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Benzodiazepines: Good or Bad Medicine?

The mere thought of getting into a car sends Liz Stewart, a 28 year old nurse practitioner living in Albuquerque, New Mexico, into a tail spin of fear and agitation.

She had survived 2 near fatal car accidents while in high school. Since then, she’s struggled with post traumatic stress disorder and random panic attacks. Liz was seeing a therapist and taking Zoloft, a medication that treats anxiety and depression. But the only thing that truly calmed her nerves before getting into a vehicle’s passenger seat, she says, is Valium. “I notice that once I go ahead and take it, I feel so much better – like I can finally relax,” she says. “Sometimes that makes all the difference in the world.”

Valium is a medication that’s part of a larger class of drugs called benzodiazepines, commonly prescribed for anxiety and agitation. They can also be used for insomnia, seizures and alcohol withdrawal.

Some easily recognizable benzodiazepine include; Ativan, Xanax, Klonipin, and Valium which are “quick fixes” for everything from panic disorders to poor sleep.

Benzodiazepines are some of the most common medications in the world; a recent study

sponsored by the National Institutes of Health found that about 1 in 20 adults received a prescription for them in 2013. A recent survey found that 1 in 15 people are taking benzodiazapines on a daily basis.

They’re extremely effective for patients like Liz, who have crippling anxiety. Medications like Zoloft are selective-serotonin reuptake inhibitors (SSRIs), which take several weeks to reach full efficacy, while benzodiazepines work almost immediately.

Is There A Down Side?

Benzodiazepines can be habit-forming.

A study sponsored by the National Institute of Mental Health recently linked long-term use of benzodiazepines to a heightened risk for Alzheimer’s Disease.

Furthermore, data from the Centers for Disease Control and Prevention showed that benzodiazepines, along with opioid pain killers are the prescription drugs most often responsible for emergency department visits and drug-related deaths.

And they carry a host of dangerous side effects including: – impaired cognition and mobility in older individuals – potentially life-threatening withdrawal symptoms in people with severe addictions

So Are Benzodiazepines Helpful Or Dangerous?

Like most pharmaceutical drugs, experts say, they’re “a mixed bag”. Even though studies suggesting that physicians over-prescribe them, even those in the medical community tend to disagree on whether the benefits of benzodiazepines outweigh the risks.

Anti-Anxiety Medication Safety Concerns And Risk Factors

Beyond the common side effects, medication for anxiety comes with additional risks. While the tranquilizing anti-anxiety drugs are relatively safe when taken only occasionally and in small doses, they can lead to severe problems when combined with other substances or taken over long periods of time. Furthermore, some people will have adverse reactions to any amount of anti-anxiety medication. They are not safe for everyone, even when used responsibly.

Jerrold Rosenbaum, chief of psychiatry at Massachusetts General Hospital says, “For every doctor who writes a prescription for Xanax, there’s another who refuses to do so.”

It’s a very polarizing topic. In fact, some take the position that anxiety isn’t a disease at all and to administer medication when one is anxious takes away from that person’s growth in the management of life and it’s circumstances.

Phillip Hickey, PhD a retired psychologist who has worked in prisons (UK and US), addiction units, community mental health centers, nursing homes, and in private practice declares, “Anxiety is not an illness. It is a normal human response to ambiguous or potentially challenging or dangerous situations. Modern life is fraught with anxiety-arousing situations. If psychiatry had had the slightest interest in truly helping people, it would have focused on this reality, and developed genuinely helpful concepts and practices in this area.”

The Discussion Is Very Polarizing

There is a constituency that views benzodiazepines as evil and harmful. Typically they, like Dr. Hickey, tend to come out of the substance use disorder community.

Most doctors say benzodiazepines should not be prescribed for more than a few weeks. The body slowly builds up a dependency to the pills, which can be averted by not taking them for an extended duration.

Others say: They’re not perfect drugs, but they do work for conditions for which nothing else is as effective

When Benzodiazepines Are Safe For Long-Term Use

There are a subset of people who seem to respond very well to long-term benzodiazepines. They may be maintained on a low dose and never need anything higher – meaning they don’t develop a tolerance. They go for periods of time without taking the medicine. They may be intolerant to other classes of medications. And it seems to augment their treatment for anxiety.

Benzodiazepines Are Not A Cure-All

Many people with panic disorder or acute anxiety use benzodiazepines as a first-line method of treatment until they’re able to find another coping mechanism. But since there are usually underlying issues that contribute to their anxiety, strategies for dealing with the issues, like Cognitive Behavioral Therapy, antidepressant medication, etc.

Benzodiazepines Are Not Suited For Everyone

People with a history of alcoholism or drug addiction are advised against taking benzodiazepines.

Similarly, elderly people face an increased risk of falls, cognitive disturbance, sleep apnea and a potentially heightened chance of dementia.

Researchers have reported there is an increased risk of dementia in benzodiazepine users, the nature of this association, whether causal or not, remains unclear.

Benzodiazepine prescription in older people should comply with good practice guidelines—that is, the shortest duration with a preference for formulations with a short half life.

There Are Exceptions To The Exceptions

Certain factors that often appear with aging – for instance:

  • Bereavement

  • Insomnia

  • Low-grade depression complicated by anxiety

In the management of emotional distress in older adults, their best bet is a short-acting benzodiazepine prescribed for a limited duration.

WARNING: It goes without saying, that anyone taking benzodiazepines should avoid depressants such as alcohol or opioids.

Patients should also make sure to follow their doctor’s dosage instructions, and to slowly taper off the medication instead of stopping cold turkey.

Doctors Should Carefully Monitor Patients’ Use Of Benzodiazepines.

In most cases of benzodiazepine dependence, addiction begins with a legitimate prescription. Folks seek intervention for a variety of conditions, from muscle spasms to chronic anxiety disorders, and they’re often issued a prescription for Xanax, Valium, Clonazepam, Ativan or another tranquilizer. Their dosage should always be time-limited and closely monitored by a physician who addresses the potential for addiction.

Patients should also make sure to follow their doctor’s dosage instructions, and to slowly taper off the medication, never stopping cold turkey.

Patient Behavior

Over time, a patient will sometimes develop a tolerance toward the benzodiazepines. Their negative symptoms will return, and they will:

  • request a larger dosage from their doctors

  • buy the medicine illegally or

  • turn to another substance like alcohol

People don’t recognize that they’re dependent. When they make the decision to stop taking the medication they quickly find that they experience uncomfortable withdrawal symptoms such as:

  • mood swings

  • agitation

  • irritability

  • changes in appetite

  • changes in sleep patterns

In worst-case scenarios, unmonitored benzodiazepine withdrawal can lead to stroke, seizures and heart attacks. And benzodiazepines, when combined with other drugs, can result in overdose and death.

It’s Possible To Safely Withdraw From Benzodiazepines, Even After Extended Use Or Abuse.

Public support programs such as the 12-step programs Narcotics Anonymous and Chemically Dependents Anonymous provide a social support network that aids in recovery. Also nationally National centers Addiction Center 877-680-9296, Sober Solutions 888-762-3730, and Promises 844-241-3299.

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