Why Are Benzodiazepines Good and Bad?

Why are benzodiazepines good and bad? I’ll discuss that further in the post. Altogether, they are a class of medications that slow down activity in your brain and nervous system. They’re most often used for treating anxiety and related mental health conditions, as well as brain-related conditions like seizures. Consequently, these medications are tightly regulated and are only available with a prescription.

Many countries, including the U.S., classify benzodiazepines (sometimes known by the slang term “benzos”) as controlled substances. Therefore, that means you need a prescription to get them. It’s illegal to have or obtain them (depending on the laws where you are) if you don’t have a prescription.

Basically, the short-term use of these medications is usually safe and effective, but long-term use can lead to tolerance, control, and other adverse effects.

Benzodiazepines Side Effects

Benzodiazepines are good and bad. The side effects of their use may include:

firstly, drowsiness
confusion
dizziness
impaired coordination, increasing the risk of falls and accidents
depression
lastly, increased anxiety

More serious effects include:

firstly, memory problems
behavioral changes — for example, increased risk taking
Incoherence, especially in older people
risk of dependence, especially with long-term use
lastly, possibly an increased risk of dementia, although scientists are unsure of this

Experts do not recommend using benzodiazepines for more than 2 weeks.

Subsequently, A person who uses them for 3–4 weeks and then stops suddenly is likely to experience withdrawal symptoms. People who use them in the long term may need to withdraw their use over a 3–12 month period that their doctor should oversee.

Types of Benzodiazepines

There are many different benzodiazepines. But they differ in terms of potency, how quickly the body absorbs them, and their uses.

The most common benzodiazepines approved in the United States include (but aren’t limited to):

Firstly, Alprazolam (Xanax®): Approved for treating anxiety disorders, panic disorder and premenstrual syndrome disorder.
Chlordiazepoxide (Librium®; brand name is no longer available in the U.S.): Approved for treating alcohol withdrawal and anxiety-related conditions.
Clobazam (Onfi®, Sympazan®): Approved for treating seizures and certain forms of epilepsy.
Fourthly, Clonazepam (Klonopin®): Approved to treat agitation, anxiety and seizures.
Clorazepate (Tranxene®): Approved for treating anxiety and seizures.
Diazepam (Diastat®, Valium®, Valtoco®): Approved to treat alcohol withdrawal, seizures and muscle spasms. Also approved for use as pre-anesthesia for surgery and procedures. These can also treat toxic effects on the heart from chloroquine and hydroxychloroquine.
Additionally, Estazolam (ProSom®; brand name is no longer available in the U.S.): Approved to treat insomnia.
Flurazepam (Dalmane®; brand name is no longer available in the U.S.): Approved to treat insomnia.
Lorazepam (Ativan®, Loreev®): Approved for treating seizures, chemotherapy-related nausea and vomiting, anxiety, pre-anesthesia for surgery and procedures, and phobias.
Midazolam (Nayzilam®, Seizalam®, Versed®; brand name Versed is no longer available in the U.S.): Approved to treat seizures, sedate people on a ventilator, and as pre-anesthesia for surgery and procedures.
Oxazepam (Serax®; brand name is no longer available in the U.S.): Approved as a treatment for alcohol withdrawal syndrome, anxiety and tension.
In addition, Quazepam (Doral®): Approved to treat insomnia and sleep problems.
Remimazolam (Byfavo®): Approved for pre-anesthesia before surgeries and procedures.
Temazepam (Restoril®): Approved for treating insomnia.
Lastly, Triazolam (Halcion®): Approved for treating insomnia.

Withdrawing From Benzodiazepines

Benzodiazepines are good and bad. Emphatically, on the bad side there is no final guide to the symptoms, timeline, or seriousness of benzo withdrawal. Each individual may experience withdrawal differently, depending on factors such as:

firstly, duration of taking these drugs
dosage
misuse of prescription
fourthly, using the drug without a prescription
having an underlying mental health condition
taking other drugs at the same time
lastly, misusing other drugs or alcohol

There are three possible phases for benzo withdrawals, each with an estimated timeline. Equally important, a person should always withdraw from benzos under the guidance of a healthcare professional. They should never quit benzos suddenly without first consulting a professional and developing a plan with them.

 Early or Immediate Withdrawal

Early withdrawal symptoms, sometimes called rebound symptoms, occur shortly after a person stops taking benzodiazepines.

However, a person’s withdrawal symptoms often depend on the half-life of the drug. Withdrawal symptoms from short-acting drugs, such as Xanax, may come on faster than withdrawal symptoms from long-acting drugs, such as Valium.

During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound. For example, symptoms of anxiety or sleeplessness may come back or get worse without the drugs.

Overall, practices such as drug tapering or using other drugs to help ease withdrawal may make early withdrawal symptoms milder and more doable.

 Acute Withdrawal

Acute withdrawal begins after the initial withdrawal symptoms, generally within a few days. Symptoms generally last 5–28 days, though some may last for several months.

In any case, most of the withdrawal symptoms will occur in this phase. People who have been through acute withdrawal often say that this phase is the most difficult.

