Benzodiazepines are a class of psychoactive drugs used to treat a range of conditions, including anxiety and insomnia.

They are one of the most widely prescribed medications in the United States, particularly among older patients.

Benzodiazepines have qualities that can help to reduce anxiety and seizures, relax the muscles, and induce sleep.

Short-term use of these medications is generally safe and effective. However, long-term use is controversial because of the potential for tolerance, dependence, and other adverse effects. It is possible to overdose on benzodiazepines, and mixing them with alcohol or other substances can be fatal.

In this article, Medical News Today will look at how benzodiazepines work, what they are used for, and any related side effects and risks.

Fast facts on benzodiazepines

  • Benzodiazepines are used for a range of health issues, including anxiety, sleep disorders, and alcohol withdrawal.
  • They work by triggering a tranquillizing chemical in the brain.
  • Side effects can include dizziness, drowsiness, poor co-ordination, and feelings of depression.
  • Mixing alcohol with benzodiazepines can be fatal.
  • Hospital admissions for benzodiazepine misuse have tripled since 1998.

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Benzodiazepines can be used to treat anxiety, seizures, and insomnia.

Benzodiazepines are effective for treating a range of psychological and neurological disorders, due to its effects on the neurons that trigger stress and anxiety reactions.

These disorders include:

Insomnia: Benzodiazepines are normally only used as a short-term treatment for severe insomnia, as they can lead to dependence.

Generalized anxiety disorder (GAD): Benzodiazepines are often used in the treatment of GAD. The United Kingdom (U.K.) National Institute of Health and Clinical Excellence (NICE) recommends taking benzodiazepines to treat short-term GAD treatment for no longer than 1 month.

Seizures: Benzodiazepines are powerful anticonvulsants and highly effective at preventing prolonged epileptic seizures.

Alcohol withdrawal: The most common benzodiazepine prescribed for alcohol withdrawal is chlodiazepoxide, followed by diazepam. The drugs help people with alcohol dependence by removing toxins from their system and reducing the risk of severe alcohol withdrawal symptoms.

Panic attacks: Because of their fast-acting anti-anxiety effects, benzodiazepines are very effective at treating anxiety associated with panic disorder. The American Psychiatric Association (APA) says that many different study trials support their use for initial treatment.

However, NICE advises that long-term use of benzodiazepines is not recommended for the treatment of panic disorder.

The human brain contains many different neurotransmitters. These are responsible for communicating messages between brain cells that can have either tranquilizing or excitatory effects.

When someone feels overly anxious, the brain becomes excited and over-active. Tranquilizing transmitters quickly send messages to brain cells, slowing down activity in the brain and reducing the symptoms of anxiety.

GABA is the tranquilizing neurotransmitter, and billions of brain cells respond to its signals.

Benzodiazepines work by enhancing the effect of the neurotransmitter GABA. The drugs contain chemicals that add to the calming effect already produced by the human body and keep the brain in a more tranquilized state.

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Valium is one type of benzodiazepine.

There are many different benzodiazepines. They differ in potency, how quickly they are absorbed into the body, and what they are used to treat.

Benzodiazepines include:

  • Alprazolam, or Xanax: This is approved by the U.S. Food and Drug Administration (FDA) for the treatment of panic and anxiety disorders. Alprazolam is the most prescribed benzodiazepine in the U.S.
  • Chlordiazepoxide, or Librium: Chlordiazepoxide is used for the management of alcohol withdrawal syndrome.
  • Clorazepate, or Tranxene: Clorazepate is a hypnotic, sedative drug used to treat severe insomnia and anxiety disorders.
  • Diazepam, or Valium: This is an anxiety-reducing, hypnotic, sedative, and anticonvulsant drug that acts rapidly. It is used to treat panic attacks, insomnia, seizures, restless leg syndrome, and alcohol withdrawal. Diazepam is also used for the treatment of benzodiazepine dependence due to its low potency.
  • Estazolam: Estazolam is a sedative, anxiety-reducing drug prescribed for short-term insomnia treatment.
  • Flurazepam, or Dalmane: Flurazepam is a sedative, anxiety-reducing drug used to treat mild-to-moderate insomnia.
  • Oxazepam: This is used to treat anxiety and insomnia. It can also control the symptoms of alcohol withdrawal.
  • Temazepam, or Restoril: Temazepam is approved for the short-term treatment of insomnia.
  • Triazolam, or Apo-Triazo, Halcion, Hypam, and Trilam: This is only used as a sedative to treat severe insomnia.

The side effects of benzodiazepine usage may include:

  • drowsiness
  • confusion
  • dizziness
  • trembling
  • impaired coordination
  • vision problems
  • grogginess
  • feelings of depression
  • headache

A study, published in the BMJ, identified a mild link between ongoing use of benzodiazepines by people over 65 years of age and an increased risk of dementia.

The long-term use of benzodiazepines can also result in physical dependence. Dependency can begin after using the drugs for as little as one month, even on the prescribed dosage.

The withdrawal symptoms of benzodiazepines include trouble sleeping, feelings of depression, and sweating.

If someone has become dependent on benzodiazepines, it is crucial that they do not suddenly stop therapy cold turkey.

Stopping cold turkey can result in tremors, muscle cramps, and life-threatening seizures. Therefore, it is important to taper off benzodiazepines slowly with professional help.

Overdose

Benzodiazepine overdose is rarely fatal unless the drugs are mixed with barbiturates, opioids, alcohol, or tricyclic antidepressants.

The most common symptoms of benzodiazepine overdose are central nervous system depression and intoxication with impaired balance and movement control. Slurred speech will also be a sign.

Flumazenil can be used as an antidote, but more often than not, the person experiencing an overdose is observed and supported until the body has naturally cleared the drug.

Before beginning treatment with benzodiazepines, it is important to tell the doctor about every other medication currently being taken.

Some drugs, including antidepressants and oral contraceptives, can cause a dangerous buildup of medications. This can worsen the side effects of benzodiazepines.

In contrast, St. John's wort, the antibiotic drug rifampicin, and the anticonvulsants carbamazepine and phenytoin decrease the impact of benzodiazepines.

Most importantly, patients should never mix benzodiazepines with alcohol or opioids. The interaction can be life-threatening.

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Benzodiazepine abuse is a growing health concern.

Benzodiazepine abuse is becoming a serious public health issue.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), hospital admissions related to the abuse of benzodiazepine drugs for people over the age of 12 rose from 22,400 in 1998 to approximately 60,200 in 2008.

It is the responsibility of both the doctor and the patient to keep benzodiazepine use in check. Doctors need to make sure that they are not overprescribing the drug, and that they are not prescribing benzodiazepines as a first-line treatment.

Once in possession of the drug, patients need to ensure that benzodiazepines are stored safely out of reach of children, and that they follow the correct dosage and schedule as well as any advice from the prescribing doctor.

Takeaway

While the risks posed by mixing benzodiazepines with substances such as alcohol are considerable, they can have an positive impact on the impact of some mental health and neurological disorders when used correctly.

As long as the doctor is informed of any other medications you may be taking, and you are taking benzodiazepines as advised on the packaging or by your doctor, there are no major dangers in using them to treat suitable conditions.