About Benzodiazepines

The following is a brief explanation of how benzodiazepines work. For a more detailed explanation please visit this Benzodiazepine withdrawal syndrome Wikipedia link.

Benzodiazepines inhibit the activity of neurons in the brain. They work by enhancing the activity of a naturally occurring neurotransmitter or messenger, gamma-aminobutyric acid (GABA).  This causes a calming effect.  Although all chemically related, benzodiazepines affect the nervous system in different ways. These include reducing anxiety, inducing sleep and relaxing the muscles.

Long-term benzodiazepine use affects the GABA receptors. This in turn results in a decrease in GABA function. When this drug which the brain has now become dependent on for enhancing GABA’s calming activity is discontinued, because of the down-regulation of the receptors, the brain is left in a state of GABA-underactivity. These changes which result in the entire nervous system going into overdrive and becoming hyperexcitable, are reported to be the cause of the adverse withdrawal effects that many experience.

Benzodiazepines should be used for no longer than two to four weeks in the treatment of anxiety disorders and should always be tapered off under medical supervision.

This short clip further explains:

Half-Life

When a benzodiazepine is taken on a regular basis, there is an ongoing process of drug absorption and elimination. The time it takes for half of the drug to be eliminated or for the blood concentration level to fall by half is known as the half-life. This may vary according to individual, particularly in the elderly.

When someone on a longer acting half-life drug misses several doses or abruptly discontinues the drug, it can take days before withdrawal symptoms surface. This is important to know as some people who stop taking the medication abruptly spend a brief period thinking that they will not have withdrawal symptoms only to be unpleasantly surprised days later.

Tolerance

When the receptors in the brain become habituated to the action of a benzodiazepine, more of the drug is needed in order for the desired therapeutic effect to be achieved. This often develops with regular use and is known as tolerance.

Inter-dose Withdrawal

People who use benzodiazepines sporadically or users who take those with a short half-life can experience ‘inter-dose withdrawal’. When this happens, they begin to feel withdrawal effects between doses.

Paradoxical Reaction

If a patient responds to medication in a contradictory or opposite way to what is expected, it is said to have had a paradoxical effect. An example of this is pain relief medication causing increased pain. Benzodiazepine treatment can sometimes result in paradoxical reactions in susceptible individuals causing an increase in anxiety, agitation, aggressiveness, hyperactivity, insomnia and exacerbation of seizures in epileptics.

Protracted Withdrawal

When symptoms persist for eighteen months or longer, withdrawal is considered to be protracted. Complaints can be as vague as flu-like symptoms or a combination of pathologies mimicking chronic fatigue syndrome, lupus, multiple sclerosis, anxiety disorders, irritable bowel syndrome and other chronic conditions. Common to this phase of withdrawal are periods where the symptoms gradually lessen in intensity or abate totally only to resurface intermittently. These recurrences are often referred to as ‘waves’ and the periods of reprieve, as ‘windows’.

Caution:  Never stop taking a benzodiazepine or antidepressant abruptly or rush your taper. In the case of benzodiazepines the risks of quitting cold turkey include seizures and psychosis. Always taper off slowly using the Ashton or other recommended method, under the supervision of your doctor.

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Benzodiazepines, Commonly Used

Generic Name Brand Name
alprazolam Xanax
bromazepam Lexotan, Lexomil
chlordiazepoxide Librium
clobazam Frisium
clonazepam Klonopin, Rivotril
clorazepate Tranxene
diazepam Valium, Ducene
flunitrazepam Rohypnol
flurazepam Dalmane
lorazepam Ativan
nitrazepam Mogadon
nordazepam Nordaz, Calmday
oxazepam Serax, Serepax, Serenid
temazepam Restoril, Euhypnos, Normison
triazolam Halcion

‘Z’ drugs – These have similar effects:

zaleplon Sonata
zolpidem Ambien, Stilnoct
zopiclone Zimovane, Imovane
eszopiclone Lunesta