Benzodiazepines are very effective medications for treating acute, short-term anxiety and usually well tolerated when used briefly. Unfortunately, they are not believed to work long-term and often cause more problems than they solve when not prescribed and used judiciously. This is a list of some of the major reasons these medications are not prescribed commonly or for long periods of time.
1) Increased Risk of Motor Vehicle Accidents
Research shows that individuals who take these medications are significantly more likely to be involved in a motor vehicle accident. This is not just a risk to the patient but to other drivers as well. Therefore, all prescribing and use of these medications needs to be very responsible.
2) Short-Term Efficacy Causes Long-Term Problems
Because these medications usually work very effectively in the short-term (and are also highly addictive) it is not uncommon for a patient to focus solely on these medications as the solution to their problems. They often lose interest in therapy or other medications that often work even better and are safer for long-term use (but initially take more time to begin working). This can ruin the therapeutic relationship. This occurs when a patient becomes overly focused on the medication and becomes upset when the provider, trying to keep the patient’s best long-term interests in mind, refuses to prescribe more. It seems that more and more providers are simply refusing to prescribe benzodiazepines at all to avoid this.
3) They Do Not Appear to Work Very Long When Used Regularly
These medications are usually not intended for long-term use. No definitive research has shown they continue having any effect beyond a few weeks when used consistently. Now this does not necessarily mean that this can’t change, but at least so far, the research hasn’t supported long-term efficacy. However, individuals may feel like they are continuing to derive benefit long-term for several reasons.
These medications are extremely addicting. A lack of an “addictive personality” is not relevant and may even be a warning sign because it shows a false sense of security.
Tolerance usually develops and an individual may need more and more medication to achieve the same effect. They may eventually need the maximum dose just to feel like they did before they started the medication. Even when someone has been taking the same dose routinely it is possible for inter-dose withdrawal to occur where an individual begins experiencing withdrawal symptoms despite a routine, stable dose.
These medications cause a severe form of dependence and the medications cannot be stopped abruptly after long-term regular use or they may cause psychosis, seizures, or even be fatal. Once dependence develops and an individual no longer derives benefit from the medication they may now feel “trapped” and many find that reducing the medication causes extraordinary anxiety. Additionally, there’s very little we can to do combat this anxiety that wont also prolong or prevent the detoxification process. Even after a medical detox it may take a long time for the brain to revert back to its normal level of functioning. The individual may feel worse than they originally did for a period of months or even years. Again, at that point our options for effective treatments strong enough to counteract this are greatly diminished.
7) They Can Cause or Worsen Depression
Research has shown that these medications may cause or worsen depression in some individuals. Depression is already very common for those with anxiety.
8) A Fatal Combination
Benzodiazepines are often abused or mixed with alcohol, opiates, or other drugs to amplify the effects of the drugs. They are extremely dangerous to mix with alcohol or other controlled substances as they cause potent respiratory depression. Accidental overdose deaths involving more than one substance often include benzodiazepines. They may also make surgeries or the use of pain medication complicated and risky and could prevent adequate pain treatment in some circumstances now or in the future if pain medication is needed. Many, if not most providers, will not mix these medications except in extreme cases of illness.
9) “A Pill Form of Alcohol”
Imagine how outrageous it would seem if a healthcare provider told someone they should drink alcohol to treat their anxiety. Benzodiazepines are often referred to as a pill form of alcohol. While they are not exactly the same, they are very similar. In fact, benzodiazepines are often given to someone who is undergoing supervised alcohol detox to prevent seizures and other dangerous withdrawal symptoms. The rate of delivery and dosing can be controlled more adequately with benzodiazepines, but they are usually just as bad of a long-term option as self-medicating with alcohol would be.
10) Cognitive Blunting Reduces Effectiveness of Therapy and Recall
The cognitive blunting from benzodiazepines is shown to reduce an individual’s ability to use coping skills and recall techniques learned in therapy appropriately, minimizing the effect of therapy.
11) They Are Not First-Line Treatments for Anxiety
They are not usually considered first-line treatments for most anxiety disorders or for the reasons they are often requested. Some seem to believe if their anxiety is severe enough a benzo is then warranted. Severity is only one consideration and a severe case could even be a contraindication.
12) Withdrawal Can Be Horrific and Dangerous
These medications cause a very serious dependence with horrific withdrawal symptoms and abrupt cessation (which is never safe) can lead to extremely debilitating anxiety, seizures, psychosis, and even death. They are often cited as the most difficult class of medications to withdraw from, even if done slowly and under medical supervision. Some individuals do not have much difficulty with the process while others may be completely non-functional for an extended period of time. It is difficult to predict beforehand. And when someone is withdrawing from these medications there is very little that can be done to assist the extreme anxiety that accompanies this.
Furthermore, many symptoms do not go away after the acute phase of withdrawal has ended but may persist for months or years and some may possibly even be permanent. In addition to strong cravings for the substance individuals may experience a litany of symptoms. These include but are not limited to: pronounced anxiety or fear, agitation, tremor, elevated heart rate and blood pressure, hallucinations, blurry vision, severe muscle spasm and pain, involuntary twitching, nerve pain, memory problems, loss of ability to think clearly or perform everyday tasks, extreme fatigue, weakness, weight changes, hypersensitivity to light and sound, suicidal thoughts, numerous gastrointestinal problems, ringing in the ears, blood sugar imbalances, hormone imbalances, disrupted menstrual cycle, and many more.
13) Especially Bad For The Elderly
Benzodiazepines are on the Beers list. This is a list of medications not intended for use in the elderly unless absolutely necessary. They may increase the risk of developing dementia (mixed evidence but likely possible) and definitely increase the risk of falls and subsequently increase the risk of fractures. While benzodiazepine use is believed to increase the risk of motor vehicle accidents across all capable ages, this is particularly pronounced in the elderly.
While benzodiazepines are well-tolerated when taken short-term or very sparingly, there are numerous long-term side effects and they may make many of the symptoms they were intended to treat even worse. Individuals quickly find themselves dependent, if not addicted. They may reach a point where they need the medication just to feel like they did before they started taking it. Getting off of the medication can be a long and difficult process. They may have serious difficulty finding anyone who will provide anything other than a short-term detox or taper, and during that time very little will help alleviate the extraordinary level of anxiety that accompanies the process. That is the trap of benzodiazepines. They are a short-term solution that can often become a long-term nightmare. Clinicians want to help their patients achieve long-term success and not lead them down a path with a significant chance of making their situation even worse. These are some of the (many) reasons clinicians do not like to prescribe benzodiazepines.
With that being said, benzodiazepines do have their place in treatment. They just need to be used very carefully and almost never long-term.
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