Long-Term Use of Benzodiazepines and Dementia Risk

However, in the same study, 27–45% of patients experienced withdrawal symptoms even while taking propranolol [69]. The control group and the experimental group had the same dropout rate in this study [69]. Another study found that abrupt discontinuation and daily administration of propranolol in severely dependent patients was not a more successful treatment plan than current practice [65].

Benzodiazepines

They found significant changes in sleep microstructure in chronic insomnia with high dosage abuse of BZD, but sleep architecture changes were not significant. Long-term use of BZD leads to negative changes in sleep microstructure in patients with insomnia [35]. Bachhuber et al. 2016 reported an increase in ED visits for overdose and increased overdose death due to BZD use [28]. Women are more harbor house sober living review susceptible to BZD overuse because they are more likely to be prescribed than men [29]. Mclean et al. 2011 reported that the diagnosis of anxiety and stress disorders has a higher prevalence in women, which can explain the discrepancies in the prescription for men vs. women [30]. GABA is the most common neurotransmitter in the CNS, and BZDs primarily work on the GABA-A receptor subunit [1].

A Closer Look at the Study

Elderly patients may have liver impairment and trouble eliminating the drugs from their system. Side effects, such as dizziness, confusion or unsteadiness may persist in the elderly who are prescribed long-acting benzodiazepines. The older tricyclic antidepressants, such as nortriptyline (Pamelor) and imipramine (Tofranil) are effective, too, but may be hindered by drowsiness and anticholinergic drug side effects, which can be especially problematic for older patients. In those without co-existing conditions such as depression or a history of substance abuse, benzodiazepines may be used cautiously for a short period of time. Benzodiazepines are a class of medications that work in the central nervous system and are used for a variety of medical conditions, such as anxiety, seizures, and for alcohol withdrawal. Benzodiazepines work by blocking excessive activity of nerves in the brain and other areas in the central nervous system.

How long can I stay on benzodiazepines?

Other studies have shown that there is no correlation between BZD use and cognitive decline. One study showed that administration of BZD in patients with Alzheimer’s disease do not lead to further cognitive decline after 18 months of taking the drug [74]. The subjects in this study had mild to moderate Alzheimer’s dementia and showed no change in AD-Cog scores after treatment with BZD [74]. Additionally, BZD have been shown not to increase or decrease Mini Mental Status Exam (MMSE) scores, caregiver burden (CB), or the Neuropsychiatric Inventory (NPI) in Alzheimer’s patients over 12 months of treatment in one cohort study [75]. Interestingly, in this same study, SSRIs and atypical antipsychotics showed the same results; however, trazodone actually improved the NPI [75]. Another study that tested a different standardized education protocol showed more promising results [73].

Next day drowsiness and “hangover effect” is a concern with benzodiazepines that have long duration, for example, with diazepam or flurazepam. The sedative side effects can carry into the next day and impair driving and other daily activities; this is a particularly concerning risk in the elderly. Panic disorder can be a prolonged, chronic disorder, but it is very treatable with medications that lessen symptoms.

The benzodiazepine hypnotics shorten the time it takes to fall asleep and prolong the sleeping period. The main differences exist in how long they might remain in the body, possibly barbiturate withdrawal symptoms leading to prolonged side effects. For example, lorazepam has a much shorter duration than diazepam, allowing quicker clearance of the drug and theoretically less side effects.

Additionally, in this study, approximately 80% of patients experience withdrawal symptoms, which is much greater than the rate in other studies [65]. The authors attribute this to the severity of patients’ dependence on BZD before treatment with propranolol [65]. More studies need to be performed on treating withdrawal with propranolol, including testing it as a potential adjunct to tapering off both long-acting and short-acting BZD. Due to its short half-life, and rapid absorption, alprazolam is distinguished as one of the most rapid-acting BZD with fastest relief of symptomology, increasing its abuse liability [54]. Alprazolam is widely used as monotherapy for panic disorder and anxiety and was found superior to other forms of monotherapy for these conditions including other BZD, non-SSRI antidepressants, and buspirone.

