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Benzo Guide

Learn About This Prescription Depressant

Table of Contents

What are Benzos?

Benzodiazepines, also known as benzos, are depressant drugs.1 Benzodiazepine drugs have a delaying effect on the central nervous system (CNS) while slowing down messages sent between the brain and the body. Depressant drugs have a delaying effect on the brain, not to be confused with a dual diagnosis of depression and substance use disorder.1 Some examples of other depressant drugs are alcohol, cannabis, and heroin.

History

The first benzodiazepine was synthesized in 1955 by Hoffman La-Roche and chemist Leo Sternbach.2They called this benzo chlordiazepoxide. By 1960, chlordiazepoxide was marketed as Librium.3The marketing of Librium was followed by the marketing of diazepam, branded by the name of Valium, in 1963.

Drug Class

Benzodiazepines, or benzo drugs, are Schedule IV drugs and are classified as controlled substances. Though there is a low risk of addiction as a schedule IV classification, benzodiazepines carry some risk of addiction.4
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List of Benzodiazepines

Benzodiazepines are known by their generic chemical name.1 The types of benzos differ based on their release effects. There are three types of benzos: long-acting, immediate-acting, and short-acting. Though these benzodiazepines have different brand names, they all have the same function.

Diazepam: Branded - Valium

Diazepam is a prescription oral medication used to treat anxiety.5 Benzodiazepine brand names for diazepam include:

  • Valium
  • Diastat Acudial
  • Diastat
  • Diazepam Intensol

Lorazepam: Branded – Ativan

Lorazepam is used for anxiety disorder management and short-term relief of anxiety and depression symptoms.6Ativan treats symptoms of panic attacks, short-term and long-term insomnia and is also used with other medications to prevent nausea and vomiting from chemotherapy.6 Lorazepam benzodiazepine side effects include:
  • Sedation
  • Dizziness
  • Weakness
  • Unsteadiness

Alprazolam: Branded – Xanax

According to the National Alliance on Mental Illness, alprazolam treats generalized anxiety disorder (GAD) and panic disorders.7

Common Street Names for alprazolam include:8

  • Gold Bars
  • Xannies
  • Schoolbus
  • X

Clonazepam: Branded Klonopin

According to the U.S. National Library of Medicine, clonazepam is used to control certain types of seizures. It can also be used to relieve panic attacks.9 Clonazepam benzodiazepine side effects include:
  • Drowsiness
  • Dizziness
  • Unsteadiness
  • Problems with coordination
  • Difficulty thinking or remembering
  • Increased saliva
  • Muscle or joint pain
  • Frequent urination
  • Blurred vision
  • Changes in sex drive or ability

Benzodiazepines Uses

The various brands of benzo drugs on the market all carry the same function. However, the purpose of their use depends on the diagnosed condition.

Benzodiazepines for Anxiety

Benzodiazepines enhance the GABA neurotransmitter activity in the brain.10 GABA is a chemical in the brain that creates calmness. Due to this anti-anxiety effect, benzos make it easier to complete a task that may have been delayed by anxiety.

Benzodiazepines for Seizures

Due to the calming effect benzos have on the brain, they also relax the muscles. The GABA neurotransmitter activity very acutely manages seizure.11 Benzodiazepines are considered to be some of the most effective drugs for acute seizures and status epilepticus.

The benzodiazepines most commonly used for seizures are diazepam (Valium), lorazepam (Ativan), and midazolam (Versed).

Benzodiazepines for Insomnia

In the 1970s, benzodiazepines became a forefront treatment for insomnia and have been widely prescribed since then. 13Due to their relaxing effects, benzodiazepines are recommended treatments for sleep issues.12

Benzodiazepines for Analgesia

According to Access Anesthesiology, “[b]enzodiazepines produce hypnosis, sedation, anxiolysis, anterograde amnesia, anti convulsion, and centrally produced muscle relaxation.”13 They note that benzos don’t provide any analgesia.

