CONTENTS
(1) Overview
(2) For more information
(1) Overview
Benzodiazepines are often referred to as "anti-anxiety" medications, even though other medications are also used for anxiety (most notably the "anti-depressants"). Benzodiazepines include:
Xanax (alprazolam)
Klonopin (clonazepam)
Valium (diazepam)
Ativan (lorazepam)
These medications may be prescribed by doctors for the short-term management of anxiety and sometimes for anxiety-related insomnia. They are not intended to be taken on a regular basis for the long-term because they are habit forming and cause withdrawal symptoms and rebound insomnia upon discontinuance. Research has found an increased risk for cognitive impairment (including dementia) with long-term benzodiazepine use, particularly by older adults.
For longer-term medication treatment of anxiety, the anti-depressants are generally considered to be a better choice. For insomnia, Cognitive Behavioral Therapy for Insomnia is the treatment of choice. Sedative-hypnotic medications are generally preferred over benzodiazepines for the short-term treatment of insomnia.
(2) For more information
Rx List - Benzodiazepines
Wikipedia - Benzodiazepine withdrawal syndrome
Dr. Garret Rossi (psychiatrist) - "Shrinks in Sneakers" You Tube video (duration: 6.5 minutes): Can benzodiazepines be prescribed ethically?
Benzodiazepine Information Coalition: https://www.youtube.com/@BzInfoCoalition
Alliance for Benzodiazepine Best Practices: https://benzoreform.org
FDA black box warning: https://www.fda.gov/drugs/drug-safety-and-availability/fda-requiring-boxed-warning-updated-improve-safe-use-benzodiazepine-drug-class
(3) For professionals
Dell'Osso, B., Albert, U., Atti, A. R., Carmassi, C., Carrà, G., Cosci, F., … Fiorillo, A. (2015). Bridging the gap between education and appropriate use of benzodiazepines in psychiatric clinical practice. Neuropsychiatric disease and treatment, 11, 1885–1909. [Full Text]
Kaiser Permanente - Benzodiazepine and Z Drug Safety Guideline
https://wa.kaiserpermanente.org/static/pdf/public/guidelines/benzo-zdrug.pdf
Benzodiazepine Information Coalition
ASAM Guidelines for Benzodiazepine Tapering: https://www.asam.org/quality-care/clinical-guidelines/benzodiazepine-tapering / https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/guidelines/bzd-cpg-narrative-draft-for-public-comment.pdf?sfvrsn=6d96408_2
The Ashton Manual for discontinuing benzodiazepines
Effects of long-term benzodiazepine use
https://en.wikipedia.org/wiki/Effects_of_long-term_benzodiazepine_use
Benzodiazepine withdrawal syndrome
https://en.wikipedia.org/wiki/Benzodiazepine_withdrawal_syndrome
Parr, Jannette M.; Kavanagh, David J.; Cahill, Lareina; Mitchell, Geoffrey; Mcd Young, Ross McD. (2009). "Effectiveness of current treatment approaches for benzodiazepine discontinuation: A meta-analysis". Addiction. 104 (1): 13–24.
Fluyau, D; Revadigar, N; Manobianco, BE (May 2018). "Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation". Therapeutic Advances in Psychopharmacology. 8 (5): 147–168.
Santos C, Olmedo RE (2017). "Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition And Treatment". Emergency Medicine Practice. 19 (3): 1–20.
Benzodiazepines
https://www.rxlist.com/benzodiazepines/drug-class.htm
https://www.drugs.com/drug-class/benzodiazepines.html
Xanax (alprazolam) alprazolam
Klonopin (clonazepam) clonazepam
Valium (diazepam)
Ativan (lorazepam) lorazepam
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Benzodiazepines (also called “benzos”) are a class of agents that work in the central nervous system and are used for a variety of medical conditions.
They act on specific receptors in the brain, called gamma-aminobutyric acid-A (GABA-A) receptors. Benzodiazepines attach to these receptors and make the nerves in the brain less sensitive to stimulation, which has a calming effect.
Benzodiazepines may be used to treat:
as a muscle relaxant
to induce relaxation and cause amnesia prior to surgical operations.
All benzodiazepines work in a similar way but there are differences in the way individual benzodiazepines act on different GABA-A receptor sub-types. In addition, some benzodiazepines are more potent than others or work for a longer length of time. The table below summarizes the common benzodiazepines available in the U.S.
Generic Name / Brand Name / Half-life* / * The half-life is the amount of time it takes for half of the drug to be eliminated from the body. The shorter the half-life, the quicker the drug is eliminated.
alprazolam; Xanax; 6-26h (short-acting)
clonazepam / Klonopin; 20-50h (long-acting)
diazepam / Valium / 20-100h (long-acting)
lorazepam / Ativan / 10-20h (medium-acting)
temazepam / Restoril / 10-20h (medium-acting)
triazolam / Halcion / 2-5h (short-acting)
estazolam / ProSom / 10-24h (medium-acting)
flurazepam / Dalmane / 40-100h (long-acting)
midazolam / Versed / 2.5h (short-acting)
oxazepam / Serax / 5-15h (short-acting)
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When prescribed by a doctor and used for short periods of time, such as the day of surgery or for less than two weeks to aid sleep, benzodiazepines are safe to take.
Problems start to arise when benzodiazepines are taken at higher dosages than recommended, or when they are taken for more than two to four weeks. Benzodiazepines are potentially addictive and the risk of becoming emotionally and physically dependent on them increases the more you take. In addition, tolerance can develop with their use. This is when the same dose no longer gives the same effect, and a dosage increase is needed to ease symptoms again.
Benzodiazepines should only be taken at the lowest dose for the shortest possible length of time.
Drowsiness, sleepiness, or dizziness are the most common side effects reported. This can make it dangerous for people taking benzodiazepines to drive or operate machinery or perform other hazardous tasks. Alcohol may potentiate these effects.
Other commonly reported side effects include:
amnesia (forgetfulness)
confusion
sexual dysfunction
unsteadiness when walking or standing
unusually slow and shallow breathing
vision problems (blurred or double vision).
Withdrawal symptoms may occur with abrupt discontinuation – symptoms may include convulsions, cramps, insomnia, sweating, tremors, and vomiting.
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.
For more about benzodiazepines see Benzodiazepines: Overview and Use.