Benzodiazepines

The benzodiazepines (often abbreviated to "benzos") are a class of psychoactive drugs with varying hypnotic, sedative, anxiolytic (anti-anxiety), anticonvulsant, muscle relaxant, and amnesic properties, which are mediated by slowing down the central nervous system. Benzodiazepines are useful in treating anxiety, insomnia, agitation, seizures, and muscle spasms, as well as alcohol withdrawal. They can also be used before certain medical procedures such as endoscopies or dental work where tension and anxiety are present and prior to some unpleasant medical procedures in order to induce sedation and amnesia for the procedure. Another use is to counteract anxiety-related symptoms upon initial use of SSRIs and other antidepressants, or as an adjunctive treatment. Recreational stimulant users often use benzodiazepines as a means of "coming down." Benzodiazepines are also used to treat the panic that can be caused by hallucinogen intoxication.

Benzodiazepines can cause a physical dependence and a benzodiazepine addiction to develop and upon cessation of long term use a benzodiazepine withdrawal syndrome can occur.

Benzodiazepines and their therapeutic uses

The core chemical structure of "classical" benzodiazepine drugs is a fusion between the benzene and diazepine ring systems. Benzodiazepines are molecularly similar to several groups of drugs, some of which share similar pharmacological properties, including the quinazolinones, hydantoines, succinimides, oxazolidinediones, barbiturates and glutarimides. Most benzodiazepines are administered orally; however, administration can also occur intravenously, intramuscularly, sublingually or as a suppository. Benzodiazepines have a number of therapeutic uses, are well-tolerated, and are very safe and effective drugs in the short term for a wide range of conditions.

Anticonvulsants

Benzodiazepines are potent anticonvulsants and have life-saving properties in the acute management of status epilepticus. The most commonly-used benzodiazepines for seizure control are lorazepam and diazepam. A meta-analysis of 11 clinical trials concluded that lorazepam was superior to diazepam in treating persistent seizures. Although diazepam is much longer-acting than lorazepam, lorazepam has a more prolonged anticonvulsant effect. This is because diazepam is very lipid-soluble and highly protein-bound, and has a very large distribution of unbound drug, resulting in diazepam's having only a 20– to 30-minute duration of action against status epilepticus. Lorazepam, however, has a much smaller volume of distribution of unbound drug, which results in a more prolonged duration of action against status epilepticus. Lorazepam can therefore be considered superior to diazepam, at least in the initial stages of treatment of status epilepticus.

Anxiolytics

Benzodiazepines possess anti-anxiety properties and can be useful for the short-term treatment of severe anxiety. Like the anticonvulsants, they tend to be mild, well tolerated, and extremely safe. Benzodiazepines are usually administered orally for the treatment of anxiety; however, occasionally lorazepam or diazepam may be given intravenously for the treatment of panic attacks.

Insomnia

Certain benzodiazepines are strictly prescribed for the short-term management of mild (flurazepam, quazepam, estazolam), moderate (lormetazepam, midazolam, loprazolam, brotizolam, nitrazepam), and severe or debilitating (triazolam, nimetazepam, temazepam, flunitrazepam, flutoprazepam) insomnia. Hypnotic benzodiazepines have strong sedative effects, are typically the most rapid-acting benzodiazepines, and have strong receptor affinity. In addition, many of the hypnotics are powerful anticonvulsants (midazolam, nitrazepam, nimetazepam, temazepam, and flutoprazepam) and all are very strong anxiolytics and amnesic agents. Longer-acting benzodiazepines, such as nitrazepam or quazepam, have side-effects that may persist into the next day, whereas the more intermediate-acting benzodiazepines (for example, temazepam or loprazolam) may have less "hangover" effects the next day. Benzodiazepine hypnotics should be reserved for short-term courses to treat acute conditions, as tolerance and dependence may occur if these benzodiazepines are taken regularly for more than a few weeks.

Physical dependence and withdrawal

Long-term benzodiazepine usage, in general, leads to some form of tolerance and/or drug dependence with the appearance of a benzodiazepine withdrawal syndrome when the benzodiazepines are stopped or the dose is reduced. Withdrawal from chronic benzodiazepine use is usually beneficial due to improved health such as cognition and improved functioning with possible improved employment status. Abrupt withdrawal can be hazardous therefore a gradual withdrawal is recommended. The time needed to complete withdrawal differs from expert to expert but ranges from 4 weeks to several years, with aiming for 6 months suggested by one leading expert.

Approximately half of patients attending mental health services for conditions including anxiety disorders such as panic disorder or social phobia may be the result of alcohol or benzodiazepine dependence. Sometimes anxiety disorders pre-existed alcohol or benzodiazepine dependence but the alcohol or benzodiazepine dependence often act to keep the anxiety disorders going and often progressively making them worse. Many people who are addicted to alcohol or prescribed benzodiazepines when it is explained to them they have a choice between ongoing ill mental health or quitting and recovering from their symptoms decide on quitting alcohol and or their benzodiazepines. It was noted that every individual has an individual sensitivity level to alcohol or sedative hypnotic drugs and what one person can tolerate without ill health another will suffer very ill health and that even moderate drinking can cause rebound anxiety syndromes and sleep disorders. A person who is suffering the toxic effects of alcohol or benzodiazepines will not benefit from other therapies or medications as they do not address the root cause of the symptoms. Recovery from benzodiazepine dependence tends to take a lot longer than recovery from alcohol but people can regain their previous good health.

Withdrawal management

Benzodiazepine withdrawal symptoms occur when benzodiazepine dosage is reduced in people who are physically dependent on benzodiazepines. Abrupt or over-rapid dosage reduction can produce severe withdrawal symptoms. Withdrawal symptoms may also occur during a very gradual and slow dosage reduction but are typically less severe. Withdrawal symptoms may persist as part of a protracted withdrawal syndrome for many months after cessation of benzodiazepine.

Benzodiazepine withdrawal is best managed by our Teen Challenge’s rehabilitation programme which includes expert advice for Benzodiazepines and any other type of substance abuse.  We are open to everyone both men and women who need addiction help. Wilkerson House Center in London is open to men only and Hope House Center in Wales is for women. For more information you will need to complete an online application form.

 

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