Doctors often prescribe medications and counseling, but diet can also make a difference. What is idiopathic intracranial hypertension? Read on to learn more about this rare condition, including its symptoms, risk factors, and treatments. The benefits and risks of benzodiazepines. Medically reviewed by Alan Carter, Pharm. Uses Function Types Side effects Interactions Misuse Takeaway Benzodiazepines are a class of drugs that can treat a range of conditions.
Name Use alprazolam panic and anxiety disorders chlordiazepoxide Librium alcohol withdrawal and anxiety diazepam panic attacks, restless leg syndrome, insomnia, seizures, and alcohol withdrawal flurazepam Dalmane insomnia clonazepam panic disorder and seizure disorders lorazepam anxiety, seizures, and anesthesia temazepam Restoril insomnia. Side effects. Exposure to air pollutants may amplify risk for depression in healthy individuals. Costs associated with obesity may account for 3. Related Coverage.
Medically reviewed by Dena Westphalen, Pharm. Treatments for anxiety. Medically reviewed by Dillon Browne, PhD. What foods are good for helping depression? J Clin Psychopharmacol ;13 suppl 1 :1— According to the APA report on benzodiazepines, 1 11 to 15 percent of the adult population has taken a benzodiazepine one or more times during the preceding year, but only 1 to 2 percent have taken benzodiazepines daily for 12 months or longer.
In psychiatric treatment settings and in substance-abuse populations, however, the prevalence of benzodiazepine use, abuse and dependence is substantially higher than that in the general population. Because benzodiazepines are controlled substances with abuse potential, special attention must be directed toward the patient's addiction history before these agents are prescribed. An understanding of the toxicity and side effects of benzodiazepines, abuse patterns and alternative anxiolytic and hypnotic agents may help clinicians maximize treatment outcomes and reduce medicolegal liability risks.
Benzodiazepine receptors are ubiquitous throughout the central nervous system. Activation of the benzodiazepine-GABA-chloride ionophor complex is responsible for producing the therapeutic anxiolytic effects of benzodiazepines and for mediating many of the side effects and, possibly, dependence and withdrawal from these drugs. Similarly, other sites for drug and neurotransmitter binding are associated with the GABA receptor complex, which serves as a primary site of action of benzodiazepines, barbiturates and other sedative-hypnotics, such as alcohol.
They do so by allosterically altering the receptor changing its conformation so that it has a greater binding affinity for GABA. Ethanol modifies the receptor by altering the membrane environment so that it has increased affinity for GABA and the other sedative-hypnotic drugs.
That benzodiazepines, barbiturates and ethanol all have related actions on a common receptor type, which explains their pharmacologic synergy and cross tolerance. Thus, benzodiazepines are used during alcohol detoxification. With long-term high-dose use of benzodiazepines or ethanol , there is an apparent decrease in the efficacy of GABA-A receptors, presumably a mechanism of tolerance. With the introduction of chlordiazepoxide Librium in , and because of the relative safety of benzodiazepines, these agents rapidly replaced barbiturates as sedative-hypnotics.
They cause significantly less respiratory depression than barbiturates and, consequently, are rarely lethal in an overdose. As a class of drugs, benzodiazepines share many clinical properties, although the different agents in this class may display different pharmacokinetic and pharmacodynamic properties Table 2. Pharmacologic properties such as potency, half-life and lipophilicity, the duration of treatment and the rate of a dosage increase or decrease have a bearing on the occurrence of side effects.
Alprazolam Xanax. Lorazepam Ativan. Triazolam Halcion. Clonazepam Klonopin. Oxazepam Serax. Temazepam Restoril. Chlordiazepoxide Librium. Clorazepate Tranxene. Diazepam Valium. Flurazepam Dalmane. When used alone, benzodiazepines carry an extremely low risk of acute toxicity. However, benzodiazepines often are used with other types of medications, including other drugs with abuse potential, and these drugs can enhance the toxic effects of benzodiazepines.
The latter interact synergistically with other central nervous system depressants, including other hypnotics, sedating antidepressants, neuroleptics, anticonvulsants, antihistamines and alcohol.
In addition, pharmacokinetic drug interactions may occur. For instance, selective serotonin reuptake inhibitors SSRIs may increase diazepam blood levels, 9 and nefazadone Serzone may increase alprazolam levels 10 through hepatic enzyme inhibition, leading to increased sedative-hypnotic effects or side effects. Psychomotor slowing may be especially profound following initial administration of a benzodiazepine or with a sudden dosage increase.
