However, because benzodiazepines have more severe side effects, including a risk of dependence, SSRIs are often recommended first for generalized anxiety disorder. People who drink alcohol while taking this medicine will feel the effects of alcohol faster. Other studies have assessed different methods of counseling on BZD dangers and alternatives to patients alongside a gradual taper off the drugs. One study compared the mainstay of treatment with a standardized interview/counselling approach to treatment 72. The experimental group in this study had a weekly 1/10-dose reduction after a 2 week stabilization period 72. The experimental treatment also included a BZD diary, a drinking diary, BZD withdrawal education, and assessments for ways of coping and “progressive relaxation exercise” 72.
What are the most commonly prescribed benzodiazepines?
- Current treatment for withdrawal is through tapering with clonazepam, and overdose should be treated with flumazenil 67.
- The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol.
- Additionally, these patients are more likely to have comorbid substance use disorders and anxiety disorders so it can be harder to find an efficacious treatment for their withdrawal symptoms 68.
- The medicine was supposed to help, and instead it has derailed their life.
Tapering off benzodiazepines gradually, under a doctor’s supervision, allows your brain to recalibrate and recover. Secondly, approximately 20% of the children in the intensive care unit given BZD during sedation, more specifically midazolam, have been shown to exhibit withdrawal effects. The severity of the withdrawal sequelae depends on the total dose and duration of infusion and usually presents as agitation, tremors, difficulty sleeping, and inconsolable crying 60. A study analyzing over 1000 cases of oxycodone-related drug abuse deaths showed that BZDs are among the most abused drugs by individuals using multiple drugs of abuse.
Benzodiazepines
Benzos aren’t recommended for long-term use because they become less effective over time. As the body continues to adapt to the presence of the benzo, it requires higher doses to feel a therapeutic effect. Some people develop a paradoxical reaction to benzodiazepines – this is the opposite reaction to what you would expect. They may become agitated or very anxious, develop hallucinations, have difficulty sleeping or exhibit bizarre behavior such as taking off their clothes in public or taking unnecessary risks. It is essential not to use benzodiazepines with opioids or alcohol, as this can lead to life threatening effects.
Risks / Benefits
Despite this, numerous studies report usage extending for months benzodiazepine withdrawal into years or even decades in many users 9. Additionally, according to several studies, BZD use increases with age, with long-term usage most prevalent in the 65 and older population 16. Long-term use is defined as two or more months at a therapeutic dose and when used long-term, BZDs pose potential harmful effects. Some additional side effects of concern include aggressive behavior and expressing anger towards others in between 1% and 20% of users 17.
Benzodiazepine Drug Interactions
This receptor is a protein called gamma-aminobutyric acid type A (GABA-A) receptor. Benzodiazepine drug molecules mimic the naturally occurring neurotransmitter GABA and bind to this receptor. This allows chloride ions to enter the neuron cells, which results in CNS depression.
Elderly patients in intensive care can develop delirium if they are on a BZD 1. Further, as the brain adjusts to the increased levels of GABA, there is a risk that tolerance can build. This means your partner will require a higher dose to feel the same calming effects.
Treatment options
- Drug treatment will depend upon the level of anxiety, patient characteristics such as age and organ function, and patient preference.
- The study found no significant cognitive impairment in adults with long-term use of BZD 20.
- A study analyzing over 1000 cases of oxycodone-related drug abuse deaths showed that BZDs are among the most abused drugs by individuals using multiple drugs of abuse.
- The table below summarizes the common benzodiazepines available in the U.S.
- Don’t ever stop taking a benzodiazepine without talking to your doctor first.
Alprazolam is widely used as monotherapy for panic disorder and anxiety and was found superior to other forms of monotherapy for these what is Oxford House conditions including other BZD, non-SSRI antidepressants, and buspirone. This superior effect is thought to be due to its unique alpha-2 adrenergic activity, enhancing its potency for relieving panic and anxiety disorders. This same mechanism is also thought to be the cause behind alprazolam’s strong rebound hyperadrenergic effects with cessation 54,55.
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The main driving factor for dependence is the development of tolerance, causing users to need increasing doses for the same symptom relief 18. Yes, withdrawal is a possible complication of misusing benzodiazepines. Unfortunately, it’s also possible with long-term use of these drugs even when you take them as prescribed.