Benzodiazepines (BZs)

Benzos, Downers, Nerve Pills, and Tranks

Primary Uses

Control of acute anxiety

Long term control of anxiety

Insomnia Epilepsy

Muscle relaxant

Alcohol Withdrawal

Presedation

Examples of Benzodiazepines

Drug Name Brand Name Therapeutic Effect

Alprazolam Xanax, Helex, Xanor Anxiolytic

Chlordiazepoxide

Librium, Risolid Anxiolytic

Clonazepam Klonopin, Rivotril, Paxam

Anxiolytic/Anticonvulsant

Diazepam Valium, Vival, Atenex Anxiolytic/Anticonvulsant, Muscle Relaxant

Flunitrazepam Rohypnol Anxiolytic/ Hypnotic/Muscle Relaxant

Halzepam Paxipam Anxiolytic

Lorazepam Ativan, Lorenin, Temesta, Tavor,

Anxiolytic/ Anticonvulsant

Temazepan Restoril, Normison, Tenox

Hypnotic

Tetrazepam Mylosstan Skeletal

A Brief History Discovered in 1954 by Dr. Leo Sternbach, an Austrian chemist working for the pharmaceutical company Hoffmann-La Roche.

In 1960, chlordiazepoxide (Librium) was the first BZ introduced in the United States as an antianxiety medication.

Benzodiazepines were intended to be a safe, non addictive replacement for the barbiturates.

Benzodiazepines have become the most frequently prescribed class of psychotropic medications in the world

How is it Taken?BZs are usually taken in capsule or tablet from, but some are available as an injectable solution.

Tablets are typically pastel shades of yellow, green, or blue.

Some users dissolve the pills in water, mix them with other drugs, and then inject them directly into the vein.

How it Works

Benzodiazepines are a class of drugs that produce central nervous system (CNS) depression.

Benzodiazepines enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA-A).

GABA is the primary inhibitory neurotransmitter. Meaning that it tells the neurons that it comes in contact with to slow down

How it Works Continued

Because there are millions of GABA receptors located in many different regions of the brain BZs have a general quieting influence on the brain.

It is still unclear whether the BZs must bind to GABAA receptors in only one part of the brain to induce their anxiolytic effect of if there are multiple cites of action.

GABAs inhibitory activity also leads to reduction in excitatory neurotransmitters including norepinephrine, serotonin, acetyl choline and dopamine.

Benzodiazepine Classification

BZs are classified by their therapeutic half-life. a) ultra-short- acting (<4 hours)b) short-acting (<6 hours)c) intermediate duration (6-24 hours)d) long-lasting (24 + hours)

Regardless of their potency, speed of elimination, or duration of effects, actions in the body is virtually the same.

Short and intermediate acting are preferred for treatment of insomnia

Long- lasting are recommended for treatment of anxiety

Physical Effects BZs are designed to produce feelings of relaxation and an increased sense of well-being in the user

Other physical side effects may include Decreased emotional reactions, mental alertness, and attention span

Confusion

Drowsiness

Loss of coordination

Dizziness

Light headedness

Learning & Memory

Never take Benzodiazepines while studying!

BZ interfere with learning and memory consolidation, partly because of difficulties with attention and concentration

Even when taken at normal dosage levels, the BZ’s can interfere with normal memory function

The mechanisms for the BZ-induced memory impairment appears to be similar to that of alcohol-related “blackout,” and it will last for the duration of the BZ’s effects on the user

Paradoxical Stimulant Effects

BZ’s occasionally cause paradoxical excitement with increased anxiety, insomnia, nightmares, hallucinations at the onset of sleep, irritability, hyperactivity or aggressive behavior, and exacerbation of seizures in epileptics

Increases in irritability and common and are frequently remarked upon by patients or by their families

The aggression/rage response appears to reflect the benzodiazepine-induced cortical disinhibition effect

Can be likened to the effects of alcohol.

Other Side EffectsBZ-related psychomotor impairment is common. The risk of a motor vehicle accident is significantly increased after taking benzodiazepines.

Respiratory depression

BZs can induce, or exacerbate, a depressive thoughts or feelings

Interference with normal sexual function in both men and women

Suicidal thoughts

Should BZs be used as a short-term or long-term treatment? There is strong disagreement among medical professionals as to whether BZ are effective in long term treatment of anxiety.

Some researchers believe that the BZ’s are only effective anxiolytics for only 1-2 months, after which they become less effective

Some physicians view the BZs as being effective for the control of anxiety even over extended periods of time. There is little evidence to suggest that patients become tolerant to the antianxiety effects, however they may reach a plateau.

It is now common for doctors to prescribe BZs concurrently with SSRIs for long-term antianxiety purposes. After 6-8 weeks patients should slowly discontinue their use of BZs.

