Valium, Ativan and other benzos - 10 things you should know

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Courtesy of Foto.fritz - Stock Free Images and Dreamstime Stock Photos

The term benzodiazepines refers to a group of sedative drugs that were discovered in the 1960s. The most popular drugs of this type, along with their trade names, are shown in the following table.

The most common benzodiazepines

Chemical
Trade name
Diazepam
Valium
Chlordiazepoxide
Librium
Nitrazepam
Mogadon
Lorazepam
Ativan
Temazepam
 

Listed below are ten key pieces of information about benzodiazepines (or “benzos” for short).

1. Benzos effectively reduce anxiety

These drugs produce general sedation. They have the same effect on everyone, irrespective of whether an anxiety disorder is present. Thus, taking this drug will reduce a person’s arousal level. If a person is anxious, the medication will induce relaxation. If calm, the drug will induce sleep. Unlike other groups of drugs (for example, anti-depressants and anti-psychotics) it is rarely claimed that benzos reverse a specific biochemical deficiency underlying anxiety disorders.

© Stab | Stock Free Images & Dreamstime Stock Photos
© Stab | Stock Free Images & Dreamstime Stock Photos

2. Benzos were over-prescribed in the 1960s & 1970s

In the 1950s, barbiturate drugs were often used for the treatment of insomnia and anxiety but they had important disadvantages: they were dangerous in overdose and patients easily became dependent on them. The emergence of the benzos in the early 1960s displaced the barbiturates and they were extensively dispensed as a safe and effective means of relaxing people. The benzos were typically prescribed over long periods of time and were disproportionately targeted at women.

3. Benzos are associated with problems of dependence

Many patients suffering anxiety disorders or insomnia used benzos continuously over many years. In the 1980s there was growing realization of the problem of physical dependence.

The body strives to maintain balance so, after a period of chemical sedation, the brain increases its arousal mechanisms in an attempt to compensate and higher doses of the drug are required to achieve the same effect. Consequently, stopping benzos after as little as several weeks’ continuous use can trigger a range of withdrawal symptoms including: anxiety, insomnia, muscle stiffness and irritability. Less often, unpleasant tactile feelings arise such as electric-shock sensations, tingling and numbness. Withdrawing from high doses after long periods of consumption may elicit epileptic seizures.

Given that some people find it extremely difficult to get off benzos, it is recommended that they should not be prescribed for longer than one month.

Dr. Heather Ashton on Diazepines

4. Benzos are relatively safe compared to other drugs

Benzos do not have an adverse effect on the heart, do not cause movement disorders and do not affect metabolism. As such they are safer than alcohol, barbiturates, anti-psychotics and opiates. They only cause dangerous levels of sedation at very high doses.

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© Mimal | Stock Free Images & Dreamstime Stock Photos

5. Benzos are often abused

As they can cause a sensation of euphoria and pleasure, benzos are often misused by people with addictions. It is commonplace for them to be used concurrently with heroin.

6. Benzos are used to sedate disturbed psychiatric patients

As they achieve a sedative effect within minutes, benzos are frequently used in acute in-patient units (sometimes in combination with other drugs) to calm highly agitated psychiatric patients. This process of sedating disturbed psychiatric patients is called “rapid tranquillization.” If benzos are deployed with agitated elderly patients there is an increased risk of falls.

7. Benzos increase the activity of GABA

GABA (full name gama-amino butyric acid) is a neurotransmitter that is found in all parts of the brain. A neurotransmitter is a chemical messenger that passes information between our millions of brain cells. The effect of GABA is to reduce brain activity. As benzos increase the action of GABA, the effect is to produce general sedation.

8. Benzos have varying half-lives

The half-life of a drug is the time taken for half of the drug to be eliminated from the body. Benzos have differing half-lives. The ones with shorter half-lives include lorazepam and temezapam and tend to be used to induce sleep, their speedier elimination from the body mitigating against next-day drowsiness. In contrast, longer acting benzos such as diazepam are typically prescribed to reduce anxiety.

Short-acting benzos, as a result of their rapid expulsion, are prone to produce harsher withdrawal symptoms.

9. Benzos impair judgement

In common with all drugs that produce sedation (alcohol, anti-psychotics, and anti-depressants) benzos can impair judgement and may make driving, or the operation of machinery, hazardous. At higher doses confusion and slurring of speech may occur.

