Facts about Benzodiazepines

xanax
The Xanax bar is  one of the most sought after “benzos”, for recreational use (a.k.a. abuse).
  • Benzodiazepines include medications such as clonazepam (Klonopin), alprazolam (Xanax), diazepam (Valium), lorazepam (Ativan), clorazepate (Tranxene), estazolam (Prosom), and chlordiazepoxide (Librium).  There are many other medications in this class, but those listed are the most commonly prescribed.
  • The benzodiazepine class of medications have been around for approximately 70 years. The first benzodiazepine, Librium (chlordiazepoxide), was discovered in 1955.  Valium was the next to become available, a few years later, in 1963.  When first created, benzodiazepines offered many improvements to the sedatives prescribed at that time, the barbiturates.  The most noteworthy improvement was the reduction of severe respiratory depression, which had been a real problem with barbiturates.  Many overdoses, and suicides, had been attributed to the barbiturate medications, during the 1950’s to 1960’s, due to their tendency to cause respiratory arrest.

ad for benzo towards women

  • As you can see, from the above antique advertisement for a benzodiazepine medication (oxazepam), the pharmaceutical companies promised these medications would offer relief from anxiety for the overwhelmed housewife.  Much of the marketing, for this class of medication, was designed to appeal to women.  The drug initially seemed to be marketed as a “cure all” for the normal stress, (and possible boredom), that the housewives during their era dealt with.  Remember, during this time period, the majority of women were at home, while men went off to work.  “Happy wife, happy life”… husbands did not seem to be against the use of this “amazing” new medication (a.k.a. the “happy pill” or “peace pill” during that era).
  • Furthermore, the medical community initially gave the benzodiazepines a warm reception.  This is not the case today.  A lot has changed in the years since benzodiazepines were first introduced, both negative and positive changes.  Regardless, the benzodiazepines were very popular, and liberally prescribed, during their incipient introduction.  As evidenced by the number of prescriptions that were written, many medical providers and/or patients, viewed the benzodiazepines as a “miracle cure” for conditions related to stress and anxiety.  In the 1970’s, benzodiazepine medications were at the top of the list for the most frequently prescribed medications (Tone, 2009).

mint_mothers_little_helper

  • One interesting tidbit I found, discussed a sedative type drug called Miltown (meprobamate). It was not technically a benzodiazepine, but rather a carbamate based minor tranquilizer, used to relieve anxiety.  However, it is interesting to note the popularity of these “sedative” type drugs, among the women of the time period, especially the housewife. Statistics show that this drug was extremely popular, and was ironically dubbed as the “mother’s little helper”.  By 1957, Americans had filled 36 million prescriptions for Miltown, more than a billion pills had been manufactured, and these popular “peace pills” accounted for one third of all prescriptions (Tone, 2009).

Benzodiazepines in our current era:

