Anti-Anxiety Medications (Benzodiazepines) | CAMH

Overview

Anti-anxiety medications help reduce the symptoms of anxiety, such as panic attacks or extreme fear and worry. The most common anti-anxiety medications are called benzodiazepines.

Benzodiazepines are a group of medications that can help reduce anxiety and make it easier to sleep. They are also used as a muscle relaxant, to induce sedation for surgery and other medical procedures, and in the treatment of seizures and alcohol withdrawal. Benzodiazepines are also called minor tranquillizers, sedatives or hypnotics. They are the most widely prescribed psychoactive drugs in the world.

The calming effects of benzodiazepines can often be achieved without drugs.

Various kinds of exercise, such as walking, running, yoga or tai chi can help, as can reducing the stress in your life and taking time for relaxing activities such as meditation, reading a book or having a warm bath. Talking with a trusted friend, family member or therapist and working out the problems that are troubling you can also help. Whenever possible, these approaches should be tried first, before benzodiazepines. However, when non-drug approaches are not possible or do not help, benzodiazepines can provide relief.

When used appropriately, benzodiazepines are safe and effective drugs. They do, however, have potential for abuse and can be addictive. For this reason, they are usually only recommended for short-term or occasional use.

Do I need this treatment?

A certain amount of anxiety or insomnia is a normal reaction to what is happening in your life. You may worry or feel stressed, and sometimes these feelings can keep you up at night. Most often, these feelings pass and are not a problem. However, these feelings can become a problem when they continue over a longer term, cause severe distress, make you feel physically ill and affect your behaviour. This kind of anxiety may be triggered by a challenging life event. It can also be a symptom of a mental health problem.

The ability to fall asleep and to sleep through the night can be affected by many types of health problems. These include physical conditions that cause pain or trouble breathing, as well as mental health problems. When sleep is disrupted, health can be further affected.

While each situation is unique and different treatment approaches may be called for, benzodiazepines can help to provide relief.

What does Anti-anxiety Medications (Benzodiazepines) do?

Benzodiazepines enhance the activity of the neurotransmitter GABA—a chemical in the brain that helps you to feel calm. Their effect also produces drowsiness, making it easier to fall asleep and sleep through the night.

Side effects of Anti-anxiety Medications (Benzodiazepines)

The side-effects of benzodiazepines are generally mild and may not be noticed when these drugs are used at low doses.

Common side-effects include:

• drowsiness
• sedation
• dizziness
• loss of balance.

At higher doses, side-effects can include:

• confusion
• disorientation
• amnesia
• breathing difficulties
• depression.

Other possible effects, which are extremely rare, include agitation, hallucinations and nightmares. Reducing the dose can help to reduce side-effects.

Benzodiazepines can make it harder to learn and remember new information and to do certain physical and mental tasks. These abilities return to normal once the effect of the drug wears off.

When used to help you get to sleep, benzodiazepines can have some “hangover” effects, such as morning and daytime drowsiness.

Types of Anti-anxiety Medications (Benzodiazepines)

Many types of benzodiazepines are available in Canada. All benzodiazepines work the same way; however, the intensity and duration of their effects vary.

Benzodiazepines most commonly used to treat anxiety disorders are clonazepam (Rivotril)*, alprazolam (Xanax) and lorazepam (Ativan). Also used are bromazepam (Lectopam), oxazepam (Serax), chlordiazepoxide (once marketed as Librium), clorazepate (Tranxene) and diazepam (Valium).

Benzodiazepines used for the treatment of insomnia include lorazepam (Ativan), nitrazepam (Mogadon), oxazepam (Serax), temazepam (Restoril), triazolam (Halcion) and flurazepam (Dalmane).

Another drug used for insomnia is zopiclone (Imovane). This drug is similar to benzodiazepines and has similar side-effects. Zopiclone may have less abuse potential than some benzodiazepines; however, people can still become addicted to this drug.

Benzodiazepines are available in the form of tablets or capsules, which are taken by mouth. Some are also available as a sublingual tablet, which is dissolved under the tongue, or as a solution for injection.

* Medications are referred to in two ways: by their generic name and by their brand or trade names. Brand names available in Canada appear here in brackets. For example, alprazolam (Xanax) and lorazepam (Ativan).

Frequently Asked Questions

How long should I take benzodiazepines?