10. Benzos can control epileptic seizures

Their general dampening effect upon the central nervous system has led to benzos sometimes being used with epilepsy sufferers. In particular, they can be of therapeutic value when a person is suffering continuous, unrelenting epileptic fits (a serious condition known as status epilepticus). Lorazepam and diazepam are most commonly used for this purpose.

Concluding comments

Over the last two decades, doctors have shown increasing caution in their prescribing of benzos. Given the risk of dependence such reticence is appropriate, psychological interventions being rightly considered the first-line treatment option and benzos viewed as a short-term, last resort.

While accepting the addictive pitfalls of the benzos, these drugs cause less physical health problems and are safer in overdose than other types of medication. With this in mind it is curious how medical practitioners grossly over-prescribe anti-depressant and anti-psychotic medications (drugs that also have a generalized sedative effect) while being judicious in their dispensing of benzos.

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Comments 8 comments

carol7777 profile image

carol7777 3 years ago from Arizona

This is really interesting as I know nothing about these drugs. Well done with great research. I know these drugs are probably well over prescribed. Voted UP+++


meloncauli profile image

meloncauli 3 years ago from UK

Great hub gsidley!

Many years ago, in desperation it was found that "drugging up" or sedating those with mental illness, had somewhat of a desired effect i.e symptoms lessened in intensity. Most drugs used in psychiatry still have this effect to some degree.

I was on diazepam for many years and it is extremely tough weaning off this drug, but I have to say it helped me tremendously throughout the years and I didn't get major side effects from it (unless you count the weaning off stage).

I have never understood why benzos haven't played a bigger role in treatment when people are being left with long term effects from some other powerful medications. Yes, they are dulling to a degree and dependence becomes high, but aren't all the other drugs open to dependency if only by the need and desperation of the individual?

Best wishes :)


gsidley profile image

gsidley 3 years ago from Lancashire, England Author

Carol7777, thanks for taking the time to comment and voting up.

They once were over-prescribed, but much less so now. Indeed, given that they are not associated with unpleasant physical side-effects (in contrast to anti-psychotics and anti-depressants) there is probably an argument for benzos to be prescribed a bit more freely as alternatives to these other groups of drugs.


gsidley profile image

gsidley 3 years ago from Lancashire, England Author

Hi again meloncauli

I think you're right - it seems odd that psychiatrists continue to dish out anti-psychotics and anti-depressants like they are on commission (? perhaps they are!) while avoiding valium at all costs.

I have often said to colleagues that if I should ever become acutely psychotic please give me valium for a few days to get my arousal level down (rather than anti-psychotics). A number of mental health professionals I have spoken to have a similar view.


lambservant profile image

lambservant 3 years ago from Pacific Northwest

Xanax is widely used today. I stay away from Benzo's because I have a very low tolerance for them. If I take the smallest dosage of Ativan, I am out for twelve hours and it's like coming out of anesthesia when I wake up. I accidentally overdosed on Xanax once because I took two extra in the smallest dosage. I had friends who took that at one setting daily or twice a day and they had no problems. They are extremely addictive as well, but I have to admit, they are extremely effective for anxiety.

I made a choice some time ago to learn to manage my anxiety with life tools that I learned in counseling and groups. I am glad I am finally at the place where I can do that. Once in a great while I wish I had a Xanax, but it is so rewarding to use my tools and get through it successfully. Great job.


gsidley profile image

gsidley 3 years ago from Lancashire, England Author

Great to hear you can manage your anxiety through use of psychological strategies rather than resorting to chemicals. Long may it last!

I appreciate you taking the time to drop by.


AudreyHowitt profile image

AudreyHowitt 3 years ago from California

I have worked with so many clients with anxiety disorders who tended to abuse benzos. It is so difficult to learn to sit with anxiety and work through it. I thought this was an excellent hub on the subject. It is a pleasure to meet you and read your work.


gsidley profile image

gsidley 3 years ago from Lancashire, England Author

Hi Audrey

Thank you so much for your generous comments. When plagued by acute anxiety it must take a great deal of strength to resist achieving short-term relief via benzos. However, those who do resist are usually glad they did in the longer term.

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