Benzodiazepines for Muscle relaxation

Out of the benzodiazepines list, diazepam is used for muscle relaxation due to its calming and hypnotic effects.14

Benzodiazepines for Alcohol Withdrawal

Benzodiazepines are a leading recommended withdrawal treatment for alcohol use disorder due to their similar depressant effects on the brain.15 Benzodiazepines work in this case because they act like alcohol and stimulate the inhibitory GABA-signaling pathway. Benzodiazepines suppress alcohol withdrawal symptoms and shorten how long withdrawal lasts. They are also the only medication known to prevent associated withdrawal seizures, delirium tremens, and death from alcohol withdrawal.

Benzodiazepines Side Effects

As with any prescription drug, there may be some unwanted side effects.16 Although benzodiazepines have many safety features, they too have several undesirable effects.

Short-Term Side Effects

Benzodiazepine short-term side effects include:1
  • Depression
  • Confusion
  • Feelings of isolation or euphoria
  • Impaired thinking and memory loss
  • Headache
  • Drowsiness, sleepiness, and fatigue
  • Dry mouth
  • Slurred speech or stuttering
  • Double or blurred vision
  • Impaired coordination, dizziness, and tremors
  • Nausea and loss of appetite
  • Diarrhea or constipation

Long-Term Side Effects

Benzodiazepine long-term side effects include:1
  • Impaired thinking or memory loss
  • Anxiety and depression
  • Anxiety and depression
  • Irritability, paranoia, and aggression
  • Personality change
  • Weakness, lethargy, and lack of motivation
  • Drowsiness, sleepiness, and fatigue
  • Difficulty sleeping or disturbing dreams
  • Headaches
  • Nausea
  • Skin rashes and weight gain
  • Addiction Withdrawal symptoms

Benzodiazepines Withdrawal

Withdrawal symptoms can begin in as little as one month of active use.17 If benzos have been taken for longer than six months, about 40 percent of people experience moderate to severe withdrawal symptoms when they suddenly quit. The other 60% experience mild symptoms.

Benzodiazepine Withdrawal Timeline

  1. Early or Immediate Withdrawal: Early withdrawal occurs shortly after a person stops taking benzodiazepines. 19 Withdrawal symptoms from short-acting benzos may come faster than longer-acting benzo drugs. In this initial stage, anxiety or insomnia may return or worsen. Tapering helps relieve symptoms like this.18
  2. Acute Withdrawal: Acute withdrawal generally begins within a few days. Symptoms typically last 5–28 days, though some may last for several months. Most of the withdrawal symptoms occur in this phase. This phase requires medical monitoring and possible medical prescription to ease the symptoms.
  3. Protracted Withdrawal: Many symptoms subside after the second phase, the acute phase, yet side effects still linger. Within this phase, post-acute withdrawal symptoms occur.19 Symptoms include insomnia, anxiety, low concentration, loss of sex drive, depression, and mood swings.

Benzo Withdrawal Symptoms

How severe the withdrawal symptoms are will depend on a variety of factors, including:

  • Your current dose
  • How long you've been taking it
  • Whether you take more than one benzo
  • Whether you take other sedating drugs
  • Any substance use issues
  • Whether you are quitting more than one substance at a time
Benzodiazepine withdrawal symptoms include:17
  • Anxiety
  • Insomnia
  • Irritability
  • Restlessness
  • Hand tremors
  • Muscle spasms
  • Headache
  • Sweating
  • Racing pulse
  • Hyperventilation
  • Nausea or vomiting
  • Aches and pains
  • Panic attacks
  • Hypersensitivity to stimuli like light and touch
  • Abnormal bodily sensations (skin-crawling, goosebumps)
  • Depression
  • Problems with concentration and memory
  • Visual disturbances (flashes of light or blurred vision)
  • Auditory, tactile, or visual hallucinations
  • Feelings of unreality
  • Delirium
  • Grand mal seizures

Benzo Overdose

Large amounts of Benzodiazepines can lead to a Benzodiazepine overdose. A Benzodiazepine overdose can occur on purpose or accidentally.1 Symptoms of Benzodiazepine overdose include:

  • Over-sedation or sleep
  • Jitteriness and excitability
  • Mood swings and aggression
  • Slow, shallow breathing
  • Unconsciousness or coma
  • Death, which is more likely when taken with another drug such as alcohol

Misconceptions about Benzodiazepines

Benzodiazepines lower risk of addiction compared to other drugs can lead to misconceptions about the drug. One misconception about Benzodiazepines is their strength. Many believe that because of its low risk of addiction, a benzo has little effect. The truth of the matter is, some benzos are a lot more potent than others. Some have longer-lasting effects and are therefore more impactful.