People with severe anxiety before starting treatment with BZD typically have more severe withdrawal symptoms, and thus have a harder time fully discontinuing the drug [63]. Psychiatric diagnoses have also been linked to one’s ability to discontinue treatment with BZD. One study showed a high co-occurrence with BZD dependence and all psychiatric disorders in general [64,65]. Specifically, those with cluster B personality disorders have the worst prognosis in regard to discontinuing BZD. In one study, not a single subject diagnosed with a cluster B personality disorder successfully discontinued BZD use [63].

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. Numerous treatment guidelines recommend that long-term use of benzodiazepines (BZD) should be avoided primarily due to development of tolerance and a risk for BZD dependence. Despite this, long-term BZD use remains a controversial subject in clinical patient care with “for and against” debates. However, there is no explicit understanding of what is meant by long-term BZD use in real world.

Anyone who shows signs of an overdose or an adverse reaction after taking benzodiazepines will need emergency medical help. When people take benzodiazepines, the brain will send messages to counter this overstimulation. That’s despite warnings against long-term use of these drugs, especially among older people, because they can increase the risk of car crashes, falls and broken hips, as well as causing other 14 ways to cure a headache without medication side effects. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Data sources include Micromedex (updated 7 Jul 2024), Cerner Multum™ (updated 14 Jul 2024), ASHP (updated 10 Jul 2024) and others.

1. Another study found that abrupt discontinuation and daily administration of propranolol in severely dependent patients was not a more successful treatment plan than current practice [65].
2. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS).
3. The chemical signals, known as neurotransmitters, can attach to cells with the right receptors.

BZ are effective and well-tolerated, and they should be prescribed as carefully and judiciously as any other medication [2, 3]. For example, due to the possibility of withdrawal symptoms with BZ, most recent treatment guidelines recommend SSRI as the first-line choice for the treatment of anxiety [7]. This conflict-of-interest-based preference for SSRI treatments deprives individuals with anxiety disorders of potentially valuable treatment with BZ. Even worse, some physicians avoid prescribing them, and some patients take every pill feeling guilty or as if they are doing something against their health [2, 4]. Studies comparing approved BZ with approved SSRI in PD patients have been conducted, but they did not reach the impact of SSRI marketing [1, 2, 6].

“Everyone’s ability to metabolize the medications they’ve been taking for a long time may change.” A drug tolerated well at first can cause side effects later, leading to cognitive decline and injuries from falls. Benzodiazepines (also called “benzos”) are a class of agents that work in the central nervous system and are used for a variety of medical conditions. Benzodiazepines can help treat some mental health and neurological conditions, but it is essential to use them with care. A person who uses them for 3–4 weeks and then stops suddenly is likely to experience withdrawal symptoms. People who use them in the long term may need to withdraw their use over a 3–12 month period that their doctor should oversee.

BZDs gained popularity in the 1960s and 1970s through household names such as The Rolling Stones and numerous Hollywood movies sensationalizing Valium (diazepam). BZDs were encouraged for anyone wanting to calm their nerves and ease their sleep, causing them to rapidly attain favor in society [6]. Additionally, given the continual rise of anxiety and sleep-disordered problems over the decades, BZDs remain a regular fixture in the United States today [7]. However, with this ongoing, widespread use comes the dark reality of BZD dependence [6]. You could also check out the wide range of mental health apps available, such as Calm (good for meditation), MoodMission (this one has evidence-based CBT activities for anxiety), and Talkspace, which can connect you with an online therapist. “CBT-i (cognitive behavioral therapy for insomnia) is a non-medication approach to treating insomnia,” says psychotherapist Annie Miller, LCSW.

Other studies have assessed different methods of counseling on BZD dangers and alternatives to patients alongside a gradual taper off the drugs. One study compared the mainstay of treatment with a standardized interview/counselling approach to treatment [72]. The experimental group in this study had a weekly 1/10-dose reduction after a 2 week stabilization period [72]. The experimental treatment also included a BZD diary, a drinking diary, BZD withdrawal education, and assessments for ways of coping and “progressive relaxation exercise” [72]. This was compared to a gradual taper without the other components of the treatment plan [72]. There was no difference in the success rate of BZD discontinuation between the control and experimental groups in this case [72].