For most people, benzodiazepines are helpful only as a temporary measure, to be used only in the following ways:

• on occasion, to help you sleep or when anxiety can’t be managed with non-drug approaches
• daily, for up to a few weeks, to help re-establish sleep patterns or to reduce anxiety while waiting for an antidepressant or other treatment to take effect.

Some people may continue to use benzodiazepines for longer, even months or years. Some do so because they continue to find these drugs helpful and have agreed with their prescribing physician that the benefits of continuing to use them outweigh the risks. There are also those who continue to use benzodiazepines over a longer term because the prescribing doctor has not re-examined their continued use. In this instance, ask another doctor to review your prescription.

Are benzodiazepines addictive?

When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction. This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted.

Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence.

Physical dependence: When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug. This is known as physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance and withdrawal.

Tolerance: People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. With benzodiazepines, it is known that:

• Tolerance to the sleep-inducing effects may develop within a few weeks of regular use; however, tolerance does not usually develop with occasional use.
• Tolerance to the anxiety-relieving effects is less likely to develop.
• Tolerance to the effects of one type of benzodiazepine leads to tolerance to other benzodiazepines, and to other drugs with similar effects, including alcohol.

Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug. These people may find it difficult to stop using benzodiazepines.

Withdrawal: Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly. Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite. Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and they may continue for two to four weeks or longer.

How do I safely use benzodiazepines?

Take only as directed by your doctor; do not increase your dose.

Once you have slept well for two or three nights in a row, try to get to sleep without taking the medication.

If you have been taking benzodiazepines regularly for a few weeks or more, check with your doctor before reducing or stopping your medication.

How do I cut down or stop taking benzodiazepines?

Most often, benzodiazepines are prescribed to help people get through stressful situations or to provide relief while waiting for other treatment to take effect. When used in this way, on occasion or daily for a few weeks, most people can stop taking them without difficulty or withdrawal effects.

Stopping use can, however, be hard for some people, even when the use is short term. Problems are most likely to occur when:

• the issues that caused you to take these drugs in the first place have not yet been dealt with
• no other medication or talk therapy has been started.

People who wish to stop using benzodiazepines after using them regularly over a longer term will need to cut back their use gradually over an extended period of time. This approach reduces withdrawal effects and helps ensure success in stopping. Because the ideal process for cutting down varies depending on the benzodiazepine you are taking, the dose and the length of time you have been taking it, ask your doctor to help you set up a schedule. If the long-term use has been at high doses, stopping use requires medical supervision.

Will benzodiazepines interact with other medications?

These drugs may interact with other medications. If your doctor or dentist prescribes any medication, inform him or her about the drug you are taking. Check with your pharmacist before using any over-the-counter medication, including herbal products, cold or allergy tablets, or cough syrups.

When taken on their own, the risk of overdose with benzodiazepines is low; however, combining these drugs with other sedatives, such as alcohol, or with medications containing codeine or other opioid drugs, can result in overdose and possible death. Symptoms of overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness.

What if I drink alcohol or coffee while taking benzodiazepines?

Benzodiazepines can be dangerous when combined with alcohol. Benzodiazepines increase the effects of alcohol, making you more sleepy, dizzy or lightheaded. One danger of this is the increased risk of stumbling, falling and related injuries. Another is the increased risk of overdose. Both alcohol and benzodiazepines slow down the central nervous system, which controls breathing. In overdose, breathing can stop.

Drinking too many caffeinated beverages (i.e., more than four cups of coffee or six cups of tea daily) may counteract the anxiety-reducing effects of benzodiazepines.

What if I use street drugs while taking benzodiazepines?

If you are taking benzodiazepines to help reduce the distress of a mental health problem, chances are that you want to feel less anxious and get a good night’s sleep. Street drugs, such as marijuana or cocaine, have effects that can worsen symptoms of anxiety and interfere with sleep—making you feel worse, rather than better.

Taking benzodiazepines to enhance the effect of other sedative drugs, such as opioids, is dangerous and increases the risk of overdose and injury.

Will benzodiazepines affect my ability to drive safely?

Benzodiazepines can affect your ability to drive a vehicle and increase the risk of a crash, especially if taken in combination with alcohol or other sedative drugs. The risk is highest when you first start taking benzodiazepines, before you are used to their effect. Avoid driving or operating other machinery if you feel drowsy or slowed down.