  • Skip forward to 2017, today benzodiazepines are still very helpful in the treatment of anxiety disorders.  However, in the years since their debut, the medical community has become increasingly aware of the potential for misuse, psychological addiction, and physiological dependence, associated with the use of benzodiazepines.  Additionally, many people did begin illicitly using these medications, or abusing their prescriptions.  Unfortunately, the risk for abuse, physical dependence, and/or addiction, has now become an almost paralyzing fear for medical providers.
  • Despite all of this, the benzodiazepines are still a very efficacious medication for the treatment of anxiety, as well as control of seizures.  It is very important for health care providers to be able to find a balance between prescribing this, very effective, medication to those individuals who will benefit from it, and keeping it out of the hands of those who are seeking to misuse the drug.
  • Those who are seeking to misuse the benzodiazepines also need to understand the damage they are causing, not just to themselves, but to others as well.  Misuse of any drug contributes to making it difficult for people, who really would benefit from these medications, to be able to have access to them. Some of these medications are potentially life changing for some people. We all need to think about how our actions can potentially affect others in a negative way.
  • Unfortunately, when a person  is caught in the cycle of addiction, thinking of others in not in the forefront of their thoughts.  This is understandable, due to the hold that drugs can have on people, once addiction has set in.  However, if you are considering abusing this medication, take a look at a couple examples of what it is like for a person who may truly need this type of medication. Please refer to these articles and be thankful you don’t have these conditions!   When Home Becomes a Prison and When the past won’t let go…
  • Many people live with debilitating anxiety disorders and their quality of life could be greatly improved by a low dose benzodiazepine.  However, again too many are denied this treatment due to the medical providers fear of liability related to addiction.  This is somewhat understandable due to our current culture of addiction, however the majority of patients with true anxiety are not looking for a drug of abuse, but rather relief from a real disorder.
  • Unfortunately, the Selective Serotonin Re-uptake Inhibitors (SSRI’s) have become the standard treatment for any form of anxiety.  While the SSRI’s may help in some cases, they do not help with episodes of acute anxiety, that often still occur, especially during initial induction of treatment with an SSRI, or similar type of medication. In addition, SSRIs are simply not effective for some individuals.  Patients need to be treated as individuals without preconceptions and prejudgment.
  • Without proper treatment, many resort to self-medication in an attempt to find relief from overwhelming anxiety, which can easily lead to addiction and other problems.  For example, overdose, serious drug interactions, an increased “black market” for prescription drugs, use of illicit drugs, and addiction, to name a few. It would be much safer to treat anxiety disorders, effectively, under the supervision of a health care professional.  If you are suffering from anxiety, it is important to find a health care provider who will really listen to you, treat you as an individual, and not stigmatize you based on the actions of other patients.
  • There are many tactics a medical provider can use to deter abuse of any drug. For example, prescribing small amounts at a time and seeing the patient more frequently, calling the patient randomly to come in for “pill counts”, and testing for use of illicit drugs, too name a few.  In my humble opinion, these drugs can be prescribed safely, with close monitoring, and should not be denied to patients who need them simply based on value judgments, and the actions of others who choose to misuse their medications.
  • Statistics also show that the majority of people who are prescribed a low dose of a benzodiazepine, and are monitored closely, generally do not become addicted. Epidemiological evidence suggests the rate of abuse and dependence, in individuals who are legitimately prescribed these medications, is less than 1% (Sheehan & Raj, 2009).  If the medication needs to be discontinued, a slow tapering schedule usually will help the patient discontinue the medication with very minimal discomfort, or withdrawal symptoms.  However, it must be said that if these medications are misused, and not taken as prescribed, a person can easily become dependent on benzodiazepines.  The withdrawal syndrome can be deadly and extremely difficult.  Therefore, if you have been prescribed these medications, it is very important that you take them as prescribed. If a person is addicted to benzodiazepines, a medical detox setting is the safest way to initially discontinue the medication.
  • If the dose prescribed is not relieving your symptoms, discuss this with your healthcare provider.  Do not change your own dose or take extra medication.  Your healthcare provider can help you adjust your dose safely, if needed, or add additional medications, or therapeutic treatments, that may help.  However, in order to do this, you must find a medical provider who will treat you fairly, with personalized treatment, based on listening to you and asking you a lot of questions to really understand your symptoms.  It takes more than 15 minutes, which is the time limit for many appointments, to diagnose a complicated mental disorder and devise an effective treatment plan.
  • Prescription medications should ONLY be taken under the supervision of a medical professional.  Although it can be frustrating to find a healthcare provider who will be willing to spend the time to help you find the right treatment for you, it is important to keep looking, rather than self medicate.  Change providers as often as you need to until you find one that is willing to work with you to appropriately treat your condition.
  • Side note:  I don’t mean to sound harsh towards medical providers.  There are MANY excellent health care professionals, who care about patients, and are good at what they do.  I am a medical professional and I also am a patient with a mental disorder.  So I can understand the difficult issues from both sides.  The things I have said in this article are my personal opinions, and observations, regarding the current problems happening in mental health treatment settings.

How to benzodiazepines work in the brain:

  • dopamine happy faceOur brains have many types of neurotransmitters that work as little chemical messengers that send messages, back and forth, between the billions of tiny nerve cells in our brains.  The main neurotransmitter that is affected by benzodiazepines is called GABA.  Dopamine is also affected by benzodiazepines, but to a lesser degree.   This affect, that benzodiazepines have on the neurotransmitter dopamine, is generally what leads to the potential for addiction.  Dopamine is regarded as one of the neurotransmitters that cause us to feel happiness in normal life events.  Too much dopamine, released at one time, is what leads to the euphoria that can cause addiction.
  • Regardless, the main neurotransmitter affected by the benzodiazepines is GABA.  Our bodies normally use GABA to produce a calming, inhibitory effect, in the central nervous system. This is a normal function in the brain that enables a person to feel relaxed and a sense of calmness.  When GABA binds to a receptor on a nerve cell in the brain, intricate changes happen inside that nerve cell, that ultimately result in an inhibiting (or quieting) effect in the brain, as well as the rest of the central nervous system.  This is how benzodiazepines reduce the feeling of anxiety.
  • We also have several other neurotransmitters in the brain, that are quite opposite to GABA.  For example, other drugs like amphetamines and cocaine produce excitatory (or awakening) signals in the brain and central nervous system, usually via the effects of too much dopamine being released at one time.

