Benzodiazepines for the Treatment of Anxiety

Benzodiazepines are a class of medications commonly used for their tranquilizing and anti-anxiety effects. They can be effective in the treatment of anxiety, but they also have some side effects and risks that you should know about.

These medications were once the most common treatment for anxiety, but there are also newer and often more effective treatments available that do not carry many of the same risks associated with benzodiazepines. If you have anxiety, learning more about the use of benzodiazepines to treat this condition can help you decide if this is the right treatment choice for your needs.

How Benzodiazepines Work for Anxiety

Benzodiazepines affect the gamma-aminobutyric acid (GABA) receptors of the brain. This action results in slowing of the central nervous system (CNS), inducing a state of relaxation. Benzodiazepines are fairly quick-acting, relieving symptoms in a short amount of time.

They may also be used to treat insomnia, which can be both a symptom of anxiety or a contributing factor. Anxiety may interfere with sleep, but a lack of sleep may also lead to or worsen symptoms of anxiety.

Depending on your condition and symptoms, benzodiazepines may be taken once per day, multiple times per day, or on an as-needed basis. Your doctor may begin with a low initial dose that may be increased if you are still experiencing symptoms. The therapeutic dosage varies greatly from individual to individual and may depend on the severity of one’s symptoms and his or her unique body chemistry.

In addition to prescribing benzodiazepines, your doctor may also recommend psychotherapy to help treat your anxiety. Research has found that combining medications and therapy may be the most effective treatment option. A type of therapy known as cognitive behavioral therapy (CBT) is one of the methods most frequently used to treat anxiety. 

Examples of Benzodiazepines

Common uses for benzodiazepines include the treatment of anxiety, panic attacks, and insomnia. Examples of benzodiazepines used for the treatment of anxiety-related to panic disorder or other anxiety disorders include:

• Xanax (alprazolam): Prescribed for short-term relief of anxiety symptoms
• Klonopin (clonazepam): Prescribed to treat panic disorder and panic attacks
• Valium (diazepam): May be prescribed during the initial phase of treatment for panic disorder
• Ativan (lorazepam): May be prescribed to treat anxiety symptoms that occur with other psychiatric conditions
• Librium (chlordiazepoxide): May be used to treat anxiety disorders as well as alcohol withdrawal

Benzodiazepines may also be prescribed for other conditions including seizures, muscle spasms, and withdrawal from alcohol or other drugs. They may also be used to treat sleep disorders and to induce a relaxed state prior to surgery.

Precautions

Benzodiazepines should be taken only as directed by your doctor. You should not increase your dosage without consulting your doctor. If you've been prescribed a benzodiazepine, do not stop the medication without your doctor’s advice. Doing so may cause unwanted withdrawal symptoms or worsen your condition and symptoms.

In the United States, benzodiazepines are classified as Schedule IV controlled substances.

Safe Usage

Benzodiazepines can cause drowsiness, which can affect your ability to drive safely. You should avoid driving or operating other heavy equipment if you feel drowsy or sleepy. You should also avoid taking benzodiazepines with alcohol or other sedatives.

Drug Interactions

Certain drugs, including some types of the SSRIs, may affect how a benzodiazepine is metabolized and excreted from your body. This may cause a rise of benzodiazepine medication in your blood. It is important to follow your doctor’s dosing instructions when taking benzodiazepines with SSRIs or other medications to avoid an increased risk for overdose or unwanted side effects.

Mixing benzodiazepines with alcohol or other classes of sedative (depressant) medications may produce an increased depression of the ​CNS. These interactions can be potentially serious and can result in an increased risk of overdose. There have been reports of fatalities involving these interactions.

This list is not all-inclusive. There are other drug interactions that should be avoided and medical issues your doctor may need to consider before starting benzodiazepine therapy. Be sure to tell your doctor about all medications, including over-the-counter drugs and supplements you are taking. Talk to your doctor or pharmacist before taking any prescription or over-the-counter medications with benzodiazepines.

Pregnancy and Breastfeeding

Benzodiazepines have been linked to congenital birth defects when administered during the first trimester of pregnancy. They are also excreted in human breast milk. If you are taking benzodiazepines and become pregnant, talk to your doctor right away.

Age

Benzodiazepines should generally not be used to treat anxiety in children and teens. These medications may cause symptoms of irritability rather than inducing feelings of calmness.

Older adults may also be more sensitive to the effects of benzodiazepines. Because of this, they may be more likely to experience symptoms of confusion and poor muscle coordination, which may lead to falls, bone fractures, or other accidents. 

Health Conditions

Before beginning benzodiazepine therapy, tell your doctor if you have any of the following conditions:

• A history of alcohol or other drug abuse or dependence
• Glaucoma
• Kidney or liver disease
• History of seizures
• History of bipolar disorder or depression
• Suicidal thoughts

Side Effects

The most common side effects of benzodiazepine use are drowsiness and impaired coordination. Such side effects tend to be mild and may not be noticeable or troublesome when benzodiazepines are taken at low doses for short-term periods. Other side effects include:

• Confusion
• Fatigue
• Memory impairment
• Slowed mental processing

The side effects associated with benzodiazepines abate once the effects of the drugs wear off. When used as a treatment for insomnia, you may notice lingering feelings of daytime drowsiness the following day.

If these or other side effects arise and continue to be bothersome, talk to your healthcare provider.

It is also important to note that this class of medications carries an FDA black box warning noting the serious risks of abuse, addiction, physical dependence, and withdrawal. Even when taken at prescribed doses, benzodiazepines can lead to physical dependence, and abruptly stopping their use can lead to serious withdrawal reactions, including seizures.

Tolerance, Dependence, and Withdrawal

Benzodiazepines have the potential for physical dependence when used for long periods of time, especially at high doses. They can also be psychologically addictive in some individuals.

Studies have shown that people who take benzodiazepines over a long period of time may develop tolerance that reduces the therapeutic benefits. If tolerance occurs, larger doses of benzodiazepines may be needed to bring about desired results.

Long-term use of benzodiazepines may result in physical dependence and withdrawal symptoms if the medication is stopped or decreased suddenly. Withdrawal symptoms may include:

• Anxiety
• Diarrhea/stomach upset
• Insomnia
• Muscle cramps
• Headache
• Decreased concentration
• Rapid breathing
• Tremors
• Seizures

Again, do not discontinue or decrease your benzodiazepine medication without consulting your doctor. It may be necessary to decrease your dosage slowly to avoid withdrawal complications.

A Word From Verywell

Anxiety is a treatable condition and benzodiazepines are just one way to relieve symptoms. If you have symptoms of an anxiety disorder, work with your doctor to find the treatment that works best for you.