Under Review March 2018
- have been prescribed benzodiazepines
- have used benzodiazepines
- know someone who has been prescribed benzodiazepines
- are worried about addiction and withdrawal effects with these
What are benzodiazepines?
A group of medications which have been
used since the 1960s to treat:
- agitation and restlessness, particularly for people in
- epileptic seizures/fits
- 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.
Benzodiazepines all work in a similar way
(see below). The shorter-acting ones have been marketed as
sleeping tablets – the idea being that you don't get a muzzy head
the next day. The longer-acting ones have been
marketed for their use in controlling anxiety.
How do they work?
They boost the effect of a substance in the
brain – called GABA (Gabba Amino Butyric Acid). This is a
neurotransmitter – a chemical which is used in the brain to control
the passage of messages from one cell to another. GABA has a
generally calming effect in the human brain.
What are the main side effects?
- Problems with memory and concentration.
These side-effects affect older people
|Benzodiazepines should generally not be prescribed
to people over the age of 60
Occasionally, benzodiazepines can make a person feels more
agitated or even aggressive.
Aren't benzodiazepines addictive?
Yes. Around 4 in every 10 people who
take them every day 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
These 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, some people have severe symptoms. You
- 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. These
symptoms will usually last for days or weeks, depending on
whether you have been taking a long- or short-acting
|Some people go on to have unpleasant symptoms for
many months or even years.
f you have taken a benzodiazepine every
day for more than 3 weeks or so, you should not stop them suddenly.
It's safest to stop 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 they 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 withdraw
Are blood tests necessary?
Apart from the real problems with addiction
and withdrawal, benzodiazepines are otherwise safe for adults
of working age and no routine tests are needed before taking
How effective are the benzodiazepines?
They can be helpful in
the short-term treatment of both anxiety
and sleep problems. 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 - are more effective.
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
The main treatments for anxiety and sleep
problems are now psychological (see our leaflets on Cognitive Behavioural Therapy and Sleep Problems). For more severe anxiety,
SSRI antidepressants can be
For the short-term relief of disturbed sleep, a new class 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
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, or from
time-to-time. This should only be carried out
by a specialist unit after other treatments have been tried and
How do benzodiazepines differ from each
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
For anxiety that is there all the time, a
longer-acting benzodiazepine such as diazepam could be more
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.
|Whether long- or short-acting,
all benzodiazepines can be addictive (see above).
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 losing 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
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
- Nutt, DJ & Ballenger, JC. (2003) Anxiety
disorders. Blackwell Science Limited, Oxford. I-xii, 1-542. ISBN
- 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
- Wilson SJ and Nutt DJ (2008) Sleep Disorders;
Oxford Psychiatry Library.
- British National Formulary:
information on hypnotics and anxiolytics
This factsheet was produced by the Royal College of
Psychiatrists Public Education Editorial Board.
Series Editor: Dr Philip Timms.
Under Review March 2018
. Royal College of Psychiatrists. This factsheet may be downloaded,
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