Benzodiazepines are a type of drug prescribed by doctors and psychiatrists in order to treat anxiety, depression and insomnia. These drugs have a mild sedative effect and can help to ‘calm the brain’ thereby reducing the severity of racing thoughts and ruminations that lead to anxiety and difficulty sleeping.
Benzodiazepines are generally considered safe for short term treatments but they are also potentially addictive and may have serious side effects in the long term. Benzodiazepine addiction is on the rise (1) so it’s important to understand the risks and the best preventative measures and treatments before starting a course yourself.
What Are Benzodiazepines?
Benzodiazepines work by stimulating the GABA receptors in the brain. GABA is the ‘gamma aminobutyric acid’ and is the principle ‘inhibitory’ neurotransmitter in the brain. What this means, is that neurons release GABA during certain communications (action potentials) and this then suppresses their activity. In high enough quantities, GABA can have highly sedative effects causing individuals to become unresponsive and sleepy. In the correct doses this can have a therapeutic effect helping those suffering with anxiety and other problems to relax and enjoy a sense of calm.
Benzodiazepines are normally used for short durations of about four weeks. In this time the patient might also receive cognitive behavioral therapy or other treatments to help them cope more effectively with stress and anxiety and to better fall asleep.
Side Effects
Side effects of benzodiazepines are relatively minor in the short term but may include impaired memory, difficulty waking and drowsiness. Those who exceed recommended doses however are more likely to experience these symptoms as well as difficulty walking and ataxia. In some rare cases, benzodiazepines might cause what are known as ‘paradoxical symptoms’ (symptoms that appear to be the opposite of the way the medication works) including disinhibition, increased risk taking and aggression.
In cases of long term abuse, side effects are more severe and can lead to permanent brain damage in the form of impaired memory and disassociation (2). At the same time, sufferers might engage in ‘drug seeking’ behavior, may become secretive and defensive and might be more inclined to take risks in order to obtain BZP. This can also put strain on interpersonal relationships that might ultimately result in divorce, loss of job etc.
Those who have developed an addiction to benzodiazepines will then also experience negative side effects when they aren’t able to access the medication. These withdrawal symptoms include:
- Sweating
- Anxiety
- Difficulty sleeping and tiredness
- Muscle ache
- Muscle tremors and twitching
- Mood disorders/irritability
- Headaches
Causes and Risk Factors for Benzodiazepine Addiction
The cause of benzodiazepine addiction is both psychological and physical. Those with addictive personalities can begin to rely on benzodiazepine as a form of self-medication and as a way to deal with stressful situations. Others might use benzodiazepines if they have self-destructive tendencies, or they might even use them as a ‘cry for help’.
More often, benzodiazepine addiction is the result of the physical changes in the brain known as ‘dependence’ and ‘tolerance’. These changes occur as a result of repeated use of BZP, which the brain then ‘adapts’ to by reducing GABA receptors. This in turn then means that more benzodiazepine is required to have the same effects and this is what’s known as ‘tolerance’. At the same time, the brain’s reduced sensitivity to GABA means that patients will feel worse when they are not using the drug. This is called ‘dependence’ and it’s what causes the withdrawal symptoms.
There are a number of risk factors that make addiction more likely. Those who use benzodiazepine to treat insomnia for instance are at higher risk than those who use it for anxiety, seeing as we develop tolerance to the sedative effects of BZP much more quickly. Likewise, those who use the medication for longer than a month at a time are also at increased risk (3).
Treating Benzodiazepine Addiction
Treatment for benzodiazepine addiction will often involve CBT or ‘cognitive behavioral therapy’ along with gradual tapering of dosages in order to avoid severe withdrawal symptoms. The substance ‘flumazenil’ has also been shown to be effective in helping recovery and has been shown in studies to be more effective than placebo. Flumazenil is also used to treat alcohol addiction and can also help to prevent withdrawal symptoms (4).
Conclusion
For severe anxiety, benzodiazepines might be a helpful treatment if prescribed by your doctor. However it is important to be aware of the risk factors and to focus on treating the root cause of the anxiety as quickly and effectively as possible to minimize the duration of BZP use and to avoid addiction and abuse.