Valsa Madhava, MD
Why you should consider a Benzo Taper :
Updated: Oct 20, 2022
Benzodiazepines are widely used to treat anxiety, seizures, and insomnia. Non-benzodiazepines known as Z-drugs (zaleplon, zolpidem) are also used to treat sleep disorders and act on the same benzodiazepine receptors. The short-term use, less than 2-4 weeks of such drugs is usually safe and beneficial, but long-term use can lead to many harms detailed below:
Benzodiazepine usage can give rise to psychological and physiological dependence based on the dosage of the drug, duration of therapy, and potency. Thus, dependence will develop sooner in a patient taking a large dosage of high potency drugs such as alprazolam and lorazepam than in a patient taking a relatively low dosage of a long-acting and less potent drug such as chlordiazepoxide and clonazepam. Due to physiologic dependence, withdrawal symptoms will emerge in 40-80% of those taking the medication, with any dose reduction and especially with abrupt discontinuation of these drugs.
Protracted withdrawal syndrome (Benzodiazepine-Induced Neurologic Dysfunction-BIND)
Some (10-20%) patients who discontinue benzodiazepine drugs may experience withdrawal effects that last more than 30 days- the washout period of all benzodiazepines. These long-term “withdrawal” symptoms are collectively known as Protracted Withdrawal Syndrome (PWS) or BIND. Please go here for more information. The withdrawal symptoms persist for months and even years after the cessation of benzodiazepines. The common BIND symptoms are:
● Low energy
● Nervousness, Anxiety, fear
● Trembling or tingling in limbs, skin
● Brain fog
● Brain Zaps
● Difficulty focusing, distracted
● Benzo belly
● Stabbing pain, burning, aching sensations, or joint pain
● Difficulty breathing or swallowing
● Uncontrollable crying or anger
● Sensitivity to light, noise, smell, triggering symptoms
Reference: Finlayson R., Macoubrie J., Huff C., Foster D., Martin P. Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey. Therapeutic Advances in Psychopharmacology. 2022, Vol. 12: 1–10
Cognitive impairment and dementia
Benzodiazepines have acute harmful effects on memory and cognition, such as drowsiness, ataxia, anterograde amnesia, and motor incoordination. Chronic use of benzodiazepines and related Z-drugs can even cause Alzheimer's disease. Benzodiazepines such as Rohypnol are also used as a "date rape" drug because they can impair and even abolish the ability of a person to resist sexual aggression or assault. The person cannot remember what happened during that time because it causes unconsciousness and amnesia.
Overdose deaths when combined with opioids
Most deaths from benzodiazepine overdose are from respiratory depression. This occurs when benzodiazepines are mixed with other respiratory depressants such as alcohol and opioids (fentanyl, morphine). Both benzodiazepines and opioids cause sedation and suppress breathing, so the risk of coma and death are increased from the use of opioids with Benzodiazepines together.
Motor vehicle accidents
Driving a car or performing some hazardous task can be dangerous while using benzodiazepines because these sedative-hypnotic drugs cause drowsiness and dizziness as their side effects and minimize the focus and concentration level. It is widely accepted that motor vehicle accidents, particularly in older adults can be due to the use of benzodiazepines and related Z-drug users.
Falls and fractures in elderly
Benzodiazepine use increases the risk of falls and has been associated with an increased risk of hip fracture. The liver of older patients may not metabolize these sedative-hypnotic drugs as well, so these drugs can build up in their system. This leads to dizziness or drowsiness that may result in a fall, leading to bone fractures.
Increased risk of respiratory infections
Studies have shown that patients taking benzodiazepines are at increased risk of developing respiratory infections such as pneumonia. Benzodiazepines can diminish respiratory function by either reducing the tone of airway smooth muscle or increasing the threshold for arousal by desensitizing neurons in the airway. The respiratory depression side effect of benzodiazepines is common in people who already have a respiratory disease such as COPD.
Increased risk of emotional blunting
Although benzodiazepines treat mental health conditions such as anxiety and insomnia, these drugs can also lead to other mental and emotional disturbances. Benzodiazepine use is linked to suicidal thoughts, depression, and emotional blunting (lack of emotions).
Caution with use in pregnancy
The usage of benzodiazepines is contraindicated during pregnancy as they lead to preterm delivery and low birth weight. These drugs can pass to the fetus and may lead to adverse conditions. A recent study has also shown that the ratio of cesarean delivery is 2.5 times higher in women who used benzodiazepine during pregnancy. Short-term neonatal effects such as hypotonia, depression, and withdrawal are also observed due to these drugs.