Short-term or emergency conditions usually merit the use of stronger, short-acting benzodiazepines. Chronic, non-emergency conditions are usually treatable with lower-strength, longer-acting benzodiazepines. BZDs gained popularity in the 1960s and 1970s through household names such as The Rolling Stones and numerous Hollywood movies sensationalizing Valium (diazepam). BZDs were encouraged for anyone wanting to calm their nerves and ease their sleep, causing them to rapidly attain favor in society [6]. Additionally, given the continual rise of anxiety and sleep-disordered problems over the decades, BZDs remain a regular fixture in the United States today [7]. Also, long-term users were more likely to say they had sleep problems, despite the fact that benzodiazepines are not recommended for long-term use as sleep aids and may even worsen sleep the longer they are used.
For example, of older, low-income adults with a benzodiazepine prescription between 2008 and 2016, 26.4% had long-term prescriptions, defined as having a prescription 1 year later (29). The lower prevalence of benzodiazepine prescribing among VHA patients, compared with the general population, could reflect responses to VHA’s PDSI (4). PDSI provides performance data on prescribing measures and facilitates clinical review of patients who may benefit from improvement in psychotropic medication regimens. Says Oslin, “Benzodiazepines are one of several classes of medications that have a high addictive potential and substantial risks for falls, cognitive dulling, and sleep impairment. From a public health perspective, starting 80-year-old patients on benzodiazepines is a high-risk prospect.
BZ are effective and well-tolerated, and they should be prescribed as carefully and judiciously as any other medication [2, 3]. Clinicians and investigators have recognized their benefits for many anxious patients, but some medical “propagandists” have popularized a critical view of these medications, and this view has become entrenched in the media and general medical opinion [2, 4]. For example, due to the possibility of withdrawal symptoms with BZ, most recent treatment guidelines recommend SSRI as the first-line choice for the treatment of anxiety [7].
- They showed that benzodiazepine increased the incidence of non-overdose death in these patients which may be attributed to its impairment of cognition, sensory, and motor skills and increased risk of fall leading to injuries [49].
- For example, of older, low-income adults with a benzodiazepine prescription between 2008 and 2016, 26.4% had long-term prescriptions, defined as having a prescription 1 year later (29).
- Your healthcare provider can tell you more about what you can do to avoid dependence on these drugs or developing benzodiazepine use disorder.
- Additionally, given the continual rise of anxiety and sleep-disordered problems over the decades, BZDs remain a regular fixture in the United States today [7].
Certain factors play a role in the severity of withdrawal symptoms, such as dosage, duration of action of the BZD duration of treatment with the drug, and severity of psychiatric symptoms pre-treatment. Studies have shown that treatment for longer periods with high-dosage, short-acting BZD contribute to more severe withdrawal effects [61]. Those who have never experienced withdrawal symptoms from BZD discontinuation could quit using BZD more easily [62].
Long-term use of benzodiazepines can reduce their effectiveness and put you at risk for severe side effects. People being prescribed any medication should disclose all other substances and medications they use and consult with their health care teams about avoiding or managing the risks of using certain medications and substances in combination. Gerlach points to two other concerning findings from the review of records and detailed interviews with program participants.
Such a path would have been impossible if new drugs had to be compared to a gold standard because direct comparisons clearly show that BZ outperformed AD in efficacy and tolerability [12]. In fact, BZ present to be superior over AD in generalized anxiety disorders, complex phobias, and mixed anxiety depressive disorders [11]. Furthermore, BZ were better tolerated than SSRI and SNRI, leading to fewer dropouts and adverse reactions [11]. They are used for immediate symptom relief of anxiety, epilepsy and other seizure disorders, spasticity from CNS pathology, catatonia, sleep disorders such as insomnia, and withdrawal from alcohol and other BZDs [3].
They continually deserve a comprehensive update of their pharmacological and clinical features. Dubovsky and Marshall [3] provided an excellent updated review that increased our self-confidence in prescribing BZ and criticizing the literature that is full of data involving conflicts of interest [4]. The savage marketing of serotonin selective reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor (SNRI) is among the worst episodes in the recent history of psychopharmacology [1]. Psychiatrists and physicians do not need to study and oxycodone uses, side effects, dosages, precautions think about what they read or see in front of them; they should simply prescribe an antidepressant (AD) for every anxiety disorder. The illusion of guidelines sponsored by the SSRI and SNRI industry decided that they should demonize BZ, and physicians should prescribe an AD for every anxiety disorder without comparison to any other group or drug [1, 5]. It is not possible that every anxiety disorder and post-traumatic stress disorder should have an AD as the first choice of treatment without any face-to-face clinical trial demonstrating these data.
