Benzodiazepines, commonly referred to as “benzos”, are perhaps the most popular prescription treatment for anxiety and insomnia. According to the DEA, doctors across the US wrote 45 million prescriptions for alprazolam—widely known by the brand name Xanax—in 2017 alone. 

While there are many types of benzos, they are all defined as psychotropic medications, meaning that they affect a person’s mood. Though they have many proven uses, and can be very effective for some people, most psychotropic medications come with adverse side effects. 

Benzos can be physically and psychologically addictive. Learning more about them and their possible effects can protect you and your loved ones from misuse of benzos.

What Benzos Treat

Benzos are a central nervous system depressant, or CNS. They’re most commonly prescribed to treat generalized anxiety disorder, but they are also very effective against panic disorder. The tranquilizing effects of benzos are also effective in treating insomnia.

These disorders are the more common uses, but doctors may prescribe them to lessen the harsh side effects of alcohol withdrawal. Some types of benzos are used to treat epileptic seizures.

Because benzos are so effective as suppressing brain activity, they can be used by doctors as muscle relaxers, or in addition to general anesthesia.

Of course, [Benzos] do reduce feelings of stress and anxiety, and make users feel much more calm. However, this can also come with side effects like slurred speech and weakened motor function.

Particularly for treating insomnia and anxiety, doctors will typically only prescribe benzos for a week or two. Taking benzos for longer than a few months greatly increases the risk of developing an addiction.

How Do Benzodiazepines Work?

Benzos are known for their sedative effects. This is why they are so effective against anxiety and insomnia. They work by essentially blocking some nerves from talking to each other, and spreading the message that they need to be active and excited. 

This is accomplished through gamma-aminobutyric acid (GABA). GABA is an inhibitory neurotransmitter. Nerves in your brain and all over your body talk to each other through chemicals called neurotransmitters. Each one has a different function such as mood regulation and body functions. Nerves receiving and releasing these neurotransmitters is how your body communicates.

If a neurotransmitter isn’t passed along to the next nerve cell, that message is stopped, and your body can’t complete that action. This is essentially what GABA does. It tells the nerve “we don’t need that, delete that message.” 

Benzos increase activity of GABA in the brain. When more GABA is floating around, more neurotransmitters—such as anxiety-linked norepinephrine—are inhibited. 

Effects

How does this affect the rest of the body? First and foremost, benzos are famous for their sedative, tranquilizing effects. Even the types that treat anxiety often cause people to feel sleepy or fatigued. 

Of course, they do reduce feelings of stress and anxiety, and make users feel much more calm. However, this can also come with side effects like slurred speech and weakened motor function. 

Depending on the type, dose, and need for the drug, these effects might seem dreamy. However, taken improperly, benzos can lead to:

• Slowed breathing
• Amnesia
• Double vision
• Irregular heartbeat

Typically, doctors prescribe benzos for short term use. Adverse side effects can impact everyone differently, but are more likely when the substance is taken outside of prescribed guidelines.

Types of Benzos

All benzos increase GABA activity and are not meant for long-term use. Like many prescription drugs, however, there are multiple types that can be prescribed, and each functions differently. Most benzos are made to be short-, intermediate-, and long-acting.

Fast-Acting Benzos

These are the types of medications you take in the moment, when you need it most. They start to take effect in as little as 30 minutes, and can last anywhere from three to eight hours.

Xanax is the most well-known fast-acting benzo; though an intermediate-acting dose is available as well. Lorazepam and clonazepam—which often appear under the brand names Ativan and Klonopin, respectively—can also be fast-acting.

Intermediate-Acting Benzos

As the name suggests, these benzos have a delayed response that takes longer than fast-acting but lasts for less time than long-acting. Generally, they’re taken once or twice a day. 

Long-Acting Benzos

Diazepam (Valium) is the most commonplace example of a long-lasting benzo. This type lasts anywhere from one to three days. Again, each generic drug can be manufactured to be taken at different intervals.

GABA

Benzos do not create GABA, they simply work by increasing GABA production and enhancing GABA activity. When GABA is not functioning optimally in the body, it can lead to mental health disorders such as anxiety, schizophrenia, and depression. GABA deficiency can even bring about physical health disorders like epilepsy and Parkinson’s.

GABA Supplements

Even though benzos increase GABA activity, GABA supplements are becoming more popular in advertising. This is because manufacturers of these supplements believe that they can result in the same desired effects, without the same addiction risks as benzos.

GABA In Food Products

GABA is naturally found in many foods, including broccoli, tomatoes, soy, and wheat. However, the amount greatly varies in each product.

So far, science has found that consuming GABA through supplements or food isn’t as effective as prescription medications. The blood-brain barrier is a membrane surrounding your brain, and not everything is allowed to pass through. This may include GABA.

Most of the fruits and vegetables that contain this chemical have many health benefits, but GABA shouldn’t be treated as the primary motive to consume them.

