Author: Charles Frank

Benzodiazepines: What They Are, Uses, Side Effects & Risks

what is considered long term benzodiazepine use

Your healthcare provider can tell you more about the laws surrounding prescribing these medications and the recommended schedule for you to return for a follow-up visit. One benzodiazepine that’s noteworthy — even though it’s not approved (and illegal) in the United States — is flunitrazepam. This drug is best known as Rohypnol (or by the slang term “roofies”), and it’s infamous for its use as a “date rape” drug. As a result, flunitrazepam is a well-studied drug in the U.S. (and in many places worldwide). Healthcare providers can test for it and treat people under its influence (see below under “What are the disadvantages, side effects and complications that are possible with benzodiazepines?”). An article published in Neurotherapeutics in 2019 advises doctors to be “very cautious” before prescribing benzodiazepines to older patients and recommends pursuing good sleep hygiene to alleviate the symptoms of anxiety or insomnia.

Dorostkar was one of the lead researchers on an animal study, published in Nature Neuroscience, which demonstrated that the active ingredient in benzodiazepines results in a loss of neural connections in the brain. Exposures  Use of BZDRs, modeled from register-based data using the PRE2DUP (from prescriptions to drug use periods) method. Neuroscience News is an online science magazine offering free to read research articles about neuroscience, neurology, psychology, artificial intelligence, neurotechnology, robotics, deep learning, neurosurgery, mental health and more. The mechanisms by which benzodiazepines trigger these changes had previously been unknown. The strength and duration of action of benzodiazepines are important in what conditions they treat.

Your healthcare provider can tell you more about what you can do to avoid dependence on these drugs or developing benzodiazepine use disorder. Alcohol can interact with these drugs, causing dangerous side effects or complications. There may be other circumstances where you shouldn’t take benzodiazepines with certain foods or beverages.

  1. However, the mechanism by which benzodiazepines might contribute to persistent cognitive decline remains unknown.
  2. As a result, flunitrazepam is a well-studied drug in the U.S. (and in many places worldwide).
  3. After several weeks, they found that the mice had suffered synapse loss and cognitive impairment.
  4. Because benzodiazepines have a higher risk for misuse and can be habit-forming, healthcare providers tend to prescribe them cautiously.

CBT-i is a short-term therapy that typically takes about 6-8 sessions, and studies show that it can be up to 80 percent effective in reducing the symptoms of insomnia. One meta-analysis, published in Sleep Medicine Reviews, found that CBT-i had significant positive effects on insomnia severity, sleep efficiency, and sleep quality. Elderly patients often require lower benzodiazepine doses due to slower metabolism of the drugs. Here we report that diazepam, a widely prescribed benzodiazepine, impairs the structural plasticity of dendritic spines, causing cognitive impairment in mice. Diazepam induces these deficits via the mitochondrial 18 kDa translocator protein (TSPO), rather than classical γ-aminobutyric acid type A receptors, which alters microglial morphology, and phagocytosis of synaptic material.

A Closer Look at the Study

Your healthcare provider can answer questions about whether to change what you eat or drink while taking these medications. It included a large, nationwide cohort of adults initiating BZDR use, which ensured good generalizability. The new-user design with a 2-year washout period was used to define incident users, and the long follow-up time enabled identification of persons who became long-term users somewhat later after the first use. In the opinion of the researchers, the study could have effects on how sleep disorders and anxiety are treated in people at risk of dementia. “Drugs that are known to have no binding affinity to TSPO should be preferred where possible,” say the authors. Because benzodiazepines have a higher risk for misuse and can be habit-forming, healthcare providers tend to prescribe them cautiously.

They may prescribe them only for use as needed, not daily, and they may prescribe lower doses or pick benzodiazepines that aren’t as strong. Your healthcare provider can explain their recommendations for your treatment, including the timeline for which treatments you receive and why. The researchers believe that the study could have effects on how sleep disorders and anxiety are treated in people at risk of dementia. Your healthcare provider will likely recommend that you don’t work or drive right after you start taking benzodiazepines. You may be able to work or drive after you start taking them, depending on how these drugs affect you, the dose you take, how long the drugs last and other factors. Benzodiazepines (sometimes called “benzos”) are a class of psychoactive drugs that may be prescribed for conditions like anxiety, insomnia, and seizures.