Will benzodiazepines affect my sex drive and function?

There is no clear evidence that benzodiazepines have any effect on sex drive or function.

Is it safe to take benzodiazepines while pregnant or breastfeeding?

The risk of birth defects from taking benzodiazepines while pregnant is not known, though it is thought to be very small. If benzodiazepines are used regularly close to the delivery date, the baby may be born drowsy or may have withdrawal symptoms such as restlessness and feeding problems.

Small quantities of benzodiazepines can be passed through breast milk from the mother to the baby. This may cause drowsiness in the baby.

If you are pregnant or breastfeeding, or thinking about becoming pregnant, talk to your doctor about the risks and benefits of continuing or stopping benzodiazepines. If your doctor recommends that you stop taking benzodiazepines, he or she will help you to slowly reduce your dose over time, to avoid withdrawal symptoms.

Can children and teens use benzodiazepines?

Benzodiazepines are not recommended for use by children and teens, except to bring sedation prior to surgery or for brief medical procedures. Extra caution should be used when considering giving benzodiazepines to children as these drugs may cause children to become irritable rather than calm.

Can older adults use benzodiazepines?

Sensitivity to the effects of benzodiazepines increases with age. When older adults take these drugs, they may become confused and have reduced muscle co-ordination, putting them at greater risk of falls, hip fractures and motor vehicle crashes.

If an older person has been taking benzodiazepines regularly for a very long time, the process required to stop taking them may be long and difficult. In some cases, a doctor may decide to leave the older person on the medication, with regular assessment of daytime side-effects.

Copyright © 2009, 2012 Centre for Addiction and Mental Health

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Additional Resources

• For more information on medications, contact your doctor, nurse or pharmacist.
• Anxiety Disorders: An Information Guide
  
  (PDF)
• A free tutorial on anxiety disorders is available on the Mental Health 101 page.

SSRIs and Benzodiazepines for General Anxiety Disorders (GAD)

Angela F. Gomez, MA

Angelina F. Gomez, M.A. is a doctoral student in clinical psychology at Boston University, working with Dr. Stefan Hofmann. Her research focuses on mindfulness-based treatments for anxiety, depression and trauma; understanding the neurobiological basis of adult psychopathology from trajectories of change throughout childhood and adolescence; and developing novel technology-based platforms to disseminate evidence-based treatments to underserved populations. She is passionate about helping individuals understand their mental illness and take empowered steps to live a life of fulfillment.

Stefan G. Hofmann, PhD

Stefan G. Hofmann, PhD is Professor of Psychology at the Department of Psychological and Brain Sciences at Boston University. He has been president of numerous professional organizations and is currently editor-in-chief of Cognitive Therapy and Research. He has been included in the list of Highly Cited Researcher and received many other awards, including the Aaron T. Beck Award for Significant and Enduring Contributions to the Field of Cognitive Therapy and the Humboldt Research Award. His research focuses on the mechanism of treatment change, translating discoveries from neuroscience into clinical applications, emotion regulation, and cultural expressions of psychopathology. He has published more than 400 peer-reviewed journal articles and 20 books, including his recent self-help book, The Anxiety Skills Workbook.

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May 26, 2020

SSRIs and Benzodiazepines for General Anxiety Disorders (GAD)

Feeling anxious, worried, and tense? You are not alone! Anxiety disorders are the most common mental illness in the US, and General Anxiety Disorder (GAD) affects 6.8 million adults (or 3.1% of the population) every year (https://adaa.org/understanding-anxiety/facts-statistics). When feeling overwhelmed with worries and tension, the first step many people take is to ask their doctors about medication. If you struggle with GAD, and are thinking about starting medication, here is some information about two of the most commonly prescribed types of medication: SSRIs and benzodiazepines.

