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.
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