Why Does Long-Term Benzodiazepine Use Cause Cognitive Impairment?

Researchers call for clinicians & patients to ‘begin with the end in mind’ with sedatives like Valium or Xanax for anxiety, sleep issues & more. Exposures  Use of BZDRs, modeled from register-based data using the PRE2DUP (from prescriptions to drug use periods) method. Per the Centers for Disease Control and Prevention (CDC), good sleep hygiene includes several steps. Many physicians are now suggesting therapy before prescribing medications, particularly for sleep problems. “CBT-i (cognitive behavioral therapy for insomnia) is a non-medication approach to treating insomnia,” says psychotherapist Annie Miller, LCSW.

  1. Benzodiazepine reduction is not always an easy task as the patients may resist to dose reduction or discontinuation, but the question arises if patients have ever been educated or advised about the optimal BZD use and adverse effects.
  2. Therefore, it may be time to reassess the use of BZ in the long-term treatment of anxiety disorders.
  3. This approach has not been conducted in the VHA and will help identify patient subpopulations that may be overlooked for tapering, as well as whether more tailored discontinuation strategies are needed for high-risk populations.

Most prescription drug withdrawal programs prioritize psychoeducation, brief interventions, relaxation, and techniques to reduce anxiety and increase quality of sleep (14). Future studies of benzodiazepine discontinuation in the VHA and other health care systems may include behavioral interventions to increase efficacy and effectiveness of discontinuation approaches. There is an emerging awareness of the deleterious and bothersome adverse events that may ensue specially with long-term treatment with AD, such as high rates of sexual dysfunction, bleeding, hyponatremia, weight gain, and osteoporosis [7].

The drug class is the mainstay of treatment for catatonia, which is characterized by postural rigidity, immobility, purposeless activity, and disturbances in one’s consciousness [10]. Catatonia presents in populations suffering from bipolar disorder, schizophrenia, or a variety of medical conditions. BZDs act on the CNS to exert anxiolytic and sedative effects and, together with electroconvulsive therapy, are the mainstay therapy for catatonia [13]. Mental health conditions examined were anxiety, depression, PTSD, bipolar disorder, psychosis, alcohol use disorder, and drug use disorder.

Benzodiazepine Prescriptions

BZDs are most commonly used for panic disorder and generalized anxiety disorder (GAD) regarding its indications for anxiety. In terms of anxiety, BZDs are used as a bridge when starting another medication or as abortive therapy for panic attacks. Given concerns for use dependence and withdrawal, SSRIs and antidepressants have been made mainstay therapy for these conditions.

Benzodiazepines: Uses, Dangers, and Clinical Considerations

The dependence on BZDs generally leads to withdrawal symptoms, which necessitates careful tapering of the medication when prescribed [26]. Still, due to the severe potential for dependence and deadly withdrawal sequelae, guidelines for recommended use are no longer than a few weeks. Despite this, numerous studies report usage extending for months into years or even decades in many users [9]. Additionally, according to several studies, BZD use increases with age, with long-term usage most prevalent in the 65 and older population [16]. Long-term use is defined as two or more months at a therapeutic dose and when used long-term, BZDs pose potential harmful effects.

This is especially concerning in the elderly, who are at increased risk for psychomotor impairment, car accidents, and cognitive impairment such as anterograde amnesia-diminished short-term recall, and increased forgetfulness [11]. Some additional side effects of concern include aggressive behavior and expressing anger towards others in between 1% and 20% of users [17]. The main driving factor for dependence is the development of tolerance, causing users to need increasing doses for the same symptom relief [18]. Benzodiazepine abuse is common in those on methadone maintenance treatment (MMT), so special consideration must be taken for those withdrawing from the drugs while on MMT [68]. These patients are more likely to die from methadone toxicity because of the synergistic effects of methadone and BZD [68].

Additionally, these patients are more likely to have comorbid substance use disorders and anxiety disorders so it can be harder to find an efficacious treatment for their withdrawal symptoms [68]. One potential candidate for treatment of withdrawal symptoms in these patients is gabapentin, which works similarly to the neurotransmitter GABA [68]. However, one study showed no significant difference in BZD use in MMT patients between gabapentin and placebo [68]. However, how to detox your body while pregnant this study was limited by a small sample size, so further randomized clinical trials need to be conducted to assess the efficacy of gabapentin treatment in BZD -dependent MMT patients [68]. Further studies need to be performed on not just gabapentin, but other medications for MMT patients with BZD dependence should be evaluated since treating them is more complicated. Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States.

1. Factors Influencing Withdrawal Symptoms

Bromazepam has shown itself to be at least as effective as alprazolam as anxiolytic, and a superior sedative. The program provides a supplement to a Pennsylvania can adderall cause heart problems? medication coverage program for low-income older adults. The program provides behavioral health and case management services by telephone across the state.

What are the most commonly prescribed benzodiazepines?

Chronic use may increase your risk for side effects of benzos, like drowsiness, psychomotor impairment, or sedation. Some studies have shown that long-term benzodiazepine use is connected to a higher risk of hip injury in geriatric patients, or older adults above the age of 65. Long-term benzodiazepine use can lead to addiction, physical dependence, and withdrawal symptoms. Food and Drug Administration boxed warnings on their labels highlighting the potential dangers of using these drugs together. Taking opioids in combination with other central nervous system depressants—like benzodiazepines, alcohol, or xylazine—increases the risk of life-threatening overdose.1,2 Learn more about the effects of taking more than one type of drug (polysubstance use) from the U.S.

Many countries, including the U.S., classify benzodiazepines (sometimes known by the slang term “benzos”) as controlled substances. It’s illegal to have or obtain them (depending on the laws where you are) if you don’t have a prescription. Secondly, approximately 20% of the children in the intensive care unit given BZD during sedation, more specifically midazolam, have been shown to exhibit withdrawal effects. The severity of the withdrawal sequelae depends on the total dose and duration of infusion and usually presents as agitation, tremors, difficulty sleeping, and inconsolable crying [60].

Research is needed on provider readiness to offer patients from racial and ethnic minority groups benzodiazepines when indicated, patient preferences for benzodiazepines, and whether lower prescription rates among minority groups offer benefits or harms. In contrast, prescribed benzodiazepine use is higher (10.4%) among the U.S. civilian and noninstitutionalized population (2). The prevalence of long-term prescribing (or of discontinuation) among patients with any benzodiazepine prescription (or with long-term prescriptions) is difficult to compare across samples, because different definitions of long-term prescribing or discontinuation are utilized.