Selective Serotonin Reuptake Inhibitors (SSRIs) include medications such as Zoloft (sertraline), Prozac (fluoxetine), Celexa (citalopram), and Lexapro (escitalopram). These medications work on serotonin, an important neurotransmitter that plays a role in feelings of well-being and happiness, as well as thinking, memory, sleep, digestion, and circulation. SSRIs are currently considered the first-line medication for many forms of anxiety. If you are considering starting an SSRI, here are some important things to consider:

• Many people describe SSRIs as “turning the volume down” on their anxious thoughts. This can also help you engage more with psychotherapy and other wellness-related activities such as mindfulness.
• SSRIs may also reduce the physiological symptoms of anxiety (sleep, muscle tension, headaches).
• SSRIs are antidepressants; so if you struggle with depression as well as GAD, these medications can help with both.
• SSRIs need to be built up in your system slowly. Your doctor will recommend a gradual increase in dosage over the course of 4-8 weeks. It may therefore take a while before you experience full, consistent effects on anxiety reduction.
• When first starting SSRIs, you may experience some unpleasant side-effects, though these usually diminish or go away after 4-8 weeks. Some possible side-effects include nausea, diarrhea, insomnia, drowsiness, headache, dry mouth, dizziness, restlessness, and problems with sexual arousal.
• SSRIs are relatively safe for long-term use, and are not addictive. It is hard to overdose on SSRIs, and they are thus considered safe for individuals with severe suicidal tendencies. While it is not recommended to mix SSRIs with alcohol, this is rarely a toxic combination.
• Stopping abruptly (“cold turkey”) from SSRI treatment can throw your brain into a state of imbalance that leads to cognitive and physiological symptoms that are much worse than before. Some symptoms of rapid SSRI discontinuation include fever, nausea, panic attacks, hallucinations, vivid dreams, and impaired coordination. This can be quite dangerous, so check with your doctor before changing the dosage of your SSRI

Benzodiazepines (sometimes called “benzos” or “minor tranquilizers”) include medications such as Xanax (alprazolam), Ativan (lorazepam), and Valium (diazepam). These medications strengthen the effect of the neurotransmitter GABA, which is the primary inhibitory (“turn off”) signaler in the brain. GABA plays a role in sleep, feeling calm, muscle relaxation, and reduction in brain activity. If you are considering starting a benzodiazepine, here are some important things to consider:

• Benzodiazepines reduce the intensity of physiological symptoms of GAD, such as muscle tension, headaches, panic attacks, sweating, insomnia, and restlessness.
• Benzodiazepines may also reduce the cognitive symptoms of anxiety, such as worry and rumination.
• Benzodiazepines are fast-acting, but do not stay in the system very long. Thus, people often experience immediate anxiety relief, which lasts for a few hours. This temporary relief of anxiety may help you complete important life tasks that you have been avoiding (e.g. giving a presentation, interviewing for a job, or travelling to see family).
• Overall, people report relatively few bothersome side effects when taking benzodiazepines; some possible side-effects include drowsiness, confusion, dizziness, depression, impaired coordination, and vision problems.
• Benzodiazepines are not considered safe for continuous use, as this can increase risk for physical dependence (addiction). Furthermore, mixing benzos with alcohol can be very dangerous. They are also not recommended for people with severe suicidal or addictive tendencies, or a family history of addiction.

So what’s the take-home message? SSRIs are considered the first-line medication for GAD, and will typically be prescribed first. Benzodiazepines are considered a second-line or adjunctive medication for GAD, though are still prescribed frequently, especially when a person complains of panic attacks, sleep problems, severe muscle tension, or avoidance of specific situations due to anxiety. Depending on your symptoms, your doctor may recommend starting both an SSRI and a benzodiazepine, and then tapering off the benzodiazepine after 2-4 weeks. This may help you tolerate the initial unpleasant side-effects of SSRIs, while limiting the risks of longer-term benzodiazepine use.

Regardless of who you are or your thoughts on these medications, here are some essential things to know and do when taking medication:

• Make sure you describe your specific symptoms with your provider. Rather than only saying “I’m anxious,” describe in more detail the most frequent and bothersome symptoms you are experiencing, and in what contexts these symptoms disrupt your life.
• Tell your doctor if you struggle with suicidal thoughts, addiction, and/or cognitive impairment, or if these conditions run in your family.
• Communicate with your doctor during the first few weeks/months of taking medications, so they are aware of any side-effects or other contraindications.
• Always take your medication as prescribed, as deviations may lead to worse symptoms and will not help you know whether the medication is working for your anxiety.
• Always consult with your doctor before stopping any medication. Do not withdraw cold-turkey or change your dosage on your own.
• Consider psychological treatment as well as medication; if your provider does not suggest this, ask for recommendations. The most effective psychological treatment for GAD is cognitive behavioral therapy (CBT). Mindfulness-based therapies, such as yoga, can also be beneficial.

