An Overview of Benzodiazepines

Understanding the Uses, Benefits, and Risks

Side Effects
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Benzodiazepines are a class of drugs known as central nervous system depressants that are used to treat a variety of mood disorders and other health conditions, including insomnia and alcohol withdrawal.

Benzodiazepines work by enhancing the brain's response to a neurotransmitter known as gamma-aminobutyric acid (GABA). Doing so reduces the excitability of nerve signals in the brain and leads to the relaxation of certain physiological and emotional responses.

While effective in treating certain conditions, benzodiazepines may cause side effects, including drowsiness, the loss of libido, and the lack of coordination. Long-term use can lead to adverse behavioral symptoms and drug dependence.

The most commonly prescribed benzodiazepines are:

Indications for Use

Benzodiazepines have properties that make them useful in treating a number of health conditions. They can act as a muscle relaxant and anticonvulsant and also have sedative (relaxing), hypnotic (sleep-inducing), and anxiolytic (anti-anxiety) effects.

Among their indications for use:

  • Alcohol withdrawal symptoms may sometimes be relieved with a short-course of benzodiazepines, although the response can vary from person to person. Because of the risk of drug dependence, they are usually prescribed for no longer than a couple of weeks.
  • Epileptic seizures can be effectively controlled with either Klonopin, Valium, or Ativan. Klonopin offers stronger anticonvulsant action, Valium works faster, and Ativan has a longer duration of action.
  • Generalized anxiety disorder (GAD) can be treated with benzodiazepines, although they are less effective in achieving long-term control. As such, they should not be used for longer than two to four weeks due to the risk of dependence.
  • Insomnia can be alleviated over the short term with benzodiazepines but may result in rebound insomnia is overused. Long-term use should be strictly avoided.
  • Panic disorder may be effectively treated with benzodiazepines as they can alleviate anxiety symptoms much faster than antidepressants, an important factor for those who experience severe or debilitating panic attacks

    Other uses include the inducement of calm before surgery or a medical procedure and the treatment of muscle spasms or abnormal sleep patterns.

    Side Effects

    Most of the side effects of benzodiazepines are related to their depressant effect the drug has on the central nervous system.

    Common side effects include:

    • Constipation
    • Diarrhea
    • Drowsiness
    • Dry mouth
    • Erection problems
    • Fatigue
    • Impaired motor skills and coordination
    • Loss of appetite
    • Low libido
    • Muscle weakness
    • Short-term memory loss and impaired cognition
    • Slurred speech

    Long-term use may trigger a worsening of side effects and, in some cases, paradoxical side effects (meaning that you may experience an opposite response to the drug than previously achieved). Some of these side effects can adversely affect mood and behavior, causing an altered perception of yourself, your environment, or your relationships.

    Long-term side effects may include:

    • Acute anxiety
    • Agoraphobia (the fear of public spaces)
    • Anhedonia (the inability to feel pleasure)
    • Depression
    • Inability to think cohesively
    • Loss of libido
    • Social phobias

    Dependence and Withdrawal

    Benzodiazepines are a schedule IV medications due to their risk of physical and psychological addiction. As such, they are usually prescribed for no more than two to four weeks. When taken for longer periods, benzodiazepines can lead to tolerance and dependence, meaning that the body will require more of the drug to achieve the same therapeutic effect.

    If overused, you can experience symptoms of withdrawal if the drug is suddenly stopped. To avoid this, dosages should be gradually tapered off to minimize some of the more profound symptoms of withdrawal, including:

    • Abdominal cramps
    • An altered sense of reality
    • Confusion and disorientation
    • Depression
    • Hallucinations
    • Increased sensitivity to light
    • Increased sensitivity to pain
    • Increased sensitivity to sound
    • Insomnia
    • Irritability
    • Muscle cramps
    • Nausea and vomiting
    • Nervousness
    • Paranoia
    • Profuse sweating
    • Seizures and convulsions
    • Tachycardia (rapid heart rate)
    • Tingling, burning, or "skin-crawling" sensations
    • Tremor

    In addition to dependence, there are many substances can interact with benzodiazepines and cause accidental overdose or even death.

    Alcohol and opioid pain relievers, both of which also act as central nervous system depressants, can greatly magnify the effect of benzodiazepines. Together, these drugs can slow respiration and heart function to a point where they may altogether stop. To this end, benzodiazepines should never be taken with alcohol, opioid drugs, or any other benzodiazepine.

    Contraindications

    There are circumstances where the use of benzodiazepines is contraindicated. Among them:

    • Benzodiazepines should be avoided if you have an underlying respiratory disorder as they may impair breathing, sometimes critically. Examples include bronchitis, sleep apnea, myasthenia gravis, and chronic obstructive pulmonary disorder (COPD).
    • Benzodiazepines are classified as either category D or category X drugs (meaning that they may cause harm to the fetus) and are contraindicated in pregnancy. While the reported risk of cleft palate is relatively low (0.07 percent), the drugs may also cause floppy baby syndrome characterized by low muscle tone and weakness.
    • Benzodiazepines should not be used in people with personality disorders (such as borderline personality disorder or post-traumatic stress disorder) as they can lead to a worsening of personality disorder symptoms.
    • Benzodiazepines should not be used in people with depression due to an increased risk of self-harm and suicide.
    • Benzodiazepines should not be used in the elderly due to the increased risk of dependence and an increased sensitivity to drug side effects (including memory loss, impaired coordination, and loss of cognition).
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