What are the effects of benzodiazepines?

The benzodiazepines (BZD's) are a relatively new family of depressant drugs, discovered in 1957 and introduced throughout the world in the 1960s and 1970s. Although the drugs first found fame for their "anxiolytic" (or anxiety-reducing) effects, they're also prescribed as muscle relaxants, anticonvulsants, and sleeping pills. In general, though, the drugs are more alike than different. Their main differences involve how quickly they go to work and the length of time they remain active in the body.

What are some common BZD's?

Although Valium ranked for years as the leading benzodiazepine (and at one time was the best-selling prescription drug in America), it's been slipping lately, a victim of its own success--and its failure at being trouble- and addiction-free.

Today, the top-selling tranquilizer in the United States is Xanax, and another benzodiazepine, Halcion, is one of the most widely-used prescription sleeping pills. They're the two biggest slices in the benzodiazepine marketing "pie," which, according to the American Psychiatric Association, accounts for about 61 million prescriptions a year.

Down but not out, Valium (and its generic equivalent, diazepam) is still widely prescribed and still probably the best-known member of the family. Other common BZD's include Klonopin®, Ativan®, Serax®, Centrax®, and Tranxene®.

What are their main effects?

The benzodiazepines' main therapeutic effects--to reduce anxiety and induce sleep--are the same as other depressant drugs, with a difference: BZD's target receptors in the limbic region of the brain (a system involved in emotional regulation and control) instead of depressing activity throughout the central nervous system that doesn't mean they're harmless.

You mean they're not safe?

Not necessarily. When taken as directed for short periods (no more than two months, in the case of tranquilizers, and two weeks, for sleeping pills), most BZD's are relatively safe. Still, they're not safe for everyone, all the time.

When taken for longer periods or at high doses they can be particularly risky. They can also be dangerous when used with alcohol--even small amounts of alcohol. And certain BZD's--particularly Halcion and Xanax--are being linked to a number of serious side effects, including depression, hallucinations, amnesia, and violence. In fact, one study by the U.S. Food and Drug Administration ranked Halcion and Xanax first and second in episodes of violence traced to 329 different prescription drugs. Experts are unsure why the drugs cause such problems

Are other risks linked to BZD's?

As a matter of fact, there are. Probably the most obvious --and most likely, for most users--is the risk of dependence that comes with the drugs. Dependence is a risk factor so often because the drugs block the experience of anxiety so well that many users forget they can (and should) try to live without their daily ration of Valium or Xanax or Tranxene. And they should try for the simple reason that benzodiazepines are addictive, and putting your life back together after a bout with BZD dependence can be an agonizing experience.

What makes getting off so tricky?

For one thing, users often don't realize they're getting hooked until they are hooked. They just know they have to have a hit of Valium or Tranxene or something every few hours to hold things together--not even to get high, since most BZD users don't take the drugs to get high, but merely to cope. It's only when the drug stops working, when tolerance builds and they have to step up the dosage just to avoid freaking out (often in the most mundane situations), that most people begin to suspect they have a problem. Unfortunately, most suspect their problem is anxiety or insomnia or whatever they started taking tranquilizers to deal with in the first place--not benzodiazepine dependency.

Is addiction serious?

Yes--and unpleasant, too. But how serious and how unpleasant depends on the drug involved and other factors. With the short-acting benzodiazepines withdrawal symptoms appear almost immediately and are difficult from the start. With longer-acting drugs (like Valium or Centrax), symptoms build gradually and may not reach a peak for several days. Still, no matter how long they take to arrive, benzodiazepine withdrawal symptoms are similar, regardless of the drug involved. Main symptoms include high (even intense) levels of anxiety, insomnia, tension, tremors, and fatigue. The main factor that determines the course of withdrawal is the pattern of use involved.

Dependency resulting from short-term, high-dose use follows much the same course as withdrawal from other downer drugs. Symptoms start and peak fast, usually within one to four days, and begin to wind down within two to three weeks.

Long-term, low-dose use is more typical for more users, though, and presents a different situation altogether. Symptoms may not be as immediately intense, for example, but may hang around a whole lot longer.

Is withdrawal really that bad?

Not if you do it right--and get professional help. But it can miserable, if you do it wrong. The fact is that benzodiazepine withdrawal can be a soul-wrenching experience simply because it unmasks so many emotional and psychological symptoms. What's worse is that many users don't recognize withdrawal symptoms for what they are--signs of chemical dependency--but see them instead as personal inadequacy or a recurrence of the original problem that gave rise to the dependency. One frequent result is that they think of themselves as defective and use that belief as a reason to stay addicted.

On top of that, potentially serious physical problems--particularly seizures--can also develop during withdrawal, especially following a long-term period of high-dose use. That's why it's usually wise to seek professional help during withdrawal. Doctors can help reduce the risk of convulsions and the severity of other symptoms by gradually reducing dosage or switching from a fast-acting drug to a slow-acting one, then reducing dosage. But with help or without, getting off benzodiazepines takes a lot longer than getting on them does.

How long does it take to get off?

Typically, the full range of withdrawal symptoms last about six weeks and run a two-phased course. This means that symptoms may seem to ease during the second week, only to get worse again during the third week of withdrawal. In addition, different symptoms can emerge at different times: Physical symptoms usually occur during the first phase of withdrawal, while psychological symptoms can hang on for weeks or months. But regardless of which problems occur (and when they kick in), withdrawal from BZD's is a difficult process and one that some recovering addicts say can take months to complete. In fact, some long-term ex-users report not feeling completely on top of their dependence--and fully in charge of their lives again--for up to a year after they stop using.

Alternative: Action

One of the biggest dangers of the benzodiazepines is their ability to reinforce what psychologists call "learned helplessness"--the tendency on the part of stressed-out people to throw up their hands and simply do nothing, believing that nothing they do will make much of a difference, anyway. The problem with that thinking is that we all need to learn the exact opposite--to be powerful to the degree that we can be to take charge of the events and circumstances of our lives.

In fact, the ultimate lesson that an anxious person, whether a BZD user or not, can learn is the ancient prayer: "God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference. Those are the key ingredients, simple as they sound, to beating anxiety and overcoming addiction: resisting it and learning to change the areas of our lives that contribute to it. It may sound easy, but it isn't. But, come to think of it, it's a lot easier than living life as a nervous wreck--or as a Valium or Xanax addict.