It’s all due to a specific protein, known as the mitochondrial 18 kDa translocator protein (TSPO). Benzodizepines bind to this protein on the surface of cell organelles of the microglia (the first immune cells to respond when something goes wrong in the brain). As the study authors explain, these cells are activated, which leads to the deterioration and recovery of synapses (connections between nerve cells).

What is the most commonly prescribed benzodiazepine?

Register-based data do not indicate whether dispensed drugs have actually been used49; this, however, may be a lesser problem than recreational use. The Care Register for Health Care data were based on inpatient care only, and thus, diagnoses may have represented only the most severe cases. For many diagnoses, data from the special reimbursement register were also used, and the register also provides diagnoses from primary care. However, register-based data lack information on severity of diseases and symptoms as well as, for example, smoking, alcohol use, and nutrition, and consequent residual confounding may still exist.

While these medications can treat many conditions and help millions, they’re not without risks. If your healthcare provider prescribes one of these medications, don’t hesitate to ask for guidance, and take the medications exactly as prescribed. That way, you can benefit from these medications and reduce the risk of problems along the way. Cognitive behavioral therapy (CBT) is a form of talking therapy aimed at changing the way a person thinks and behaves, to help reduce symptoms of various mental health conditions, including anxiety disorders. Taking these medications exactly as prescribed makes that unlikely, but it’s still possible.

what is considered long term benzodiazepine use

“CBT-i (cognitive behavioral therapy for insomnia) is a non-medication approach to treating insomnia,” says psychotherapist Annie Miller, LCSW. ADHD indicates attention-deficit/hyperactivity disorder; COPD, chronic obstructive pulmonary disease; DP, disability pension; and HR, hazard ratio. “It was known that microglia play an important role in eliminating synapses both during brain development and in neurodegenerative diseases,” say Dr. Yuan Shi and Mochen Cui, co-authors of the study.

Benzodiazepines bind to a specific protein, the translocator protein (TSPO), on the surface of cell organelles of the microglia. This binding activates the microglia, which then degrade and recycle synapses—that is, the connections between nerve cells. A “spiked” drink, meaning one with a drug added to it without your knowledge, is a threat to anyone, regardless of sex or gender. It’s also important to remember that you may not be able to taste a difference in a spiked drink.

In summary, it is unclear where long-term benzodiazepine use fits into current medical practice. Many patients underestimate the degree of impairment caused by benzodiazepines.8 Benzodiazepines increase the risk of addiction, withdrawal, cognitive decline, motor vehicle crashes, and hip fracture. The risk of overdose is particularly great when combined with sedative drugs such as opioids or alcohol. For these reasons, if used, benzodiazepines generally should not be prescribed continuously for more than one month.

Effect on sleep

Experiments carried out by the scientists showed that the synapse loss in mice that had received a daily sleep-inducing dose of the benzodiazepine diazepam for several weeks led to cognitive impairments. Per the Centers for Disease Control and Prevention (CDC), good sleep hygiene includes several steps. While physicians may still prescribe benzodiazepine and other medications for anxiety and insomnia, other treatment options are available.

Choices made with respect to drugs and drug forms were aimed at excluding BZDR use for epilepsy indication; thus, the results should only be interpreted to nonepilepsy indications. In addition, this study lacked data on whether BZDR use was initiated during hospital care. Benzodiazepines are widely administered drugs to treat anxiety and insomnia. In addition to tolerance development and abuse liability, their chronic use may cause cognitive impairment and increase the risk for dementia. However, the mechanism by which benzodiazepines might contribute to persistent cognitive decline remains unknown. They’re an important means of treating many conditions, ranging from mental health disorders to brain-related diseases.

What can I not eat or drink if I’m taking benzodiazepines?

Psychotherapy and antidepressants are the treatments of choice for anxiety disorders. Short-term medications that can be used for anxiety without risk of addiction include propranolol, anticonvulsants, or major tranquilizers. Finally, insomnia can be treated with trazodone, doxepin, or ramelteon (Rozerem) without risk of rebound insomnia. Unfortunately, it’s also possible with long-term use of these drugs even when you take them as prescribed. If you have concerns about dependence and withdrawal from benzodiazepines, your healthcare provider can help you plan the timeline for your treatment.

When should I see my healthcare provider?

You may require another type of medication if your condition is severe, but in many cases anxiety and insomnia can be managed with non-medicinal therapies. Due to the effect of long-term benzodiazepine use on cognition, several alternatives are available. “These include drugs with different mechanisms of action as well as behavioural approaches, depending on the underlying condition,” says Dorostkar.