Long-Term Consequences of Benzodiazepine Use

The long-term use of BZs may lead to addiction

BZs with shorter half-lives, higher potency, and a brief duration of action, have the greatest potential for abuse (e.g. lorazepam, alprazolam, diazepam)

Following periods of extended use, the BZs are able to induce a characteristic withdrawal syndrome similar to that of alcohol

Symptoms of withdrawal include: abdominal cramps agitation, anxiety, anorexia, confusion, delirium, depersonalization, depression, fatigue, formication, insomnia, nausea/vomiting, nightmares, seizures, sweating, withdrawal psychosis.

Medical supervision during the withdrawal process is imperative

Types of Benzodiazepine Abusers

Generally speaking BZ abusers fall into one of two types

(a) Those who abuse BZs to achieve a sense of euphoria

(b) Those who begin to abuse a prescribed BZ by taking more of it, for longer periods than was prescribed

Abusers who wish to achieve a sense of euphoria are usually polydrug abusers. BZ are used to supplement the effects of their drug(s) of choice

BZ are also used to reduce the effects of withdrawal from other drugs

Detection of BZ Use

Benzodiazepines are detectable in the urine for 3 days after therapeutic use and for 4-6 weeks after chronic term use. It is detectable in hair for 90 days after cessation and in blood for 6-48 hours.

Fun Fact

Exercise is both an antidepressant and anxiolytic

Community ResourcesAlcohol and Drug Dependency Services Inc.

291 Elm Street Buffalo, NY14203

(716) 854-2997

Services: Substance abuse treatment, Detoxification, Inpatient Rehabilitation, Residential short-term treatment (30 days or less)

Alcohol and Drug Dependency Services Family Addiction107 Delaware Avenue Suite 555 Statler Towers Buffalo NY, 14202

(716) 855-0163

Services: Substance abuse treatment, out patient

Alcohol and Drug Dependency Services Mens2025 Broadway Buffalo NY 14212

(716) 8927401

Services: Substance abuse treatment, Halfway house, Residential long-term treatment

Online Resources AlcoholDrugSOS services Addictions Counseling Online

http://www.alcoholdrugsos.com/

This site offers online answers to questions about drug and alcohol addiction for a fee based on the complexity of the questions and online addiction counseling

Life Recovery Program https://www.liferecoveryprogram.com/

Online addiction recovery support program consists of biweekly video/audio workshops, practice tools, and interactive anonymous peer support forum.

Lion Rock Recoveryhttp://www.lionrockrecovery.com/online-intensive-outpatient/

Online recovery programs consist of assessment, treatment planning, case management and transition planning for ongoing sobriety support

Journal Articles Evidence-based pharmacotherapy of post-traumatic stress disorder (PTSD).

Ipser, J. C., & Stein, D. J. (2012). Evidence-based pharmacotherapy of post-traumatic stress disorder (PTSD). International Journal Of Neuropsychopharmacology, 15(6), 825-840. doi:10.1017/S1461145711001209.

Refractory Generalized Convulsive Status Epilepticus: A Guide to Treatment.

Kälviäinen, R., Eriksson, K., & Parviainen, I. (2005). Refractory Generalised Convulsive Status Epilepticus: A Guide to Treatment. CNS Drugs, 19(9), 759-768. doi:10.2165/00023210-200519090-00003

Journal Articles Continued

A postmarketing study of relative abuse liability of hypnotic sedative drugs.

Jaffe, J. H., Bloor, R., Crome, l., Carr, M., Alam, F., Simmons, A., & Meyer, R. E. (2004). A postmarketing study of relative abuse liability of hypnotic sedative drugs. Addiction, 99(2), 165-173. doi:10.1111/j.1360-0443.2003.00631.x

Early identification, treatment, and interventions for the prevention of benzodiazepine dependence with anxiety disorders.

Blunk, M., & Williams, K. (2011). Early identification, treatment, and interventions for the prevention of benzodiazepine dependence with anxiety disorders. Mental Health And Substance Use, 4(4), 277-292.

References

Doweiko, H.E. (2009). Abuse of and Addiction to the Benzodiazepines and Similar Agents. In Concepts of Chemical Dependency 8th edition (pp.73-86). La Crosse, WI: Brooks/Cole.

Office of Diversion Control. (2010). Drugs and Chemical Concerns. Retrieved fromhttp://www.deadiversion.usdoj.gov/drugs_concern/benzo_1.htm

Gale Encyclopedia of Medicine. (2008) Benzodiazepines. Retrieved from http://medical-dictionary.thefreedictionary.com/Benzodiazepines

References Cont.

Narconon Drug Infromation Department. (2009). Benzodiazepines are a Popular Anti-Anxiety Drug withAmnesia as a Side Effect. Retrieved from http://www.narconon.org/drug-information/benzodiazepines.html