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The physician’s psychoactive medication resource guide
25% of your patients taking an antidepressant will have
weight gain and the weight gain is directly caused by the antidepressant.
What is benzodiazepine?
Benzodiazepine is a chemical compound commonly used to treat anxiety, to produce sedation, or
as a muscle relaxant.
Doctors may prescribe a benzodiazepine for the following legitimate medical conditions:
Inducing amnesia for uncomfortable procedures
Given before an anesthetic (such as before surgery)
Benzodiazepines act on the central nervous system, produce sedation and muscle relaxation, and
lower anxiety levels.
Although more than 2,000 different benzodiazepines have been produced, only about 15 are
currently FDA-approved in the United States. They are usually classified by how long their effects
last. Types of benzodiazepines therefore include those the following:
Ultra-short acting: midazolam (Versed), triazolam (Halcion)
Short-acting: alprazolam, lorazepam
Long-acting: chlordiazepoxide (Librium), diazepam
Benzodiazepines are a class of drugs with sedative, hypnotic, anxiolytic, anticonvulsant, amnestic
and muscle relaxant properties. They are often used for short-term relief of severe, disabling
anxiety or insomnia. Long-term use can be problematic due to the development of tolerance and
Benzodiazepines began to be widely prescribed for stress-related ailments in the 1960s and
1970s. They are commonly divided into three groups:
Short-acting compounds act for less than six hours and exhibit few residual
effects if taken prior to sleep, but rebound insomnia is possible and may
cause wake-time anxiety.
Intermediate-acting compounds have an effect for 6-10 hours, may have mild
residual effects but rebound insomnia is not common.
Long-acting compounds have strong sedative effects and persist. Accumulation
of these compounds may occur.
Warnings or dangers associated with benzodiazepines:
Tolerance to many of the therapeutic effects of benzodiazepines can develop rather rapidly with
daily or frequent use. Unlike tolerance to other drugs like opioids, nicotine or stimulants, tolerance
to benzodiazepines can put the patient at risk for experiencing an iatrogenic syndrome, consisting
of a range of side effects that can be worse than the original condition.
For this reason, current established guidelines restrict benzodiazepine treatment to a maximum
of 2-4 weeks in use. It is typical for tolerance to the hypnotic effects to occur within days and the
anxiolytic effects normally do not last for more than a few months. After that, the dose may need
to be increased on a regular basis to minimize the numerous unpleasant symptoms that can
emerge during long-term (more than 4 weeks) use.
Eventually the patient may reach a point where increasing the dose is no longer effective in
relieve the drug’s side effects. This is why it is important for physicians to adhere to the
established guidelines of 2-4 weeks maximum. Tolerance can cause a wide range of symptoms
related to nervous system dysfunction to emerge, many identical to benzodiazepine withdrawal
Long term use of benzodiazepines generally leads to some for of tolerance and/or dependence. As a Schedule IV controlled drug,
benzodiazepines are considered moderately addictive.
Benzodiazepine Overdose and withdrawal:
Overdoses of benzodiazepines can, especially when in combination with alcohol, may lead to coma, but does not cause severe
biochemical disturbances and therefore usally carries a relatively good prognosis. The antidote for all benzodiazepines is flumazenil
(Annexate®), which is sometimes used empirically in individuals present with unexplained loss of consciousness in an emergency room
Withdrawal symptoms can include anxiety, panic attacks, tachycardia, depression, suicidality (thought and behavior), insomnia,
hypertension, tremor, dysphoria, loss of appetite, sweating and delusions.
Abruptly discontinuing these medications may result in a severe and very unpleasant withdrawal syndrome that may additionally result in
confusion, psychosis, convulsions and effects similar to delirium tremens (sometimes called the DTs, "the horrors", "the shakes" or "rum
fits" - a condition usually associated with complete alcohol withdrawal).
As such, anyone on long-term or high dosage of any benzodiazepine should be carefully weaned off the drug. It is important to note that
the withdrawal syndrome from long-term benzodiazepine use, even at low dosage, can be severely debilitating, lasting months to years.
This can normally be avoided or minimized by very gradual tapering of the drug over a period of several months.
Benzodiazepines, as a sedative or tranquilizer, may have the opposite effect when used by children, older adults, and people with
developmental disabilities. The following are effects a benzodiazepine may have on certain people:
Aggression. You may be less tolerant than usual. You may anger quickly and yell or even hit people for no reason.
Hostility. You may become very unfriendly.
Impulsivity. You may do things without thinking about the effects of your action.
Increased excitement. You may become more anxious or nervous.
Irritability. You may grumble or be unhappy for no reason.
How do I know if I am dependent on benzodiazepines?
If you use benzodiazepines every day, or two or three times a day for weeks or months, you may become dependent on a benzodiazepine.
When you are dependent on a benzodiazepine you feel normal while you are taking it. It is important to realize that you are dependent on the
medicine. Do not suddenly stop using benzodiazepines. The amount of medicine, and the frequency that use it must be decreased over time.
Withdrawal symptoms may not begin for hours or days after decreasing use of the medicine. If you have been taking a benzodiazepine for a
long time or you are taking a high dose, withdrawal symptoms may be severe (very bad).
What are the signs and symptoms of withdrawal?
The length of time after decreasing your use of the drug, and the time that signs and symptoms of withdrawal begin depends on several
factors. These include which benzodiazepine you were using, how long you have been using it, and the amount of medicine you were
using. Signs and symptoms may begin within hours after decreasing your use of the medicine, and may continue for up to a week. Signs
and symptoms may also begin over a week after decreasing your use of the medicine, and may continue for a month or longer.
Signs and symptoms of withdrawal are two or more of the following, that begin hours to days after decreasing use of, or stopping the
Feeling nauseated (sick to your stomach) or vomiting (throwing up).
Increased sweating, and having a fast heartbeat.
Seeing, feeling, or hearing things that are not there. These are called hallucinations.
Trouble falling or staying asleep.
You may do things over and over that have no meaning, such as pacing or wringing your hands.
You may feel very nervous.
You may have a seizure (convulsion).
These symptoms may be very uncomfortable for you. They may also keep you from doing your normal daily activities.