It also may be noted in patients, such as the elderly, who have decreased rates of metabolism or greater susceptibility to central nervous system depression. Benzodiazepines induce anterograde amnesia, which accounts for the beneficial effects of benzodiazepines such as midazolam Versed for presurgical medication.
These specific amnestic effects appear to be separate from sedation. Specific deficits in visuospatial ability and sustained attention have also been described in patients who have taken therapeutic doses of benzodiazepines regularly for longer than one year. Increased excitement, irritability, aggression, hostility and impulsivity may occur in some patients who take benzodiazepines.
This paradoxical disinhibition may, in rare cases, result in attacks of rage or violence, or other indiscretionary or antisocial behaviors.
These reactions occur most commonly in children, in the elderly and in persons with developmental disabilities. An association has been noted between benzodiazepine use and depressive symptoms and, in some cases, the emergence of suicidal ideation.
Some evidence indicates that higher benzodiazepine dosages are associated with an increased risk of depression and that reducing the dosage or discontinuing therapy may resolve the depressive symptoms.
This effect may be sought by drug addicts who become progressively more incapable of tolerating their emotions and life stressors. Benzodiazepines cross the placenta and are classified as class D teratogens. They may lead to the development of dependence and consequent withdrawal symptoms in the fetus. Tolerance to all of the actions of benzodiazepines can develop, although at variable rates and to different degrees.
Tolerance to the hypnotic effects tends to develop rapidly, which may be beneficial in daytime anxiolysis but makes long-term management of insomnia difficult. Dosage escalation often maintains the cycle of tolerance and dependence, and patients may have difficulty discontinuing drug therapy.
Benzodiazepine therapy can give rise to physiologic and psychologic dependence based on the drug's dosage, duration of therapy and potency. As a result of physiologic dependence, withdrawal symptoms emerge with rapid dose reduction or abrupt discontinuation of the drug. Psychologically, long-term use of benzodiazepines may lead to overreliance on the need for the agent, loss of self-confidence and varying degrees of drug-seeking behavior.
Withdrawal effects from therapeutic dosages of benzodiazepines are mainly anxiety symptoms. The most serious acute withdrawal symptoms are seizures and delirium tremens, which most commonly occur with abrupt discontinuation.
The time frame for the emergence of acute withdrawal symptoms corresponds to the half-life of the particular agent being used. Some elements of withdrawal are believed to occur in a majority of patients who have taken therapeutic dosages of benzodiazepines for more than a few months, although the severity of withdrawal symptoms generally depends on the amount of the original dosage, the rate at which the dosage is tapered, the selection of patients and the definition of withdrawal symptoms.
A protracted abstinence syndrome has been observed by addictionologists who are familiar with benzodiazepine addiction. In addition, physical symptoms related to gastrointestinal, neurologic and musculoskeletal effects may occur.
This abstinence phenomenon may develop despite long, slow, judicious tapering of the dosage and is hypothesized to result from chronic neuroadaptation. Among the elderly, the risk of drug interactions, psychomotor slowing, cognitive dysfunction and paradoxical disinhibition may be amplified. Benzodiazepine use in the elderly is associated with an increased rate of falls that cause hip and femur fractures and an increased likelihood of motor vehicle crashes. Cognitive deterioration associated with normal aging processes and dementia can be worsened by benzodiazepine side effects.
Cortical suppression mechanisms may be disturbed in the elderly, and disinhibited behaviors may increase with benzodiazepine use. With less cognitive and social reserve in the elderly patient, the short- and long-term withdrawal symptoms and other benzodiazepine side effects may lead the patient to frequently visit or telephone the physician. Medically reviewed by Dena Westphalen, Pharm.
Can Xanax help depression? How does Xanax work? What are the side effects of Xanax? What are the benefits of Xanax? Clinical studies for depression. Does Xanax cause depression? Xanax interaction with other drugs. Xanax and alcohol. The takeaway. Read this next. Medically reviewed by Vincent J. Medically reviewed by Timothy J. Legg, Ph. Can Probiotics Help With Depression? Medically reviewed by Alan Carter, Pharm.
Medically reviewed by Karen Gill, M. Mood disorders include various forms of depression and bipolar disorder. However this is a short-term option, and medication alone is not comprehensive treatment for any mental health issue. Use needs to be closely monitored and combined with traditional and alternative therapy options. Benzodiazepines should only be used for a few weeks to stabilize mood and health.
When used for longer, they may worsen mood disorders rather than help treat them. Benzodiazepines can cause nearly immediate health problems. If use continues, individuals may experience significant changes to mood, health, and behavior.
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