Angela F. Gomez, MA

Angelina F. Gomez, M.A. is a doctoral student in clinical psychology at Boston University, working with Dr. Stefan Hofmann. Her research focuses on mindfulness-based treatments for anxiety, depression and trauma; understanding the neurobiological basis of adult psychopathology from trajectories of change throughout childhood and adolescence; and developing novel technology-based platforms to disseminate evidence-based treatments to underserved populations. She is passionate about helping individuals understand their mental illness and take empowered steps to live a life of fulfillment.

Stefan G. Hofmann, PhD

Stefan G. Hofmann, PhD is Professor of Psychology at the Department of Psychological and Brain Sciences at Boston University. He has been president of numerous professional organizations and is currently editor-in-chief of Cognitive Therapy and Research. He has been included in the list of Highly Cited Researcher and received many other awards, including the Aaron T. Beck Award for Significant and Enduring Contributions to the Field of Cognitive Therapy and the Humboldt Research Award. His research focuses on the mechanism of treatment change, translating discoveries from neuroscience into clinical applications, emotion regulation, and cultural expressions of psychopathology. He has published more than 400 peer-reviewed journal articles and 20 books, including his recent self-help book, The Anxiety Skills Workbook.

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Benzodiazepines are – causes, symptoms, signs, stages, effects, treatment

Benzodiazepines are psychoactive drugs with anti-anxiety, sedative, and hypnotic effects. They are prescribed for the treatment of anxiety disorders, insomnia, epilepsy and drug/alcohol withdrawal.

Dependence on benzodiazepines develops with uncontrolled use of the drug. The main danger of this form of pharmacy drug addiction lies in the unpredictable consequences of use and severe withdrawal symptoms.

Benzodiazepines – description, composition, effect, property

Abuse of benzodiazepines is one of the most common problems in the field of drug addiction. Its characteristic feature is the multitude of socially prosperous middle-aged and elderly patients.

Many patients with addiction use drugs of this group on the recommendation of a psychotherapist.

At the same time, pathology is also found among young people, as well as in people who regularly take illegal substances and alcoholic beverages.

Benzodiazepines do not develop such a pronounced craving as barbiturates or other hard drugs. With the abolition of the drug, withdrawal syndrome develops. But the main problem in the development of addiction is not withdrawal, but the possible consequences: lethargy, weakening of the reaction, severe drowsiness. Due to the decrease in attention and inhibition of the reaction, the likelihood of becoming a participant in an accident or getting a serious injury at work increases. With prolonged use of the drug, the patient experiences personality changes. He becomes selfish, callous, easily violates moral standards.

Benzodiazepines are drugs that have hypnotic, anti-anxiety, and sedative effects. They also relax the muscles and prevent cramps. Medicines belonging to this category are used to combat the physiological and psychological symptoms of anxiety, which is accompanied by pathological manifestations of the muscles (convulsions, twitches), autonomic signs (palpitations, severe sweating, heaviness in the stomach), fears, alertness . ;

Over the past 10 years, due to the busy rhythm of life and constant stress, panic attacks and anxiety have become widespread. Benzodiazepines are considered the safest medications that have been effective in managing all the symptoms of anxiety. They are characterized by low toxicity, do not cause movement disorders at therapeutic doses, and are less likely to provoke addiction.

Benzodiazepines were most widely used in the late 1950s and 1960s. According to statistics, today they take the 2nd place in terms of frequency of use after cardiovascular drugs. In addition to the anti-anxiety effect, benzodiazepines have an anticonvulsant effect, so they are often prescribed for stress, insomnia and panic conditions.

The effect of the drug on the human body

Benzodiazepines inhibit the central nervous system by acting on GABA receptors that inhibit the functions of the central nervous system and the limbic system of the brain. Next to GABA are benzodiazepine receptors that respond to medication and enhance the work of GABA. The drug is rapidly absorbed, reaching a maximum concentration in the body 60 minutes after ingestion. The drug acts for about 8-10 hours, it is excreted within 2-4 days.

