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BENZODIAZEPINES

Benzodiazepines have been around since the early 1960s, and are usually prescribed for anxiety, insomnia, agitation, muscle spasms and seizures, before medical procedures, and to ease the effects of alcohol withdrawal. Today these drugs account for about one out of every five prescriptions for controlled substances.

Often just called ‘benzos’, they are a class of dozens of psychoactive drugs that include a long list of brands such as Valium, Librium, and Xanax, and a very long list of generic formulas. Each has some unique properties and actions, but they all have side effects, and physical dependence needs to be watched out for.

If you’re one of the millions of Americans who take prescription drugs to get to sleep, or perhaps to treat anxiety or just calm you down, you are likely taking a benzodiazepine. You may not know that benzodiazepines can lead to physical dependence—in some people in just a matter of days.

Benzodiazepines ‘slow’ or ‘depress’ the central nervous system (CNS)—they are among a type of drug called a ‘CNS depressants’ that can slow or stop the heart and breathing. Because of this, their effect can dangerously increase if combined with other CNS drugs, or with alcohol which is also a CNS depressant.

MOST-COMMON BENZOS

About Benzodiazepines

Benzodiazepines are CNS depressants, like barbiturates, opioids, antipsychotics and alcohol. Benzodiazepines generally act as ‘hypnotics’ in high doses, ‘anxiolytics’ in moderate doses, and ‘sedatives’ in low doses.

A hypnotic dose is used to induce sleep -- not hypnotize you like in a stage act—but unconsciousness is the usual goal. Anxiolytics address anxiety, and sedatives sedate -- meaning to calm and relax.

How benzodiazepines work

Any drug that depresses the CNS appears to relax people. Bodies make a natural substance called gamma aminobutyric acid (GABA) that allows chloride ions (ions are a form of atoms or molecules) to penetrate to receptors on the cells and slow down the activity of the brain cells.

GABA and chloride ions are the body's natural relaxing agent. When GABA binds to a nerve cell receptor, it allows chloride ions to move into the nerve cell, contact a receptor in the cell, and slow down the activity of the cell. As a result, most people experience a calming effect.

Benzodiazepines act much the same on your mind as alcohol does. Like alcohol, benzos increase the effect of GABA on a cell, allowing more than the usual number of chloride ions to reach the cell receptor. This further reduces the activity of the cell.  Again, the feeling created by this action of benzos is similar to the feeling most of us experience if we are drinking alcohol.

SIDE EFFECTS OF BENZODIAZEPINES

General Dangers

Benzodiazepines are among the most widely prescribed drugs that depress the central nervous system, and they are frequently abused. And benzos are not a harmless drug, either. Government studies show that a large percentage of drug-related emergency room visits involve benzos. Like alcohol, using benzos impairs mental alertness and physical coordination and can dangerously compromise mechanical performance, such as automobile driving.

Combining the use of benzos and alcohol can have fatal consequences. In addition, because of the effect created by benzos, approximately 50 percent of people entering treatment for narcotic or cocaine addiction also report abusing benzodiazepines.

Increased Effects on Seniors

Older adults have a much more difficult time eliminating benzodiazepines and similar drugs from their bloodstreams, so these drugs accumulate in their bodies. And they are more sensitive than younger people to their effects. For these reasons, seniors are at greater risk of serious drug effects, such as unsteady walking, dizziness and even falling down, increasing the risk of hip fractures. Auto accidents, impaired thinking, memory loss, and physical dependence and addiction are more common among seniors taking benzodiazepines.

Most Common Side Effects

Common side effects of benzodiazepines include:

  • Depression
  • Confusion
  • Amnesia
  • Drowsiness
  • Dizziness
  • Impaired coordination
  • Trembling
  • Weakness
  • Changes in heart rate
  • Chest pains
  • Jaundice
  • Upset stomach
  • Blurring and other vision changes
  • Headache
  • Grogginess
  • Excessive dreaming and nightmares
  • Paradoxical reactions (see below)

Paradoxical Reactions

Severe behavioral changes due to benzos that are opposite to the expected calming and sedating effects are called paradoxical reactions—paradox meaning an unexpected contradiction. Paradoxical reactions can occur including:

  • Schizophrenia
  • Mania
  • Hypomania -- less severe mania
  • Anger
  • Impulsivity
  • Anxiety
  • Suicidal thoughts and tendencies

Violent outbursts of temper, and aggressive acts, and can occur with benzos, especially if they are combined with alcoholic beverages. Patients on high doses, and even occasional recreational abusers, are considered at a greater risk for paradoxical reactions.

DEPENDENCE, ADDICTION AND WITHDRAWAL

Physical Dependence

When discontinuing a medication creates uncomfortable and unwanted physical and/or psychological side effects, dependence to that substance has occurred. The effects are called withdrawal symptoms, and they are caused by the body’s natural detoxification process as it tries to regain its normal chemical environment.

Depending on an individual’s metabolism and DNA, physical dependence to benzodiazepines can occur from almost any dosage over time period—both short-term and long-term, large doses or therapeutic doses, have all caused dependencies.

Benzo withdrawal is similar to alcohol withdrawal, but can often be worse in terms of discomfort. And detoxing from benzodiazepines can take even longer than withdrawing from narcotics.

When someone wants or needs to stop taking benzos, they are usually advised to do so on a gradient level—reducing the dose a little each, called the ‘weaning off’ period—over a period of days, weeks or even months, and which can be very uncomfortable.

Addiction

A person who continues using a drug to ‘get high’ or experience some other psychological effect, and who will do things they would not normally do and go to any lengths to get more drugs, is addicted. This kind of addiction is not commonly associated with benzos, but reportedly is not unknown.

Some antianxiety medications—particularly the benzodiazepines and barbiturates—create physical and psychological withdrawal symptoms when discontinued. This is the sign of dependence. 

Addiction can be seen when a person continues drug use to ‘get high’ or experience some other drug effect, do things they would not normally do, and go to any lengths to get more of the drug.

MEDICALLY ASSISTED WITHDRAWAL

Withdrawal from benzos can be so severe, that people trying to get off benzos frequently require hospitalization. These dangerous withdrawal symptoms can be greatly reduced through a medical drug detox program that addresses a person’s specific metabolic needs and state of health to help avoid the worst of the symptoms.

An individualized program that provides the necessary nutritional support, monitors hydration, and applies other various therapeutics when needed, helps ease the withdrawal from benzodiazepines.

This kind of medical drug detox has been found to be far safer and much more comfortable than the usual approaches, and certainly is much faster than a long weaning period.

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