Benzodiazepines are a group of depressant medications that act as sedatives. They are used to treat an array of conditions, such as seizures, anxiety, insomnia, and alcohol withdrawal. They are controlled substances due to their addiction and abuse potential, often leading to physical and psychological dependence. These drugs are extremely dangerous when taken with opioids or alcohol secondary to respiratory depression

Mechanism of benzos 

Benzodiazepines, also known as benzos, enhance a neurotransmitter called GABA. This inhibits signals in the brain to reduce the overall activity of the nervous system. Because GABA receptors are located in the brain stem where respiration is controlled, overdosing or taking more benzodiazepines than needed can lead to respiratory depression. This is a vital concept to understand, as a significant percentage of overdoses occur when patients mix benzodiazepines with alcohol or opioids. Because of the risks of mixing opioids and benzodiazepines, the CDC recommends that this combination should be avoided unless absolutely medically necessary. 

Long-term benzodiazepine use should be avoided if possible

Experts recommend that patients not be prescribed benzos for more than a few weeks at a time for acute conditions that deem these medications necessary. Although patients on chronic benzodiazepines increase the chances of withdrawal when discontinued, the FDA black box warning states that withdrawal may occur even when used for short periods.

Properties of benzodiazepines

Anti-anxiety properties [Anxiolytic]

Benzos are effective medications to treat acute anxiety, as these drugs are quick acting. Benzos allow the nervous system to slow down relatively quickly, alleviating symptoms within minutes.  

Anti-seizure [Anticonvulsant]

Benzos are effective in treating seizure activity or status epilepticus. They  act rapidly and can alleviate symptoms immediately. Benzodiazepines come in short-acting and long-acting forms and are available intravenously, making them effective in subsiding seizure activity in emergency settings.

Muscle relaxant properties [Anti-spastic]

Benzos induce muscle relaxation by enhancing the efficacy of GABA receptors, and can act quickly for severe muscle spasms or spasticity. Benzos are used often in patients with severe spasticity from spinal cord and brain injuries.

Sleep-inducing [Hypnotic]

Benzodiazepines effectively treat insomnia, but due to the long-term consequences of dependency and other adverse effects, benzos should be prescribed judiciously if possible.  

Calming [Psycholeptic]

Benzodiazepines can alleviate the symptoms associated with panic attacks. The goal should be to taper and discontinue benzodiazepines and use them only as needed for acute situations. Benzos are often used in conjunction with SSRIs. 

Sedative [Neurolytic]

Among many other uses, benzodiazepines are often used to treat alcohol withdrawal. This can be a severe situation and can escalate quickly.  Withdrawal should be taken very seriously, and the patient should be monitored in a clinical facility. 

Physical dependence 

Physical dependence can occur when benzodiazepines are taken steadily for several days to weeks. Patients who have been taking a benzodiazepine for weeks or months can have withdrawal signs and symptoms when the medicine is discontinued abruptly or continued in lower doses to avoid withdrawal. Stopping benzodiazepines abruptly or reducing the dosage too quickly can result in acute withdrawal reactions, including seizures, which can be life-threatening. Prior to stopping benzodiazepines, patients should talk to their health care provider to develop a plan for slowly tapering the medication.

Signs of physical dependence

There are several signs of physical dependence on benzodiazepines, so it is vital to pay attention to specific changes in behavior and deviation from baseline personality. Due to the habit-forming nature of benzos, a physical dependence can occur in anyone.

• Blurry vision or visual changes in general
• Continuous and ongoing drowsiness
• Changes in behavior and mood
• Persistent in trying to obtain multiple prescriptions or doctor shopping 
• Drinking alcohol with benzos or combining it with other dangerous drugs
• High-risk behaviors 
• Unable to taper off benzos 

Signs of withdrawal

Benzos, even if taken for a short period of time, can be difficult to stop suddenly. Benzo withdrawal is a serious condition, and the earlier it is identified, the easier it is to treat.  

• Anxiety
• Tremors and restlessness
• Severe headaches
• Increased heart rate
• Agitation
• Increase sweating 
• Sudden panic attacks
• Nausea and vomiting
• Respiratory changes, including hyperventilation 
• Restlessness
• Changes in memory
• Unusual sensations 

Common Side effects of benzos

• Muscles weakness or generalized weakness
• Sudden confusion
• Changes in balance
• Dizziness and drowsiness
• Slurring words and difficulty communicating 
• Problems with memory 
• Blurry vision and sudden changes in vision
• nausea and vomiting
  

It is imperative to discuss all your health issues, family history, and which medications you are on prior to being evaluated if benzodiazepines are indicated.  Short periods of benzo treatment for seizure activity, acute panic attacks, and sedation prior to a procedure or surgery.