Benzodiazepines and Dementia

Researchers in France and Canada found a connection between benzodiazepine use and an increased risk of Alzheimer’s disease. The study showed that people who had taken a benzodiazepine for three to six months had a 32% greater risk of developing Alzheimer’s than people who did not. Those taking benzos for more than six months had an 84% greater risk.

Treatments to Stop Using Benzos

Treatment will frequently depend on if benzodiazepines were initially prescribed to address an existing condition.17 If there is a psychiatric condition previously managed by the benzos, an alternative plan to manage the condition will need to be developed. Typically, a combination of therapy and pharmacologic support is used to treat addiction to benzos.

Tapering

Tapering off prescribed medications reduces the severity of withdrawal symptoms, both mild and severe. Benzodiazepine withdrawal can be dangerous. There is an increased risk of experiencing a life-threatening grand mal seizure when benzodiazepines are quit suddenly. If you go into withdrawal without tapering, there is also an increased risk of delirium and hallucinations, which can be a terrifying and dangerous experience. The best tapering method for addressing Benzodiazepine withdrawal is one scheduled by a licensed professional. It is often based on the dosage in which it was initially taken and the specific Benzodiazepine.

Medically Supervised Detox

Medically supervised benzodiazepine tapering requires hospital admission or another form of inpatient detox. A medically supervised detox may be required by the doctor depending on:

  • The benzodiazepine dosage
  • Complicated past withdrawals
  • The presence of a severe substance use disorder
  • If other medical issues are present

Resources

  1. https://adf.org.au/drug-facts/benzodiazepines/
  2. https://pubmed.ncbi.nlm.nih.gov/24007886/
  3. https://www.deadiversion.usdoj.gov/drug_chem_info/benzo.pdf
  4. https://www.verywellmind.com/why-are-benzodiazepines-controlled-substances-2584333
  5. https://www.medicinenet.com/diazepam/article.htm
  6. https://www.medicinenet.com/lorazepam/article.htm#what_are_the_side_effects_of_lorazepam
  7. https://nami.org/About-Mental-Illness/Treatments/Mental-Health-Medications/Types-of-Medication/Alprazolam-(Xanax)
  8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553644/
  9. https://medlineplus.gov/druginfo/meds/a682279.html
  10. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/anti-anxiety-medications-benzodiazepines#:~:text=Benzodiazepines%20most%20commonly%20used%20to,)%20and%20diazepam%20(Valium)
  11. https://www.aafp.org/afp/2003/0801/p469.html#:~:text=The%20benzodiazepines%20are%20some%20of,%2C%20and%20midazolam%20(Versed)
  12. https://www.health.harvard.edu/newsletter_article/overcoming-insomnia
  13. https://accessanesthesiology.mhmedical.com/content.aspx?bookid=974&sectionid=61587929
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4103716/#:~:text=Diazepam%20is%20a%20benzodiazepine%20used,%2C%20antiepileptic%2C%20and%20hypnotic%20effects.&text=It%20is%20believed%20that%20the,at%20spinal%20and%20supraspinal%20sites
  15. https://emcrit.org/wp-content/uploads/2009/09/Diazepam-in-the-Treatment-of-Moderate-to-Severe-Alcohol-Withdrawal.pdf
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4730295/
  17. https://www.verywellmind.com/benzodiazepine-withdrawal-4588452
  18. https://www.health.harvard.edu/mind-and-mood/two-types-of-drugs-you-may-want-to-avoid-for-the-sake-of-your-brain
  19. https://www.medicalnewstoday.com/articles/benzo-withdrawal#early-withdrawalbenzo

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