During the acute withdrawal phase, doctors may monitor the person and recommend other drugs to control problematic symptoms.

 Protracted Withdrawal

Although many symptoms subside after the acute withdrawal phase, lingering side effects are possible.

Research in the British Journal of Clinical Pharmacology notes that an estimated 10–25% of people who use benzos for extended periods experience withdrawal symptoms that last for 12 months or longer.

Given that, protracted withdrawals may cause their own set of symptoms, often called post-acute withdrawal symptoms, or PAWS. These include:

firstly, deep breathing
anxiety
poor concentration
loss of sex drive
depression
lastly, mood swings

These symptoms may be troubling or affect a person’s quality of life. Consequently, some symptoms may appear without warning and can be a significant source of agony.

Withdrawal Symptoms

Benzodiazepines are both good and bad. Near the bad side, withdrawal symptoms may be mild in people who take the drugs for short periods. However, there is still a possibility of severe reactions and withdrawal symptoms.

Research showed that 40% of people taking benzos for longer than 6 months experienced moderate-to-severe withdrawal symptoms.

Although not everyone will experience the same symptoms, some are more common. These include:

firstly, physical aches and pains that can range from uncomfortable to severe
abnormal sensations, such as the feeling that bugs are crawling on the skin
muscle spasms
fourthly, deep breathing
sweating
weight loss
anorexia
in addition, anxiety attacks
trouble concentrating
hypersensitivity
nausea
vomiting
in addition, insomnia
panic attacks
grand mal seizures
detachment from reality
depression
lastly, hallucinations or delusions

Along with these symptoms, the person may experience severe cravings for the drug or other drugs to sedate them. Particularly, these cravings can easily lead to recurrence of use.

Short-Acting vs. Long-Acting Benzos

Half-life is used to measure whether a benzodiazepine is short-acting or long-acting. Generally, short-acting benzos have a half-life of less than 12 hours, and long-acting ones have a half-life of more than 12 hours.

Half-life is a measure of how long it takes the body to remove half of the drug. Xanax has a half-life of 11 hours, while Valium has a half-life of up to 48 hours.

In essence, benzos with a short half-life usually have a greater potential for addiction because withdrawal symptoms happen quickly after stopping it. Benzos with a long half-life release from the body slowly, so detox and withdrawal symptoms usually begin more slowly and are milder.

What are the Advantages of Benzodiazepines?

Benzodiazepines can be both good and bad. Benzodiazepines have several advantages:

They have an established history. In other words, they have been in widespread use since the 1960s. Decades of use mean these drugs are well-studied and well-understood.

They’re much safer than their predecessors. Before benzodiazepines, doctors primarily prescribed barbiturates for treating anxiety. But these drugs came with significant risks of side effects and complications. Polish-American scientist Leo Sternbach accidentally discovered the first benzodiazepine, chlordiazepoxide, while trying to find an alternative to barbiturates.

They treat many conditions. Benzodiazepines are useful for treating many conditions, some of which are likely to happen simultaneously. An example is the common combination of pre-surgery anxiety and the need for pre-anesthesia sedation, both of which are treatable with benzodiazepines like diazepam or midazolam.

There’s one antidote for all of them. They do have a risk of overdose. However, a drug called flumazenil is an antidote that rapidly reverses the effects of all them.

What are the Disadvantages of Benzodiazepines?

They are useful and effective, but some risks come along with them, including:

There’s a potential for misuse. This drug misuse is widespread. In reality, experts estimate that 5 million or more people in the U.S. misused benzodiazepines in a 12-month period spanning 2014 to 2015.

They can be habit-forming. In short, benzodiazepine use disorder is a possible complication from long-term use or misuse of these medications.

There’s a risk of overdose. Misusing them can be dangerous because it can lead to an overdose, which can stop your breathing.

They can interact dangerously with alcohol and certain drugs. Thus, benzodiazepines can interact with drugs like opioid pain medications (such as oxycodone or hydrocodone) or with alcohol. Interactions like these can intensify the effects of the drugs and/or alcohol, which may have deadly results.

They’re controlled. These medications are typically monitored and legally restricted depending on the laws where you are. While legal restrictions are there to prevent misuse, they also can make it harder for people who use these drugs for medical reasons to fill their prescriptions.

They have the potential for use in sexual assault. The best-known example of this is flunitrazepam, also known as Rohypnol. In summary, this drug prevents the formation of new memories and causes sedation, both of which are reasons why perpetrators of sexual assault use it. However, perpetrators of these crimes also use other benzodiazepines like clonazepam and diazepam. Research shows perpetrators may also use nonbenzodiazepines like zolpidem for similar reasons.

They can affect your ability to drive or do certain tasks. Benzodiazepines don’t affect your alertness, but they do slow down nerve signals. In other words, slowed nerve signals can slow your reflexes, making it difficult or impossible to drive or do certain tasks safely. Your healthcare provider can guide you on whether or not it’s safe to drive if you take a benzodiazepine medication.