Dependence develops with a constant overdose of the drug or as a result of prolonged use. Often it seems to the patient that the therapeutic dosage is not enough and he begins to constantly increase the number of pills taken, hoping to get rid of unpleasant symptoms. Pathological craving for the drug is often diagnosed with long-term use, so if prolonged therapy is required, then the medication is prescribed in intermittent courses. Some patients are afraid that the negative symptoms will return and continue to use the substance even during the break.

Benzodiazepines are symptomatic drugs that help relieve anxiety, but do not affect the cause of it. If in the process of planned use the patient did not eliminate the source of the problem, then when the medication is canceled, the negative manifestations will return again. This pushes people to keep taking the pills even after the expiration date given by the doctor. Dependence on benzodiazepines develops after 6-8 weeks of continuous use. Withdrawal, coupled with the return of anxiety and fears, stimulate the patient to continue taking.

There is another option – some people initially use the medication to experience euphoria. Sometimes they deliberately feign signs of any pathology in order to get a prescription for the drug. In large cities, you can buy a prescription drug on the “black market”. Uncontrolled use is usually combined with multiple excesses of the therapeutic dosage. Often in practice, physicians are faced with combined dependence on benzodiazepines and other types of psychoactive substances, which develops as a result of the patient’s attempts to increase the euphoric effect or get rid of withdrawal from alcohol or cocaine.

Signs of addiction

The clinical picture of benzodiazepine abuse resembles that of barbiturate intoxication. When taking the main part of the drugs included in this category, a person manifests drowsiness, inhibition of the reaction, problems with coordination. In some cases, there may be an improvement in mood, instability of the emotional background, excessive fussiness and unmotivated activity. In this case, the patient’s reaction speed decreases and the clarity of perception decreases.

The patient resembles a person who is in a state of intoxication. In the process of walking, they stagger, cannot pick up any object, speech becomes slurred. Perhaps the obsessive repetition of one phrase, movements or emotions. The pupils are dilated, the skin is pale, a white coating is visible on the tongue, the mucous membranes are dry, the muscle tone is reduced.

A few hours after taking the drug, intoxication subsides, the patient experiences weakness and apathy. Patients often fall asleep after the drug wears off. Residual effects of benzodiazepines disappear within 24 hours. With regular use, tolerance to the drug increases, respectively, to obtain initial sensations, an increase in dosage is required. Impaired coordination of movements becomes less pronounced. The rest of the symptoms persist, but the duration of the after-effects increases – a breakdown and indifference. The likelihood of tearfulness and irritability is high.

When using a large amount of the drug, a violation of consciousness and moments of excitement, which are accompanied by illusions, are possible. In rare cases, psychosis develops, the clinical picture resembling delirium. An overdose is characterized by a progressive impairment of consciousness, respiratory depression, interruptions in the work of the cardiovascular system.

The benzodiazepine withdrawal syndrome is accompanied by a complex of somato-neurological and mental abnormalities. The patient is diagnosed with tachycardia, drop in blood pressure, excessive sweating, tremor of the limbs and dyspeptic disorders. Fever, severe headaches and dizziness are possible. Deviations in the mental and psycho-emotional state are accompanied by severe fatigue, depression, sleep problems, and anxiety.

Withdrawal symptoms also include:

• aches in the bones;
• intolerance to bright light and loud sounds;
• increased pressure in the eyes;
• problems with urination;
• diarrhea;
• lack of appetite;
• head tremor;
• visual and auditory hallucinations;
• fever.

The duration of the withdrawal syndrome when the drug is discontinued is from 2 to 3 weeks. In some cases, individual symptoms may persist for several months. Withdrawal may be accompanied by convulsive seizures. There is a possibility of developing psychosis with a violation of consciousness, a decrease in the emotional background, visions and pronounced anxiety.

It is very difficult to cope with withdrawal symptoms on your own.

Since the likelihood of seizures and suicide attempts is high, it is better to undergo the withdrawal procedure in a hospital under the supervision of doctors. Specialists monitor the patient’s condition around the clock and, if necessary, can provide him with prompt assistance.

If the patient uses the drug for a long time, then this can provoke a personality disorder. Memory suffers, intelligence decreases, facial expressions become poor. The face of the addict is more like a mask, the movements and pace of speech are inhibited. Such patients are characterized by selfish behavior, cruelty, negative attitude towards others. Working capacity falls sharply, a person does not tolerate any intellectual and physical stress.