excitatory and inhibitory cartoon

  • The way that benzodiazepines work in the brain is a slightly complicated process.  Basically, there are special places, on the brain’s nerve cells (called receptors) that GABA binds too.  The brain’s nerve cells also have special sites for binding other neurotransmitters, and a huge variety of other molecules.  For example, benzodiazepines, when benzodiazepines bind to their specific site (receptor), they do not stimulate it directly, like GABA.  Instead, the benzodiazepines help GABA function more efficiently. The process by which they do this is a bit complicated and will take some studying to really grasp.  Most simply put, when GABA binds to it’s own receptor, the benzodiazepines increase the amount of chloride ions in the brain’s nerve cell.  This causes something called hyper-polarization.  The result of all of this is a “quieting” of the nerve cell.  The nerve cell basically becomes less excitable, ultimately producing a state of calmness and reduced anxiety.

benzo MOA

  • The main thing to remember is that benzodiazepines affect the way that GABA works in the brain, producing a calming effect in the central nervous system.  Benzodiazepines can be thought of as a medication that enhances the normal functioning of GABA, resulting in increased inhibition in the central nervous system.  With the right dose this can be very effective in reducing acute anxiety.  However, something important to remember is that our respiratory center also resides in the central nervous system.
  • If our central nervous system is inhibited too much, by taking to much of the benzodiazepines, or by mixing the medication with other drugs that also depress the central nervous system (such as narcotic pain medications, barbiturates, and even alcohol), than this can also inhibit the respiratory center.  If the respiratory center is inhibited too much this results in respiratory arrest (inability to breath), coma, brain damage, or death.  So hopefully we can understand why these medications should be taken exactly as prescribed. and only under the strict supervision of a medical provider.  Additionally, other central nervous system depressants (alcohol, narcotic pain relievers, barbiturates, sleeping pills, etc…) should not be combined with benzodiazepines, unless your doctor has approved something specific.  Your medical provider has an understanding of the effects of different doses of medication, and what can and cannot be safely taken in combination.

Facts about Addiction and Recovery:

  • What do you do if you have become addicted to benzodiazepines, or any other drug?  Seek help!  Drug addiction hurts everyone, not just the person using the drug, families and children also suffer the consequences. It is especially hard on young children and adolescents.
  • It can happen to anyone in all areas of the world, all ethnic groups, rich or poor, and all ages.  It is nothing to be ashamed of, however not seeking treatment, when you know your behavior (addiction) is causing harm, is not okay.
  • Drug dependence is a medical condition that can be treated.  Many people have recovered and returned to living healthy and happy lives.  Physical dependence on benzodiazepines can cause a dangerous withdrawal syndrome if discontinued abruptly.  You should discuss a safe tapering schedule with your medical provider. or enter a medical detox setting, to safely stop this type of medication.
  • The first step is to be honest with yourself and admit the problem.  People with drug addiction/dependence often try to justify the drug use and minimize the problem.  This is called denial.  It’s hard to admit there is a problem, but you will be glad you did when you regain control of your life!
  • The next step is seeking and accepting help.  Most people need help to stop the drug use.  Accepting help is often hard sometimes, but treatment provided by professionals is very helpful.  Remember drug addiction is a disease.  Just like any other disease that you would seek help for.  Seeking help is not something to be ashamed of, rather it is a positive step to be proud of.

Resources to seek help:

References

Sheehan, D. and Raj, A. (2009). Benzodiazepines. The American Psychiatric Publishing Textbook of Psychopharmacology. Fourth Edition. The American Psychiatric Publishing Inc.; 2009. pp. 465–486.

Tone, Andrea (2009). “The Fashionable Pill”. The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers. New York: Basic Books.

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