Benzodiazepines: Understanding the Risks

benzodiazepinesBenzodiazepines commonly known as benzo’s, are a type of medication known as tranquilizers and some of the most commonly prescribed medications in the United States. Doctors may prescribe benzodiazepines for the following reasons: anxiety, muscle relaxation, panic, agitation, seizures, and insomnia.

Some common benzodiazepines include:

•    Ativan (lorazepam)

•    Klonopin (clonazepam

•    Librium (chlordiazepoxide)

•    Valium (diazepam)

•    Xanax (alprazolam)

Benzos boost the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABA-A receptor, acting on the central nervous system. The GABA-A receptor is the brain’s “off switch” or “calm down switch”. Enhancing activity at this receptor site promotes sleep, relaxation, well-being, calmness, anti-anxiety effects, muscle relaxation, and acts as an anticonvulsant.

At normal or regular dosages, Benzodiazepines are effective at treating the conditions that they treat, typically reducing anxiety and insomnia. However, despite their helpful uses, they do come with risks including dependence, tolerance and are highly addictive when used on a long-term basis. Their abuse is partially to do with the toxic effects they produce, but also can be attributed to their wide spread availability. Tolerance to this medication develops quickly and a person may need more of the drug to produce similar results. The brain also becomes less sensitive to natural GABA causing rebound or worsening anxiety. This is referred to as the “benzo trap”.

In addition to their highly addictive nature, benzodiazepines come with other risks.  A 2012 study published in the journal BMJ suggested that benzodiazepine use may promote the development of dementia. Other risks include trouble with daily functioning, memory loss, cognitive dulling/slowing, the risk for dizziness, falls, worsening of depression and anxiety. In some cases, benzos have also shown to erode participation in therapy and impede the development of coping skills to manage anxiety and panic.  To date, therapy remains the number one most effective treatment for anxiety and panic.

The treatment of chronic benzodiazepine abuse is best planned with the help of a medical professional, as the medication cannot be stopped abruptly and withdrawal unsupervised can be deadly. Due to the potential complications, many individuals choose to enter into a medical detox program. The first step in treatment is typically gradually reducing the amount of medication being taken in order to avoid withdrawal or seizures. In addition to medical attention, individuals attempting to go drug-free will typically benefit from social support, individual and group therapy.

As stated above, the use of benzodiazepines for their intended purposes under monitored care can be beneficial; however, it’s important that anyone considering taking them is aware of the potential risks.

Author: Aimee Techau MSN, PMHNP-BC, CARN-AP – Psychiatric & Addiction Nurse Practioner


De Gage, S. B., Bégaud, B., Bazin, F., Verdoux, H., Dartigues, J. F., Pérès, K., … & Pariente, A. (2012). Benzodiazepine use and risk of dementia: prospective population-based study. Bmj, 345, e6231.

Heldt, J. P. (2017). Memorable psychopharmacology. Place of publication not identified: CreateSpace Independent Publishing Platform.

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