Benzodiazepines
Introduction
This leaflet may be helpful if you:
- have been prescribed benzodiazepines
- have used benzodiazepines
- know someone who has been prescribed benzodiazepines
- are worried about addiction and withdrawal effects with these
medications.
What are benzodiazepines?
They are a group of medications which have
been used since the 1960s to treat:
- anxiety
- epileptic seizures
- mania
- alcohol withdrawal
- sleeping problems
They replaced the barbiturates which had been
commonly prescribed for 50 years around the 1950s, but which were
addictive and very dangerous in overdose.
They include:
Some benzodiazepines commonly used in the
UK:
|
Trade
Name1
|
Proper name
|
Dose Range
|
Used for:
|
|
Valium
|
Diazepam
|
|
Anxiety
|
|
|
Lorazepam
|
|
|
|
|
Temazepam
|
|
|
|
Librium
|
Chlordiazepoxide
|
|
Sleep, alcohol withdrawal
|
|
Mogadon
|
Nitrazepam
|
|
|
|
|
|
|
|
|
Zolpidem
|
|
|
|
|
Zaleplon
|
|
|
|
|
Zopiclone
|
|
|
|
1. These are the trade names used in the UK –
they may be different in other countries
They all work in a similar way (see below).
Those which have a short effect have been marketed as sleeping
tablets – the idea being that you don't get a muzzy head the next
day. Others with a longer effect have been marketed for their
use in controlling anxiety.
How do they work?
They boost the effect of a substance in the
brain – GABA.
What is GABA?
GABA is a neuro transmitter – a chemical which
is used in the brain to control the passage of impulses from one
cell to another. GABA has a generally calming effect in the human
brain.
What are the main side effects?
- Sleepiness
- Unsteadiness
- Memory problems.
But most people find they don’t have
significant problems of this sort.
Aren't benzodiazepines addictive?
Yes. Around 4 in every 10 people who
take them continuously for more than 6 weeks with get withdrawal
symptoms. These include difficulty in sleeping, feeling tense and
agitated – rather like the return of the symptoms the medication
was originally prescribed for. You can also get dizziness, metallic
tastes, and disturbances of your vision.
They will usually start within 48 hours of
stopping or reducing the dose of a benzodiazepine. They can be mild
and pass off within a few days.
For some people they may be so severe that
they produce confusion, hallucinations and epileptic fits.
Some people experience unpleasant symptoms for
several months afterwards.
Managing withdrawal
If you have been taking a benzodiazepine for
more than a few weeks, talk it over with your doctor – you should
probably reduce the dose by just 1-2 mg every 2 weeks. It may take
a while, but nearly everyone can tolerate this very slow rate of
withdrawal.
Are blood tests necessary?
Benzodiazepines are very safe and no routine
tests are needed before taking them.
How effective are the benzodiazepines?
They are work well for the
short term treatment of both anxiety and sleep.
They work particularly well in generalised anxiety disorder and
social anxiety disorder. They can also be helpful in panic and
obsessive compulsive disorders, but in these conditions antidepressants - especially
the SSRIs - seem to work better.
In all the conditions in
which they are used, benzodiapines tend to produce dependence
and withdrawal reactions. They should really only be used for
periods of a few weeks or so.
How long does treatment last?
Just a few weeks, while other (often
psychological) treatments have a chance to work. A very few people
may benefit from taking them long-term, but this should only be
carried out by a specialist unit after other treatments have been
tried and have failed.
How do the treatments compare and how does one choose
between treatments?
The main differences between the
benzodiazepine type drugs are:
- how quickly they start to act
- how long they stay in the body.
When they are used to help sleep, then a
short-acting drug is better so that you don't get a “hangover”
effect the next day, which can make it dangerous to drive or use
machinery. The “z-drugs” were designed to fulfil this need and do
it well.
When anxiety is present all day long, then a
longer acting benzodiazepine such as valium or ativan is used.
If someone is both anxious and sleeping badly,
the longer-acting benzodiazepines can be taken at night - they will
improve sleep but still be present the next day to help with the
anxiety.
What can I do to help myself ?
Self-help treatments for anxiety and insomnia
are available from psychologists, in books and over the internet.
See the reading materials section at the end of this leaflet and of
our other leaflets:
What would happen without treatment?
Anxiety and insomnia can be short-lived,
especially when they have started because of a stress such as
bereavement or a job loss. However, many people have lasting
anxiety and insomnia because of chronic stress or family
tendencies. These need attention if the person is to get
better.
Are there any major differences of opinion about
benzodiazepines?
Most health care professionals now accept that
the benzodiazepines and z-drugs can be helpful in anxiety and
insomnia. However, it is universally acknowledged that they were
overused in the 1960s and 1970s which led to many people becoming
dependent on them – see above.
It now seems safe to use them in the short
term (less than 4 weeks). Psychological therapies and/or
antidepressants are needed in the longer term.
What are the main gaps in our knowledge about anxiety
and sleeplessness?
We do not know why some people are more
anxious or sleep less well than others. Brain scans suggest that
they may not have enough GABA (see above). This also happens in
some forms of epilepsy and alcohol withdrawal. The benzodiazepines
increase the effects of GABA and so make up for this shortage.
References
Baldwin DS, Anderson IM, Nutt DJ, Bandelow B,
Bond A, Davidson J, Den Boer JA, Fineberg NA, Knapp M, Scott J,
Wittchen H-U [2005] Evidence-based guidelines for the
pharmacological treatment of anxiety disorders: recommendations
from the British Association for Psychopharmacology.
Journal of Psychopharmacology 2005; 19: 567-596.
Malizia AL, Cunningham VJ, Bell CJ, Liddle PF,
Jones T, Nutt DJ (1998), Decreased brain GABA(A)-benzodiazepine
receptor binding in panic disorder: preliminary results from a
quantitative PET study, Arch.Gen.Psychiatry 55:
715-720.
Nutt DJ, Malizia AL (2001) New insights into
the role of the GABA(A)-benzodiazepine receptor in psychiatric
disorder. Br.J.Psychiatry 179: 390-396.
Nutt DJ [2007] chapter on
Medication, in The Mind – A Users Guide ed R Persaud.
Royal College of Psychiatrists.
Wilson SJ Nutt DJ [2007] Management of
insomnia: treatments and mechanisms. Brit J Psychiatry 191:
195-197.
Further Reading
Nutt, DJ & Ballenger, JC. (2003) Anxiety
disorders. Blackwell Science Limited, Oxford. I-xii, 1-542. ISBN
0-632-05938-9.
Doble A, Martin IL, Nutt DJ. (2004) Calming
the brain: benzodiazepines and related drugs from laboratory to
clinic. Martin Dunitz Limited, London. i-vi, 1-185. ISBN
1-84184-05201.
Wilson SJ and Nutt DJ (2008) Sleep Disorders;
Oxford Psychiatry Library.
This factsheet was produced by the RCPsych's Public Education
Editorial Board and the Psychopharmacology Special Interest
Group.
Series Editor: Dr Philip Timms.
© January 2009. Royal College of Psychiatrists. This
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