Benzodiazepine Side Effects: Mental & Physical Risks of Benzo Use
When benzodiazepines are used over a short period of time as directed by a doctor, they are relatively safe. People who abuse these medications and take huge doses for long periods can experience a variety of physical health issues, including the risk of overdose. Mental health symptoms caused by benzo abuse can include mood swings, hallucinations, and depression.
What are Benzodiazepines?
Benzodiazepines, or benzos for short, are prescription medications designed to treat anxiety, panic disorders, seizures, muscle tension, and insomnia. They are intended for short-term relief of symptoms. Xanax and its generic form alprazolam, remains one of the most prescribed psychiatric drugs in the United States with close to 50 million prescriptions being written for the anti-anxiety medication in 2013, as published by PsychCentral. Other commonly prescribed benzodiazepines include:
- Klonopin (clonazepam)
- Valium (diazepam)
- Restoril (temazepam)
- Librium (chlordiazepoxide)
- Halcion (triazolam)
- Dalmane (flurazepam)
- Ativan (lorazepam)
How Do Benzos Work?
Benzodiazepines work by slowing down nerve activity in the brain and the rest of the central nervous system, thereby diffusing stress and its physical and emotional side effects.
Benzodiazepines function to increase the levels of gamma amino-butyric acid (GABA) in the brain, which works as a kind of naturally occurring tranquilizer, calming down nerve firings related to stress and the stress reaction. Benzos also enhance levels of dopamine in the brain, which is the chemical messenger involved in reward and pleasure. The brain may learn to expect the regular doses of benzos after a few weeks of taking them and therefore stop working to produce these chemicals on its own without them.
Benzo Use & Abuse
Benzodiazepines may also be prescribed to help individuals fall and stay asleep, to control seizures, and as muscle relaxants.
Benzos are commonly diverted, or taken outside the bounds of a legitimate prescription. The 2013 National Survey on Drug Use and Health (NSDUH) estimated that 1.7 million Americans aged 12 and older were considered current abusers of tranquilizer medications, such as prescription benzodiazepines, at the time of the survey. When abused, benzos may also produce a “high” in addition to the calm and relaxed sensations individuals feel when taking them. These medications have multiple side effects that are both physical and psychological in nature, which can cause harm both with short-term and extended usage.
Side Effects of Benzodiazepines
Generally speaking, when used as directed under supervision from a doctor, benzodiazepines are relatively safe for short periods of time. They are not, however, meant to be taken for longer than a few weeks to a few months at most. They are mostly intended for the short-term relief of symptoms that often require further psychological or medical intervention to be successfully managed. Persistent insomnia, for example, may be caused by an underlying medical or mental health issue that can be treated safely with therapy or alternative pharmacological methods.
Potential short-term side effects of benzodiazepines may include:
- Mental confusion
- Short-term memory loss
- Lack of motor control
- Blurred vision
- Slurred speech
- Slow breathing
- Muscle weakness
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The most severe form of physical harm caused by a benzodiazepine occurs during overdose. Benzodiazepine overdose occurs when a person takes too much of the drug at once and overloads the brain and body. The Centers for Disease Control and Prevention (CDC) cites drug overdose as the number one cause of injury death in the United States. Close to 7,000 people died from a benzodiazepine overdose in 2013.
Since benzos are tranquilizers and sedatives that are in the drug class of central nervous system depressants, they lower heart rate, core body temperature, blood pressure, and respiration. Usually in the case of an overdose, these vital life functions get too low. The Drug Abuse Warning Network (DAWN) report published that there were 357,836 visits to emergency departments (EDs) for a negative reaction to the nonmedical use, or abuse, of a benzodiazepine medication in 2011. This means that benzos were related to almost 30 percent of all ED visits involving the abuse of pharmaceuticals.
When adding in other drugs or alcohol, the risks for overdose or additional negative reactions increase as well. Between 62 and 72 percent of those treated for drug overdose engaged in poly-drug abuse, or used more than one drug at a time, a study in the journal Drug and Alcohol Dependence reports. Benzodiazepines are commonly mixed with opioids and/or alcohol, which can be dangerous and even potentially life-threatening. The DAWN report further estimated that benzodiazepine abuse caused close to 1 million ED visits between 2005 and 2011, either when abused alone or in conjunction with alcohol or opioid painkillers.
Dependence and Withdrawal
Benzodiazepines are considered highly addictive and habit-forming when used regularly for a length of time. The U.S. Food and Drug Administration (FDA) prints in the prescribing information of many benzos, such as Valium, that even when taken as directed, chronic use can lead to a physical dependence indicated by drug cravings and withdrawal symptoms when attempting to stop use suddenly.
If benzos are suddenly stopped after a dependency has formed, a rebound effect may occur.
This is a sort of overexcitement of the nerves and neurons that have been suppressed with the drugs, resulting in an elevated heart rate, blood pressure, and body temperature as well as a return of insomnia, anxiety, and panic symptoms, perhaps even in greater measure than before. Mood swings, short-term memory loss, nausea, vomiting, diarrhea, depression, suppressed appetite, hallucinations, and cognitive difficulties may be side effects of withdrawal from benzodiazepines in addition to the rebound symptoms.
Withdrawal from benzos should be done slowly through medical detox. This is the safest way to purge the drugs from the brain and body while decreasing and managing withdrawal symptoms and drug cravings. Medical and mental health professionals can set up a tapering schedule to lessen the benzodiazepine dosage over time while attending to both the physical and psychological aspects of drug dependency as well.
Long-Term Effects on the Brain
Coupled with the potential for becoming psychologically and physically dependent on them, benzodiazepines also may interfere with cognition and memory when used regularly for an extended amount of time. Benzodiazepines are thought to particularly interfere with visuospatial abilities, processing speed, and verbal learning abilities, as published by the Journal of Clinical Psychiatry.
Visuospatial refers to the way an individual sees, processes, replicates, and understands where objects are in relation to other things. Processing speed is the way in which simple tasks can be completed automatically after learning them, and verbal learning skills are related to speech and language.
Fortunately, many of the changes made by benzodiazepines to the different regions of the brain after prolonged use may be reversed after being free from these drugs for an extended period of time.
Benzodiazepines and Harm to the Elderly
A recent study published by the British Medical Journal (BMJ) found a link between benzodiazepine usage and Alzheimer’s disease, a form of dementia involving the formation of short-term memory loss. Further explained by Harvard Health Publications, people taking benzodiazepines for more than six months had an increased risk for dementia ” up to 84 percent higher than those who didn’t take benzos. Long-acting benzodiazepines such as Valium were also more likely to increase these risks than shorter-acting ones such as Ativan or Xanax. While benzodiazepines are sedatives meant to produce short-term amnesia in some cases, these changes may not be entirely reversible, and the risks seem to increase with age.
Benzodiazepines are increasingly prescribed to the elderly population. While the general population saw prescription rates around 5 percent in 2008, more than 8.5 percent of those between 65 and 80 were taking at least one benzodiazepine medication at the time, as published in the journal JAMA Psychiatry. Many of these prescriptions were for long-term benzodiazepines as well, which increases the potential negative cognitive and memory deficits.
As people age, metabolism slows down. Since benzodiazepines are stored in fat cells, they can remain active in an older person’s body for longer than in someone who is younger, increasing their effects and the risk for adverse reactions due to the dosage being higher. Benzodiazepines have been shown to impair driving abilities, increase falls, and interfere with cognitive functions in the elderly population, as stated by the National Institute of Mental Health (NIMH). As a result, they should be used with caution in this population.