What Benzo Abuse Looks Like

Especially if you’ve suffered from anxiety or sleeplessness for a significant period in your life, the thought of a medication that can almost immediately take it away seems like a dream.

The DEA classifies benzos as a Schedule IV drug—meaning there’s low risk for dependence and abuse. True, it has lower risk for physical dependence than, say, opioids, but that risk is not zero.

In terms of long-term effects, scientists discovered that there may be a link between later development of dementia and benzo abuse.

‍

Users can misuse and abuse benzos, and even mix it with other substances to increase their perceived effects.

Symptoms of Benzodiazepine Abuse

The symptoms of benzo abuse closely resemble the normal effects of the drug, though they may be amplified. Slurred speech, loss of memory, and more intense fatigue may indicate increased use. In terms of long-term effects, scientists discovered that there may be a link between later development of dementia and benzo abuse.

Overdose

Especially when taken with other substances, benzos present a risk for overdose. Some symptoms include:

• Aggression
• Slowed, shallow  breathing
• Severe drowsiness
• Loss of consciousness
• Death, particularly when mixed with other substances

Because the purpose of benzos is to act as a depressant, reducing too many body functions too far can be extremely dangerous. Overdosing isn’t as violent or obvious as it is with a lot of drugs, and can mimic normal symptoms. Be extra cautious when taking them.  

Withdrawal

Doctors typically prescribe benzos for a few weeks at a time, because the longer you take them, the more likely you are to become dependent on them. Coming off of them requires time and occasionally medical supervision.

Benzo withdrawal includes some of the ‘standard’ symptoms of withdrawal, such as nausea, sweating, and headaches. Because of the psychotropic nature of benzos, other symptoms could include:

• Seizures
• Hallucinations
• Anxiety
• Depression
• Trouble sleeping and nightmares

Tapering off of benzos can be dangerous, depending on how long you have been taking them. Your doctor may ween you off of them, switching to a longer-acting type or a lower dose to gradually decrease the amount in your system and give the body time to adjust.

Combining Benzos

Most benzo abuse involves other substances. Despite the danger of mixing drugs, many people combine benzos with other substances to increase the euphoric feelings they experience. Some substances are more dangerous than others to combine with benzos.

 According to the National Institute on Drug Abuse, those that combine opioids and benzos are more likely to end up in the emergency room or dying of overdose than they are from taking either drug type on their own.

Opioids

Opioids on their own can be quite dangerous. Though they work through different mechanisms in the brain, opioids also produce a feeling of calm and restfulness. They also depress important functions like breathing. 

According to the National Institute on Drug Abuse, those that combine opioids and benzos are more likely to end up in the emergency room or dying of overdose than they are from taking either drug type on their own. 

Alcohol

Alcohol is also a depressant. In large quantities, it too reduces breathing and cognitive functions. It is true that benzos can be used to help with the dangerous symptoms of alcohol withdrawal; however, a doctor will only prescribe them when alcohol is no longer in the person’s system.

Like opioids, combining these depressants can have dangerous results. Not only is the likelihood of taking a dangerous dose of benzos higher, alcohol abuse increases the likelihood that a person will take benzos at all. The University of California San Francisco found that ‘problem drinkers’ were 15% more likely to use benzos than moderate and non-drinkers.

That same study showed that alcohol was involved in 1 in 5 benzodiazepine-related deaths. 

Other Anxiety and Insomnia Medications Can be Dangerous

Z-Drugs

As an alternative to benzo for treating insomnia in the short-term, many doctors may prescribe a Z-drug. These are a family of drugs that also activate the brain’s use of GABA. The most famous Z-drug is Ambien.

Z-drugs also have a potential for misuse, though it is lower than that of benzos. Studies are still being done to examine the potential for complex sleep patterns (like sleep walking) that have been reported in relation to Z-drugs.

Barbiturates

Barbiturates are an older classification of anxiety, insomnia, and seizure medications. They’ve been largely replaced by benzos due to how aggressive they are.

Barbiturates are central nervous system (CNS) depressants. After the 1950s, when their addictive potential was revealed, benzodiazepines almost entirely replaced barbiturates for common prescriptions. Today, because they are such an effective CNS depressant, barbiturates are often used in capitol punishment and assissted suicide.

Getting Help with Benzos

Science and medicine is always evolving. We live in a time where many medicines do wonders, but many others still hold the potential for danger. 

Even if a person started taking benzos for legitimate medical purposes, they can still succumb to its addictive nature. It’s not a fault of that person, just a truly tragic side effect of the medicine.  

Though it is treatable, addiction is still a disease. Whether you find yourself at risk of developing a benzodiazepine dependence, or you currently struggle with addiction, there are options, and there is hope.

Sequoia Behavioral Health will guide you through your sobriety journey. Our holistic approach to therapy can help you get to the root of your substance use disorder alongside medical treatment. Call us today to schedule a consultation.