withdrawal must be done under the supervision of your healthcare provider. It will be a lengthy process if you are taking high doses.
Developing a plan
Levelheaded Mind provides educational resources on how to withdraw safely from benzodiazepines and deal with withdrawal symptoms. This is provided in both a video resource and a blog post.
Dealing with aftereffects
After withdrawing from benzodiazepines, it is possible to experience effects even after ten months of stopping the medication. The same adverse effects experienced during long-term use can continue well after stopping. These include impaired cognitive function, including perceptual-motor, recent memory, visual perception, divided attention, visuo-construction, sustained attention, working memory, and processing speed.
Dealing with alcohol and drug use
Given the increased risk when benzos are coupled with alcohol or drug use, it is critical to avoid this combination. If you struggle with alcohol or drug abuse, you must go through alcohol withdrawal or opioid withdrawal first. After you have completed addiction treatment, benzodiazepine withdrawal can be undertaken.
Safe Uses of Benzodiazepines
Given the many side effects and risks, benzo medications are no longer recommended as a first-line treatment for anxiety disorders, including panic disorder.
However, benzos can be an effective short-term medication. Between two and four weeks of benzo use can be effective for severe anxiety and panic attacks.
Helpful Information and Next Steps
The ugly truth about benzodiazepines is that there are significant side effects and risks. These risks increase with elderly patients and those who use alcohol or opioids. However, in severe cases, benzodiazepines can be an effective short-term treatment option.
At Levelheaded Mind, Jezel Rosa, PMHNP-BC, is available to discuss your mediation choices and help you explore benzodiazepine’s uses, side effects, and risks. You can speak directly by scheduling an initial mental health coaching session here.
For more information, watch The Ugly Truth About Benzodiazepines on YouTube.
Disclaimer: All of the information on this channel is for educational purposes only and not intended to be specific/personal medical advice or substitute for diagnosis and treatment of any conditions discussed herein. Furthermore, watching these videos or getting answers to comments/questions, does not establish a provider-patient relationship. Please consult with your own healthcare provider for proper diagnosis and treatment.
Note: Some of the links are affiliate links, meaning I may earn a small commission from purchases made through links.
Patient Resources:
The Alliance for Benzodiazepine Best Practices
https://www.healthline.com/health/anxiety/rebound-anxiety#coping-tips
https://patient.info/mental-health/insomnia-poor-sleep/benzodiazepines-and-z-drugs
References:
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Dialogues in clinical neuroscience, 19(2), 93–107. https://doi.org/10.31887/DCNS.2017.19.2/bbandelow
Chouinard G. (2004). Issues in the clinical use of benzodiazepines: potency, withdrawal, and rebound. The Journal of clinical psychiatry, 65 Suppl 5, 7–12.
Crowe, S. F., & Stranks, E. K. (2018). The Residual Medium and Long-term Cognitive Effects of Benzodiazepine Use: An Updated Meta-analysis. Archives of clinical neuropsychology: the official journal of the National Academy of Neuropsychologists, 33(7), 901–911. https://doi.org/10.1093/arclin/acx120
Votaw, V. R., Geyer, R., Rieselbach, M. M., & McHugh, R. K. (2019). The epidemiology of benzodiazepine misuse: A systematic review. Drug and alcohol dependence, 200, 95–114. https://doi.org/10.1016/j.drugalcdep.2019.02.033
Wick J. Y. (2013). The history of benzodiazepines. The Consultant pharmacist: the journal of the American Society of Consultant Pharmacists, 28(9), 538–548. https://doi.org/10.4140/TCP.n.2013.538