How long does the drug stay in the body

Uncontrolled intake of drugs leads to a deterioration in the general well-being of the patient, which increases with time. With prolonged use of the substance, active elements remain in the body that block the normal functioning of internal organs and systems. How much a benzodiazepine is excreted from the body depends on several factors:

• metabolic rate;
• term of use;
• dosage;
• the rate of disintegration of the drug;
• individual characteristics of the organism.

In the blood, the drug is kept for a long time, but gradually its concentration decreases. On average, it takes 3 days to completely cleanse the body of the remnants of the product. During this period, the patient is not recommended to drive a car and engage in activities that require increased attention.

When ingested, the drug passes through the liver, and then is excreted along with urine. The duration of the substance in the urine depends largely on the type of medication. Many drugs are completely eliminated during the detoxification process, others are kept in urine and blood for several days. On average, metabolites of the drug can be detected in the urine for 3-4 days.

Types of drug dependence

The classification of benzodiazepines implies the division of all drugs into several groups:

1. With anti-anxiety action. Medicines have an anxiolytic effect: they reduce excessive excitability, eliminate panic states, and normalize self-control in stressful situations. This category includes drugs such as Lorazepam, Phenazepam, Clonazepam.
2. Sedatives. They weaken the severity of the reaction to external stimuli, slowing down their intensity, and slow down mental activity.
3. antiphobic drugs. Prevent panic attacks and stop fears.
4. Means with a vegetative-stabilizing effect. They normalize the work of the autonomic nervous system, preventing the development of psychosomatic abnormalities against the background of stressful situations and excessive anxiety.
5. Central muscle relaxants. Relax the body, eliminate the increased tone and tension of the muscles of the skeleton.
6. With hypnotic effect. They are prescribed for the treatment of insomnia and other sleep disorders. Improve the quality of sleep, accelerate falling asleep, prevent constant night awakenings. These include: Temazepam, Brotizolam, Loprazolam.
7. With anticonvulsant action. This category includes medicines that are prescribed in the treatment of serious convulsive syndromes (Lorazepam, Diazepam, Chlorasalate).

Benzodiazepines should be taken only on the advice of a doctor and adhere to the indicated dosage. With prolonged use, the effect of the drugs weakens. If you do not change the drug in a timely manner, then there is a high probability of developing dependence.

In no case do not prescribe the course and dosage of the drug yourself.

All benzodiazepines are tranquilizers. Most often, patients experience such consequences from benzodiazepines as: weakening of concentration, drowsiness, impaired short-term memory, muscle weakness. Long-term use of drugs leads to mental and cognitive abnormalities.

Do not combine benzodiazepines with alcohol. Such a cocktail is very dangerous for health, since the substances enhance each other’s action. With increasing tolerance, the dose of both alcohol and pills increases rapidly. The “inhibited” central nervous system cannot respond in a timely manner to vomiting in case of poisoning, to respiratory depression and other manifestations of an overdose of benzodiazepines. Often, the intake of such a mixture leads to death.

It is dangerous to take drugs together with narcotic psychostimulants. The heart may not withstand a strong load and stop. A mixture of barbiturates and benzodiazepines depresses the respiratory center. If you break the recommended dosage, which is what addicts often face, then there is a high risk of death as a result of respiratory arrest. A combination of sleeping pills with opiates can lead to death.

Long-term use of the drug and a regular increase in dosage leads to poisoning with benzodiazepines. The following symptoms will help to recognize intoxication: vomiting, anxiety, delirium, visions, confused speech, drowsiness. In acute poisoning, there is a strong decrease in pressure, due to which the patient may fall into a coma. There is also a high chance of stopping breathing and slowing the heartbeat. Such patients urgently need mechanical ventilation.

Treatment

The biggest problem in benzodiazepine addiction treatment is drug withdrawal. In elderly patients with a sharp withdrawal of the drug, a stroke or heart attack may occur. With polydrug addiction, there is a strong load on the body, since the patient has to eliminate withdrawal from several substances at the same time. Most experts agree that benzodiazepines should be phased out gradually.

Dose reduction is not effective in all situations. If you practice this option at home, then there is a chance of a breakdown. The patient gets tired of dealing with negative symptoms and again increases the dose to get rid of it. In such a situation, the cancellation process can drag on for many years. That is why pharmacy drug addicts are advised to undergo a course of therapy in a hospital, which will avoid relapse and gradually get rid of physical dependence.

