Benzodiazepines are a class of sedative medications that are among the most prescribed psychiatric drugs in the United States. They treat general anxiety disorder, panic attacks, insomnia, and, in some cases, epilepsy or seizure disorders, although benzodiazepines are no longer the frontline treatment for seizure disorders.
They are also prescribed mostly for as-needed use or for two weeks or less of consistent treatment. This is because the body develops a tolerance to these medications very quickly, reducing their effectiveness for long-term treatment.
The calming effect associated with benzodiazepine drugs like Xanax, Klonopin, and Valium is due to how the medication releases neurotransmitters in the brain. These drugs work on the gamma-Aminobutyric acid (GABA) receptors in the brain, binding to them to create a feeling of sedation.
The GABA neurotransmitters inhibit communication between neurons. Without enough natural GABA, neurons fire rapidly, leading to several problems, from panic attacks to seizures. However, the brain can quickly become used to the presence of chemicals like benzodiazepines that imitate GABA, so withdrawing from these medications can be difficult and requires a taper.
Long-term benzodiazepine use is not recommended. If you develop a tolerance to these drugs, you may feel like you need to take more—larger or more frequent doses—to get the initial effects. This can indicate addiction, or it can indicate a chemical imbalance that requires other approaches.
Even at prescription doses, benzodiazepines can cause side effects such as:
These are short-term effects, and they will go away as the benzodiazepine’s main effects subside. However, if you take benzodiazepines for a long time, mental and emotional changes may become chronic. Some of those are:
If you take benzodiazepines as prescribed, your doctor can help you ease off these drugs if you develop a dependence on them. However, if you take more than prescribed or abuse them for nonmedical reasons, you risk struggling with dependence and other long-term risks.
Developing a physical dependence on drugs does not mean that you are addicted, although people who struggle with drug abuse and addiction often develop a dependence on a substance. Dependence simply means your body is used to the presence of the drug to maintain its chemical balance, especially the balance of neurotransmitters.
Compulsive behaviors and seeking a high are characteristics of drug abuse and addiction, while dependence can occur separately. The risk of dependence on benzodiazepines means you should not try to quit these medications suddenly if you have been taking them regularly or abusing them for recreational purposes. Withdrawal symptoms are a risk of physical dependence, and these can be uncomfortable and, in some instances, life-threatening.
Most withdrawal symptoms from benzodiazepines are rebound symptoms, mimicking the conditions that these sedative drugs are prescribed to treat, with anxiety, panic attacks, and insomnia being the main issues. Depression, mood swings, aggression, and physical discomfort are also associated with peak withdrawal symptoms. High doses may lead to perceptual distortions, sensitivity to light or sound, and depersonalization or derealization.
However, the biggest risk to long-term benzodiazepine abuse, when quitting suddenly, is having a seizure. The structural changes to the GABA system can induce seizure disorders in people who did not have them previously, especially if the drug was abused in large doses for months or years. A survey on decades of data on benzodiazepine side effects and withdrawal reported that nearly all the seizures were grand mal seizures, and sometimes, they have been reported with less than 15 days of consistent use at a therapeutic dose.
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Having trouble with thinking and remembering have been associated with long-term benzodiazepine use, even at prescription levels, in elderly adults. There are indications that these problems may begin sooner and can impact anyone who abuses these drugs. A survey of 13 studies over several years found that each measurement consistently showed that people who took benzodiazepine drugs anywhere from one to 34 years displayed lower cognitive aptitude than control groups.
These issues begin quickly after benzodiazepines are administered, but they can be attributed to sedation on a short-term basis. Long-term, though, the study found that detoxing from benzodiazepines somewhat improved cognition, but brain function did not match benzodiazepine-free control groups.
A more recent study examined the association between dementia-like symptoms, especially cognitive decline, and benzodiazepine use. While the study did not find a causal link between the two, researchers noted that depression, anxiety, and insomnia are all reasons that benzodiazepines are prescribed, and in older adults, the onset of these issues may actually be early symptoms of dementia. Benzodiazepine prescriptions in older people may be treating early dementia issues, but they are not causing the problem. Still, this study was on older adults, and it did not examine the cognitive impairment associated with other age groups.
Like cognitive problems, gait issues and muscle weakness are short-term issues associated with intoxication and sedation from benzodiazepines.
Long-term, though, they have different underlying issues, including brain structure changes.
One case study of a 60-year-old woman admitted to the emergency room due to a suicide attempt reported that, when benzodiazepines were metabolized out of her body and a different psychiatric medication was applied to treat her condition, suicidal ideation resolved, and her gait trouble and muscle weakness improved; however, they did not disappear.
Other studies suggest that muscle atrophy or weakness can become increasingly present and may develop into a chronic issue.
Falling may also be associated with early-stage dementia.
Even when taken with a physician’s orders and oversight, benzodiazepines can be risky. Physical dependence and tolerance develop quickly; withdrawal symptoms from quitting suddenly are life-threatening; and brain state changes can lead to cognitive and emotional issues.
While benzodiazepines can play an important role in treatment, talk to your doctor if you are concerned. If you abuse these drugs for recreational reasons, get help from an evidence-based detox and rehabilitation program.
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