Benzodiazepines are medications commonly prescribed for anxiety disorders and insomnia.

Benzodiazepines have names, such as Alprazolam (Xanax®), Diazepam (Valium®), and Lorazepam (Ativan®), and have different timing of their action, often classified as short- or long-acting.

Unfortunately, these drugs can cause both physical and psychological dependence along with withdrawal symptoms. Complications with benzodiazepines are more common with short-acting benzodiazepines, such as Lorazepam.

Overdoses & Death

In 2011, Oregon’s Public Health Department reported 39 out of every 100,000 people died from unintentional benzodiazepine poisonings in combination with other drugs, such as alcohol or an opioid, with the highest rate among those ages 45-54. The same study identified 152 hospitalizations of 100,000 were due to benzodiazepine overdoses. The highest hospitalization rates occurred among females, ages 45-54.

Recommendations

While benzodiazepines certainly can have some benefit, withdrawal symptoms can occur after 4-6 weeks of continuous use and at least a third of long-term users experience these on dosage reduction. The Committee on Safety of Medicine and Royal College of Psychiatrists has concluded that all benzodiazepines should not be taken longer than 2-4 weeks.

I explain to my patients that anxiety treatment is similar to other chronic conditions, such as asthma or migraines. As-needed medications can be used once or twice a month, but certainly not every day. If the patient has daily anxiety, the symptoms can be better treated with a daily medication that’s safer.

Risks & Symptoms

Benzodiazepines can cause a physical dependence; therefore, these medications cannot be stopped abruptly. Withdrawal symptoms can include tremors, anxiety, perceptual disturbances, psychosis, dysphoria and seizures. Symptoms can be controlled through dose tapering, change of medication, and/or medication augmentation. As always, please talk to your doctor prior to any medication changes.

References

1.  Public.health.oregon.gov

2. Neale, G. Self-harm and suicide associated with benzodiazepine usage. Br J Gen Pract. 2007 May 1; 57(538): 407–408.