There are more than 15 different types of FDA-approved benzodiazepine medications. These drugs are referred to as benzos and are widely prescribed for a variety of medical and mental health concerns. PsychCentral reports that the benzodiazepine drug Xanax was the mostly widely prescribed psychiatric medication from 2005 to 2013. Benzos have hypnotic, muscle-relaxant, or anticonvulsant properties. They can provide anxiety relief.
They are therefore prescribed to treat the following:
- Generalized anxiety disorder (GAD)
- Social anxiety
- Panic disorder
- Alcohol withdrawal
- Sedation prior to surgery
- Acute agitation
Benzos are not a long-term solution for most of these issues. They are intended to be used short-term for acute symptoms. Extended use can lead to tolerance and dependence.
Types of Benzodiazepine Medications
Benzodiazepines are short-, intermediate-, or long-acting. Drugs with shorter half-lives work rapidly and leave the system faster. Longer-acting medications take longer to begin working and stay longer in a person’s system.
Short-acting benzodiazepines include the following:
- Triazolam (Halcion): A sedative hypnotic medication used for the treatment of insomnia
- Midazolam (Versed): An anesthesia-adjunct medication used prior to surgery or medical procedures to relieve anxiety and produce sleepiness
- Clorazepate (Tranxene): An anti-anxiety medication that treats anxiety, insomnia, and seizures
Intermediate-acting benzodiazepines take marginally longer to take effect and stay in the bloodstream for longer. They include the following:
- Alprazolam (Xanax): An anti-anxiety medication used for treating anxiety and panic disorders
- Lorazepam (Ativan): An anti-anxiety medication used for the treatment of insomnia, generalized anxiety, or anxiety coupled with depression
- Temazepam (Restoril): A sedative-hypnotic medication that treats insomnia
- Oxazepam (Serax): An anti-anxiety medication used for the treatment of anxiety, anxiety coupled with depression, and alcohol withdrawal symptoms
- Estazolam (ProSom): A sedative-hypnotic medication that treats insomnia
Long-acting benzodiazepines take longer to begin working and are effective for the longest period of time. They include medications such as the following:
- Diazepam (Valium): An anti-anxiety, muscle-relaxant, and anticonvulsant medication that treats anxiety and muscle spasms and may be used during alcohol withdrawal
- Chlordiazepoxide (Librium): An anti-anxiety medication used to treat alcohol withdrawal symptoms, anxiety, and tremors
- Flurazepam (Dalmane): A sedative-hypnotic medication used to treat insomnia
- Quazepam (Doral): A sedative-hypnotic medication used to treat insomnia
- Clonazepam (Rivotril, Klonopin): An anticonvulsant medication that treats anxiety, panic disorders, and epileptic seizures
All benzodiazepines are generally dispensed in tablet or capsule form, as liquid syrup, or intravenously. The Drug Enforcement Agency considers all benzodiazepines Schedule IV drugs.
Benzodiazepines and the Brain
Benzodiazepine medications are central nervous system depressants. The central nervous system is responsible for regulating heart rate, respiration, blood pressure, and body temperature. Benzos slow these functions. They do so by interrupting how brain and body communicate. The brain influences body systems through chemical messengers called neurotransmitters. Stress and anxiety have a stimulating effect on the brain. Benzodiazepines inhibit the production or interpretation of neurotransmitters. This slows brain activity and produces calming, sedative, and relaxing effects.
Since benzodiazepines can work quickly, they are often used to help manage immediate or severe effects of overstimulation. They are first-course but not long-term medications. The brain and body quickly adjust to their presence when used frequently. Users develop a tolerance to their effects. If individuals keep using the drug, they will need increases quantities or frequencies to continue to experience the same effects. Benzodiazepines work best in conjunction with other, longer-term medications. For example general anxiety disorder may be treated with antidepressants long-term after the initial symptoms of anxiety are managed with a short course of benzodiazepines.
Current Psychiatry explains that benzodiazepines, “are better first-line treatment options when considering efficacy studies and dependence and tolerance concerns…Benzodiazepines can be used in the first 2 to 3 weeks after initiating antidepressants to alleviate and prevent worsening of anxiety that may occur at the start of antidepressant therapy.”
Benzodiazepines are effective when used as indicated. They can help create balance so that longer-term solutions can take root. Longer-acting benzodiazepines can benefit individuals with social anxiety, alcohol withdrawal, and seizure disorders. Benzodiazepines have amnesiac results. This means they can cause short-term memory lapses that may be desired during a medical procedure or surgery. Many benzos are also used as short-term muscle relaxers, to relieve acute tension, or as temporary sleep aids.
Side Effects of Benzodiazepine Use
Benzodiazepines have side effects and associated risks. Side effects vary from person to person. They are determined by factors such as genes, metabolism, tolerance levels, and more. The type of medication taken, dosage amount, duration of use, and method of ingestion also influence what and if unwanted effects occur.
- Dry mouth
- Blurred vision
- Slurred speech
- Weak muscles
- Short-term memory loss
- Impaired cognition
- Impaired motor skills and coordination
- Loss of appetite
Over-sedation can occur if you take too much of a benzodiazepine. You can overdose and experience extreme sleepiness, mood swings, shallow breathing, irregular heart rate, psychosis, loss of consciousness, and even death. CNN reports benzodiazepines, “were involved in about 30% of prescription drug overdose deaths in 2013.” Mixing benzodiazepines with other medications, particularly narcotic pain relievers or alcohol increases overdose risk.
Benzodiazepines may have lasting effects on memory, processing speed, sensory perceptions, and learning when used regularly in high doses for an extended amount of time. BMJ links benzodiazepine use to an increased risk for the dementia form of Alzheimer’s disease especially when used for a prolonged period of time. Elderly patients are at an increased risk for injury due to a loss of motor control as well as heightened risks of dangerous central nervous system suppression and cognitive impairment.
Benzodiazepine Abuse and Dependency
Any non-prescribed use of a prescription medication is considered abuse. If you have a prescription but take too much of the drug or crush or otherwise tamper with it, you are abusing it. If you take the drug without a prescription, even if you have a medical or mental health need, you are abusing it. People get extra benzos from friends or family members. They doctor shop to gain multiple prescriptions and may fake or exaggerate symptoms.
Users quickly become dependent if they take large doses or use the drug for longer than recommended. Abuse makes dependence even more likely. Dependence occurs when the brain changes its circuitry to adjust for the drug’s presence. This alters the reward pathway. Individuals will experience cravings. They will experience withdrawal symptoms when the drug leaves the bloodstream. A person’s withdrawal experience depends on the level of dependency, type of drug abused, method of abuse, dosage, and duration of abuse.
- Muscle weakness
- Difficulties concentrating
- Increased heart rate
- Drug cravings
Individuals may also experience rebound symptoms of the original health condition they were attempting to treat or mask. You should never attempt to stop taking benzodiazepines suddenly without medical supervision.
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 “Top 25 Psychiatric Medication Prescriptions for 2013.” Psych Central. 17 Jul 2016. Web. 30 May 2017.
 “Benzodiazepines: A Versatile Clinical Tool.” Current Psychiatry. Apr 2012. Web. 30 May 2017.
 “Benzodiazepine Overdose Deaths Soared in Recent Years, Study Finds.” CNN.com. 18 Feb 2016. Web. 30 May 2016.
 “Benzodiazepine use and risk of Alzheimer’s disease: case-control study.” BMJ. 9 Sep 2014. Web. 30 May 2017.