Benzodiazepines
Mental
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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
- agitation and restlessness, particularly for people in
hospital
- epileptic seizures
- mania
- alcohol withdrawal
- sleeping problems
They replaced the barbiturates which had been commonly
prescribed for 50 years up to the 1950s, but which were
addictive and very dangerous in overdose.
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. This is a neuro transmitter – a chemical which
is used in the brain to control the passage of messages from one
cell to another. It has a generally calming effect in the
human brain.
What are the main side effects?
- Sleepiness
- Unsteadiness
- Problems with memory and concentration.
These side-effects affect older people
much more, so benzodiazepines should generally not be prescribed
for people over the age of 60.
Occasionally, benzodiazepines can produce a 'paradoxical'
reaction - instead of feeling calmer, the person feels more
agitated or even aggressive.
Aren't benzodiazepines addictive?
Yes. Around 4 in every 10 people who
take them continuously for more than 6 weeks will become addicted.
The signs are that you:
- feel bad if you don't take them
- find you have to take more and more to get the same effect
- crave them
- get withdrawal symptoms if you try to stop. You
- can't sleep
- feel tense and agitated
- feel dizzy
- can get odd metallic tastes in your
mouth, odd feelings like electric shocks in your arms and legs
- have blurred vision, sensitivity to
light.
Withdrawal Symptoms
These will usually start within 48 hours of
stopping or reducing the dose of benzodiazepine. You may find them
mild and that they pass off within a few days.
However, the symptoms can be severe. You
may
- become confused
- have hallucinations (hearing and seeing
things that aren't there)
- have epileptic fits.
This is similar to alcohol
withdrawal. You are more likely to have such symptoms if
you have been taking higher doses of a benzodiazepine. They will
usually last for days or weeks, depending on whether you have been
taking a long- or short-acting benzodiazepine.
Some people go on to have unpleasant symptoms for many months or
even years.
Managing withdrawal
f you have taken a benzodiazepine every
day for more than 3 weeks or so, you should not stop them suddenly.
Most people withdraw from them gradually by reducing the daily
dose every 2 - 4 weeks, by 1/8 or a
1/4. of the original dose - although some
people find theu need to do it in smaller steps. It is better
to reduce too slowly rather than too quickly, even if this takes
months or years.
Some benzodiazepines are harder to come off than others - such
as the shorter-acting ones like Lorazepam. If you are finding it
hard to stop one of these, your doctor can change it to Diazepam
which can be easier to come off.
Are blood tests necessary?
In spite of the problems with addiction,
benzodiazepines are very safe and no routine tests are needed
before taking them.
How effective are the benzodiazepines?
If used for the short-term
treatment of both anxiety and sleep problems, they can be
helpful. They can also be used for the short-term
treatment of generalised anxiety and social anxiety. They
have been used in panic and obsessive compulsive disorders, but
antidepressants -
especially the SSRIs - work better for these conditions.
In all the conditions in
which they are used, benzodiazepines tend to produce
dependence and withdrawal reactions.
So -
Benzodiazepines should only be used for periods of up to
4 weeks.
What alternatives are there to benzodiazepine
medications?
The main treatment for anxiety and sleep
problems are now psychological (see our leaflets on Cognitive Behavioural Therapy and Sleep Problems). Fpr more severe anxiety,
SSRI antidepressants can be
used.
For the short-term relief of disturbed sleep, a new calss of
sedative drugs was introduced some years ago - the "Z" drugs -
zaleplon, zolpidem and zopiclone. These were marketed as being less
addictive than benzodiazepines but work in a similar way, through
the GABA system. There is not enough evidence to show that they are
less likely to cause dependence than benzodiazepines.
The advice for their use is, therefore, much the same as for
benzodiazepines - only when psychological methods have failed, at
the lowest dose possible, and for short periods of time.
How long should I take a benzodiazepine
for?
Up to 4 weeks - no longer.
This should really be just to give other (often psychological)
treatments a chance to work.
A few people may benefit from
taking benzodiazepines long-term, but this should
only be carried out by a specialist unit after
other treatments have been tried and have failed.
How do benzodiazepines differ from each
other?
The main differences are:
- how quickly they start to act
- how long they stay in the body.
A short-acting drug is better to help
sleep, so that you don't get a 'hangover' effect the next day -
this can make it dangerous to drive, or use
machinery.
For anxiety that is there all the time, a
longer-acting benzodiazepine such as diazepam could be more
helpful.
If you are both anxious and sleeping badly,
the longer-acting benzodiazepines can be taken at night - they will
improve sleep, but will still be working the next day to help
with the anxiety.
What can I do to help myself ?
You can find how to help yourself with anxiety
and insomnia from books or through the internet. See the reading
materials section at the end of this leaflet and at the end of our
other leaflets such as:
What would happen without treatment?
Anxiety and insomnia can be
short-lived, especially when they come after a stressful
event, such as a bereavement or loosing a job.
However, these problems can be due to depression, chronic
stress, or relationship problems. Benzodiazepines do not help
with these issues - see our leaflets on Anxiety and Sleep Problems.
Are there any major differences of opinion about
benzodiazepines?
We know that the benzodiazepines and
z-drugs can help in anxiety and insomnia. But we also know that
they are addictive. These medications were greatly overused in
the 1960s and 1970s which is why so many people are still dependent
on them today.
It does seem safe to use them, with
caution, in the short-term (less than 4 weeks). But they are
best avoided if you have a history of dependence on other
substances. For anything more than a few weeks, psychological
therapies and/or antidepressants are the best treatments for
most people.
References
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 Royal College of
Psychiatrists Public Education Editorial Board.
Series Editor: Dr Philip Timms.
© Updated: April 2013. Due for
review: April 2015. Royal College of Psychiatrists. This
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Please note that we are unable to offer advice on individual cases. Please see our
FAQ for
advice on getting help.
Please answer the following questions and press 'submit' to send your answers OR
E-mail your responses to dhart@rcpsych.ac.uk
On each line, click on the mark which most closely reflects how you feel about the
statement in the left hand column.
Your answers will help us to make this leaflet more useful - please try to rate
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