Another method of therapy that is often used in practice is detoxification. But this method has a number of contraindications, for example, the presence of diabetes or cirrhosis of the liver. Cleansing the body of a drug is not a full-fledged therapeutic course. The patient needs long-term psychotherapy. Sometimes pharmacotherapy is used to correct the mental and emotional state.

Treatment for benzodiazepine addiction begins with a detailed diagnosis. Based on the results obtained, doctors draw up an individual therapy regimen for each patient. Conducting a biochemical analysis allows you to identify the cause of uncontrolled intake of the drug. The tendency to dependency is formed due to the lack of “happiness hormones”. In other words, the human body does not synthesize neurotransmitters in sufficient quantities: dopamine, endorphin serotonin. As a result, the patient begins to look for options for “compensation” in order to feel happy. Benzodiazepines give the patient these emotions for a while.

Detoxification is not able to change the state of neurotransmitters, therefore, without biomolecular therapy, the patient will again seek salvation in narcotic substances. Based on the analysis, the specialist finds out which neurotransmitter is missing in the body and draws up a course of biomolecular drugs that normalize the emotional state and reduce drug cravings.

After the elimination of physical problems, the rehabilitation stage begins, which includes mental recovery. Each patient is offered a special program that will help determine the cause of the development of addiction. Also, the specialist will teach you how to cope with stressful situations without dangerous “doping”. Classes are conducted in individual and group form. It is equally important to normalize relations within the patient’s family and restore broken ties. Since in the absence of support from loved ones, the likelihood of relapse increases several times. The duration of rehabilitation ranges from several months to a year or more – the terms are individual, it all depends on the experience of drug addiction, the state of the body, the level of socialization and the characteristics of the patient’s character.

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Literature:

1. Ed. Tiganov A.S. Substance abuse caused by the abuse of tranquilizers. Exogenous mental disorders. Chapter 52

2. Benzodiazepines. Wikipedia.
3. Agibalova T. V., Altshuler V. B., Vinnikova M. A. Federal clinical guidelines for the diagnosis and treatment of withdrawal symptoms. June 2014.
4. Bondar M.V., Domoratsky O.E. — Benzodiazepines in the practice of an emergency medicine physician // Emergency Medicine, 2013.
5. Levin O.S., Lyashenko E.A. — Anxiety and comorbid conditions // Nervous diseases, 2016.
6. Gurov V.A., Medvedev V.E. — Anxiety disorders in general medical practice: clinical and therapy aspects // Archives of Internal Medicine, 2011.

Antidepressants and benzodiazepines for panic disorder in adults

Why is this review important?

Panic disorder is common in the general population. It is characterized by spontaneous panic attacks, attacks of fear or anxiety with a rapid onset, accompanied by other symptoms (physical sensations and obsessive fear). Panic disorder treatment most often involves talking therapy and medication, usually in combination. Most often, patients are prescribed antidepressants and benzodiazepines. Evidence of their effectiveness in comparison with each other is unknown. It is important to find out whether antidepressants and benzodiazepines are effective in treating panic disorder and how well they are tolerated.

Who will be interested in this review?

Patients and practitioners.

What questions should this review answer?

The purpose of this review is to answer the following questions.

How do different antidepressants compare to benzodiazepines?

What is the comparison of tolerance between different antidepressants and benzodiazepines?

How many adverse effects do different antidepressants and benzodiazepines have compared to each other?

What studies were included in this review?

We searched electronic databases for all relevant studies up to September 2015. To be included in this review, studies had to be randomized controlled trials comparing antidepressants and benzodiazepines in adults diagnosed with panic disorder. We included 35 studies with 5365 participants in this review.

What does the evidence from this review suggest?

We found no significant differences between antidepressants and benzodiazepines in terms of efficacy and tolerability. There was not enough information to compare any differences in terms of adverse effects. However, the results obtained are limited for a number of reasons: a small number of studies to analyze, funding of some studies by pharmaceutical companies, and evaluation of only short-term outcomes. The quality of the available evidence was predominantly low. This means that further research is very likely to influence these results.

What should be done next?

Direct comparison studies with larger samples and less risk of bias are needed. Attention should be paid to long-term outcomes to establish whether the effect is transient or long-term. There is a need to more fully report any harm (negative effects) in participants during trials.