Facts about Benzodiazepines

xanax
The Xanax bar is  one of the most sought after benzodiazepines, 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 lack 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.

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 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 they were first introduced, both negative and positive changes.  Regardless, the benzodiazepines were very popular, and liberally prescribed, during their initial introduction.  Medical providers, and patients, both viewed the drugs as a “miracle cure” for conditions related to stress and anxiety.  In the 1970’s the benzodiazepines were at the top of the list for 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 type 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. Statistics show that this drug was extremely popular, and was ironically dubbed 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 introduction, the medical community became aware of the potential for misuse, psychological addiction, and physiological dependence, on these medications.  Additionally, many people did begin illicitly using these medications, or abusing their prescriptions.  Unfortunately, the risk for abuse, and dependence 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 treatment of acute 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 for 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. By misusing these drugs, they are making it very difficult for people who really do need these potentially life changing medications, to be able to obtain the medication they truly need.  If you need an example of what it is like for a person, who may truly need this type of medication, 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, 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.
  • 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.  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 the does is not working for you, discuss this with your healthcare provider.  Do not change your own dose or take extra medication.  In addition, these medications should always only be taken under the supervision of a medical professional.

How to benzodiazepines work in the brain:

  • Our brains have neurotransmitters that work as little chemical messengers.  They send messages to and from the billions of tiny nerve cells in our brains.  The neurotransmitter that is affected by benzodiazepines is called GABA.  Dopamine is also affected by benzodiazepines, but to a lesser degree.  This affect on dopamine is what leads to the potential for addiction.  Regardless, the main neurotransmitter affected is GABA.  Our bodies normally use GABA to produce a calming, inhibitory effect, in the central nervous system. when necessary, which enables a person to feel relaxed.
  • When GABA binds to a receptor on a nerve cell in the brain, changes happen that cause an inhibiting (or quieting) effect in the brain and the rest of the central nervous system.  This is how benzodiazepines reduce the feeling of anxiety, by affecting GABA.  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.

excitatory and inhibitory cartoon

  • GABA receptors on the brain’s nerve cells have special sites for binding GABA, they also contains sites for binding other molecules, such as benzodiazepines, that affect the activity of GABA.  When benzodiazepines bind to their specific site on a GABA receptor, they do not stimulate it directly. Instead, they make it more efficient by increasing the frequency with which the chlorine channel opens, when GABA binds to its own site on this receptor. What happens next is an increase in the amount of chloride ions in the brain’s nerve cell, this causes something called hyper-polarization.  The end result of this seemingly complicated process is that the nerve cell (also called a neuron) becomes less excitable (quiet).

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.  With the right dose this can be very effective in reducing acute anxiety.  However, 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 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 inhibit the respiratory center which results in respiratory arrest (inability to breath), coma, brain damage, or death.  These medications should be taken exactly as prescribed and only under the strict supervision of a medical provider.

Recovery:

  • 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.
  • Drug dependence is a medical condition that can be treated.  Many people have recovered and returned to living healthy and happy lives.
  • The first step is to be honest with yourself and admit the problem.  People with drug addiction 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

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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