Review, Nov/21: Benzodiazepines: Uses, Dangers, and Clinical Considerations

"Benzodiazepines: Uses, Dangers, and Clinical Considerations"

https://pubmed.ncbi.nlm.nih.gov/34842811/

Abstract

Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood-brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. One of the debilitating side effects of BZDs is their addictive potential. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Regular use of BZDs has been shown to cause severe, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. Some of these withdrawal symptoms can be life threatening. The current treatment for withdrawal is through tapering with clonazepam. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States.

Full Review:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8629021/

Hi Lapis2, 

Thank you for sharing this article.  I am glad to see that in general, they acknowledge that benzos can be dangerous.  They also talk about tolerance and physiologic dependence, that tapering off benzos is important and that benzos have a "toxic effect on the central nervous system" and can cause many withdrawal symptoms as well.  However, they also use terms like addictive, misuse, benzo abuse and that benzo withdrawal symptoms "may last one to a few weeks after cessation".  Sigh...I'm grateful they are studying this but, seems  like they have a long way to go.  Benzos have been around for a long time.  I don't understand why/how they have only seemed to have reached these conclusions now???  Double sigh...

Hi BurnedOut,

I guess I look at it this way: It's so hard to study what needs to be studied and to keep it ethical while doing so. If you want to get the Before/During/After of long-term benzodiazepine use, you would have to get willing participants, do all sorts of tests on them, put them on benzos for months or years, study them while they're on the meds, and then get the participants to withdraw from the benzos so that you can once again run the tests in a few days/weeks/months/years.

I've thought about this numerous times, but I always come back to the same conclusion: It's really, really, really hard to get the kind of information that we would all like to have about long-term benziodiazepine use and its withdrawal. There are ethical issues, but there are also many individual factors that could affect outcomes and complicate the picture.

Overall, I think it's a good review, and I'm really glad to see it. But I understand your frustrations, BurnedOut.