All of the patients in the study live at home or in other community settings, so the study does not include patients in nursing homes and other skilled nursing facilities. Although BZDs have been used extensively as an adjunct therapy in PSD, effects on cognition and overall functioning are not sufficiently explored in this patient population. Although there is evidence of higher prevalence of BZD prescription in women (2-folder higher risk) compared with men,29 our results did not indicate this trend.
Common withdrawal symptoms
It should be taken into consideration that in our sample, age at first diagnosis was borderline higher in the BZD-LT group (approximately 4 years higher in comparison with BZD-other group). BZ have long been used to treat anxiety disorders, sleep disturbances, and a variety of medical illnesses such as epilepsy and alcohol withdrawal [11]. Their high number of prescriptions stimulated considerable concerns and initiatives to limit their use [3]. The development of second-generation AD has resulted in more expensive treatment options for anxiety disorders [12].
BZDs lead to long-lasting impairment of episodic implicit memory while it only impairs implicit memory transiently [1]. They also lead to disinhibition, impairing the user’s ability to appropriately assess the risky actions or behaviors. This approach has not been conducted in the VHA and will help identify patient subpopulations that may be overlooked for tapering, as well as whether more tailored discontinuation strategies are needed for high-risk populations. Many clinical studies have been conducted to assess the severity and treatment of withdrawal systems, while others assess more long-term effects of chronic BZD use.
Choices made with respect to drugs and drug forms were aimed at excluding BZDR use for epilepsy indication; thus, the results should only be interpreted to nonepilepsy indications. In addition, this study lacked data on whether BZDR use was initiated during hospital care. There are pharmacological options for treatment in those suffering from withdrawal or wishing to discontinue their chronic BZD use.
ADVERSE DRUG REACTIONS
Your healthcare provider will schedule follow-up visits after prescribing benzodiazepines. In some areas, providers can’t prescribe these medications without first seeing you for a follow-up visit. Your healthcare provider can tell you more about the laws surrounding prescribing these medications and the recommended schedule for you to return for a follow-up visit. Your healthcare provider will likely recommend that you don’t work or drive right after you start taking benzodiazepines. You may be able to work or drive after you start taking them, depending on how these drugs affect you, the dose you take, how long the drugs last and other factors. In a 12-month period spanning 2014 and 2015, experts estimate that at least 30.5 million people in the U.S. took benzodiazepines prescribed by a healthcare provider.
What are the most commonly prescribed benzodiazepines?
While there are separate types because they have different primary effects, there’s a lot of overlap between them. For example, most benzodiazepines have a sedative effect in addition to their primary effect. Discontinuation of benzodiazepines was defined as a patient’s not having a benzodiazepine prescription for ≥120 days (4 months) after a prescription ended. To ensure that patients were not misclassified as having discontinued, the no-prescription period was extended for 4 months past FY2019 (October 2019 through January 2020). Studies have used a range of 3–12 months of not having a benzodiazepine prescription for patients to be considered as discontinued (11).
1. Symptoms of Withdrawal
Reasons for long-term BZD prescription could be multifactorial—one of them is lack of appropriate information and effective education at multiple levels and lack of relevant national guidelines for rational prescription of BZDs. However, in the countries where such guidelines based on the best available evidence at the time of its development exist, for example in Singapore,32 use of BZD in persons with psychotic disorders will be recommended only as a short-term trial. Psychotic patients who will be candidates for short addition of BZD are alcohol withdrawal insomnia overcoming sleep problems persons with persistent and clinically significant symptoms of anxiety, dangerous or assaultive behavior (evidence grade/level A/132(p18)). In summary, it is unclear where long-term benzodiazepine use fits into current medical practice. Many patients underestimate the degree of impairment caused by benzodiazepines.8 Benzodiazepines increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fracture. The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol.
The risk of falls leading to injuries in elderly BZD users is significantly increased in patients greater than 80 years old, while the increased risk is not significant in patients under 80 [22]. Passaro et al. described an increased risk of falls in elderly hospitalized patients prescribed short-acting BZD [23]. For mothers with BZD use during pregnancy, there is a risk of premature birth and low birth weight. While the study showed some teratogenic effects of BZDs on fetuses, the result is not statistically significant, and some of the malformations seen in fetuses in the study may have been due to the use of other medications such as antidepressants [24]. Their relative safety compared to fellow depressants or barbiturates have increased the rate at which they are prescribed [25].