How Benzodiazepines Work
Benzodiazepines, also known as benzos, downers, nerve pills, and tranks, work by enhancing your brain’s response to a neurotransmitter called gamma-aminobutyric acid (GABA). This reduces the excitability of nerve signals in your brain and slows it down, leading to the relaxation of certain physiological and emotional responses. This results in a calming, tranquilizing feeling.
Benzodiazepine Uses
Benzodiazepines have properties that make them useful in treating a number of health conditions. They can act as a muscle relaxant and anticonvulsant and also have sedative (relaxing), hypnotic (sleep-inducing), and anxiolytic (anti-anxiety) effects. Some of their indications for use include:
Alcohol withdrawal symptoms, particularly agitation and anxiety, may sometimes be relieved with a short-term course of benzodiazepines, although the response can vary from person to person. Because of the risk of drug dependence, benzodiazepines are usually prescribed for no more than a couple of weeks. Certain types of epileptic seizures can sometimes be effectively controlled with Klonopin, Valium, or Ativan. Klonopin offers stronger anticonvulsant action while Valium works faster. Valium has the longest duration of action, while Klonopin and Ativan are considered intermediate-duration benzodiazepines. Generalized anxiety disorder (GAD) and other anxiety disorders can be treated with benzodiazepines, although they are less effective in achieving long-term control. They shouldn’t be used for more than two to four weeks due to the risk of dependence. Insomnia can be alleviated over the short term with benzodiazepines but may result in rebound insomnia if overused. Long-term use should be strictly avoided. Panic disorder may be effectively treated with benzodiazepines as they can alleviate anxiety symptoms much faster than antidepressants. This may be an important factor for those who experience severe or debilitating panic attacks.
Other uses include the inducement of calm before surgery or a medical procedure and the treatment of muscle spasms, irritable bowel syndrome (IBS), and abnormal sleep patterns.
Types of Benzodiazepines
Benzos come in different formulations. Some are short-acting, some are long-acting, and they vary in potency. The most commonly prescribed benzodiazepines and the conditions they’re typically prescribed to treat include:
Xanax (alprazolam) treats anxiety disorders and panic disorder, and sometimes agoraphobia (fear of open spaces), depression, and premenstrual syndrome. Klonopin (clonazepam) treats panic attacks and seizures. Valium (diazepam) is used to treat anxiety, seizures, muscle spasms, and alcohol withdrawal, as well as IBS and panic attacks. Ativan (lorazepam) is primarily prescribed for anxiety, but may also be used for seizures, IBS, insomnia, alcohol withdrawal, and to help nausea and vomiting in people receiving cancer treatments. Halcion (triazolam) is used as a short-term treatment for insomnia.
Other benzodiazepines and the conditions they’re typically prescribed to treat include:
Restoril (temazepam), estazolam, and flurazepam are short-term treatments for insomnia. Versed (midazolam) is typically used in children before medical procedures or surgery. Librium (chlordiazepoxide) treats anxiety and alcohol withdrawal, as well as IBS. Tranxene (clorazepate) is used for anxiety and alcohol withdrawal, and it may be prescribed along with other medications to control seizures. Serax (oxazepam) treats anxiety, alcohol withdrawal, and IBS.
Common Benzodiazepine Side Effects
Most of the side effects of benzodiazepines are related to the depressant effect the drug has on your central nervous system. Common side effects depend on the medication you’re using but, in general, they include:
ConstipationConfusionDepressionDiarrheaDrowsinessDry mouthErectile dysfunctionFatigueHeadacheImpaired motor skills and coordinationIrritabilityLoss of appetite or increased appetiteLow libidoMuscle weaknessShort-term memory loss and impaired cognition
Long-Term Side Effects
Long-term use of benzodiazepines may trigger a worsening of side effects and, in some cases, paradoxical side effects, meaning that you may experience an opposite response to the drug than you previously had. Some of these side effects can adversely affect your mood and behavior, causing an altered perception of yourself, your environment, or your relationships. Long-term side effects may include:
Acute anxietyAgoraphobia (the fear of open or public spaces)Anhedonia (the inability to feel pleasure)DepressionInability to think cohesivelyLoss of libidoSocial phobias
Benzodiazepine Dependence and Withdrawal
Benzodiazepines are a Schedule IV medication due to their risk of physical and psychological addiction. As such, they are usually prescribed for no more than two to four weeks. When they’re taken for longer periods, benzodiazepines can lead to tolerance and dependence, meaning that your body will require more of the drug to achieve the same therapeutic effect. This can lead to abuse and/or dependence. Abuse of these drugs is the highest in people who also use heroin or cocaine. Your dosage will be gradually tapered off to minimize some of the more profound symptoms of withdrawal, including:
Abdominal crampsAn altered sense of realityConfusion and disorientationDepressionHallucinationsIncreased sensitivity to light, pain, and/or soundInsomniaIrritabilityMuscle crampsNausea and vomitingNervousnessParanoiaProfuse sweatingSeizures and convulsionsTachycardia (rapid heart rate)Tingling, burning, or “skin-crawling” sensationsTremor
Interactions
Not only can they cause dependence, but there are also many substances that can interact with benzodiazepines and cause accidental overdose or even death. Alcohol and opioid pain relievers, both of which also act as central nervous system depressants, can greatly magnify the effect of benzodiazepines. Together, these drugs may slow your respiration and heart function to a point where they may stop altogether. Because of this potentially life-threatening result, benzodiazepines should not be taken with alcohol, opioid drugs, or any other benzodiazepine, unless your doctor has decided that the benefits outweigh the risks in your particular situation. Some of the other medications and herbs that can cause interactions with benzos include:
AntidepressantsAntihistaminesAnticonvulsantsCertain antifungalsCertain antibioticsOpioid cough medicineOther sedativesSt. John’s Wort
Benzodiazepine Overdose
Potential symptoms of a benzodiazepine overdose include:
Altered mental statusComaDrowsinessProblems balancing, walking, or swallowingSlurred speechTrouble breathing, especially if another substance was taken with benzodiazepines
Precautions
There are circumstances and conditions in which the use of benzodiazepines should be carefully considered or even avoided. Among them include:
Breastfeeding: Benzodiazepines do cross over into breast milk and can cause symptoms in your baby, so they should be avoided if possible when you’re breastfeeding.Depression and/or post-traumatic stress disorder (PTSD): If you’ve been diagnosed with depression or PTSD, you need to be aware that using benzos can create an increased risk of self-harm and suicide, as well as drastic mood changes.Elderly: In anyone aged 65 years or older, benzodiazepines should be used cautiously and in lower doses due to the increased risk of dependence and increased sensitivity to drug side effects like memory loss, impaired coordination, and loss of cognition.Pregnancy: Benzodiazepines may cause harm to an unborn baby. Let your doctor know if you’re pregnant, plan to become pregnant, or if you get pregnant while taking benzodiazepines.Respiratory conditions: If you have an underlying respiratory disorder, you shouldn’t use benzos as they may impair your breathing, sometimes critically. Examples of respiratory conditions include bronchitis, sleep apnea, myasthenia gravis, and chronic obstructive pulmonary disorder (COPD).
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