Anxiolysis means reducing anxiety. Anxiety-reducing medicines are therefore also called anxiolytics, although most people know them simply as ‘benzos’. An important type of medicine with a calming and relaxing effect are the benzodiazepines, with such medicines as diazepam (Valium) and oxazepam (Seresta).
What are benzodiazepines?
Benzodiazepines, informally called benzos, are medicines with a calming and relaxing effect. In less medical terms they are also known as sleeping pills, tranquillisers, or by trade names such as Seresta or Valium. Benzodiazepines are often prescribed for a short time when you are having serious problems with anxiety, fear or panic attacks, unrest, or sleeping difficulties.
The underlying causes behind these problems are not solved through medication. It is thus important to also find out these underlying causes and try to solve them. This is often a long and complicated personal process, involving a lot of different aspects of your life. At the same time, working on these causes (with or without professional support) is the key to learning to deal with stress and eventually without medication. This is an ongoing process of finding a balance between being comfortable and daring to go outside your comfort zone to meet new challenges. Of finding new behaviour that enables you to feel comfortable again outside your safe space.
Benzodiazepines have an addictive effect. This means that your body becomes dependent: you need more and more of the medicine to get the same effect and you suffer withdrawal symptoms when stopping benzodiazepines. Always consult your doctor about using these medicines and reduce them carefully and gradually. Read the patient information leaflet to get a clear picture of the negative aspects and side effects.
Benzodiazepines for sleeping difficulties
Some benzodiazepines make you sleepy and relax your muscles. These can thus be prescribed for sleeping difficulties, in either shorter-acting or long-acting form. However, because your body will get used to the medicine, its effect becomes less over time. It is important to take these medicines for no more than two weeks, because otherwise dependence and addiction can develop.
Shorter-acting benzodiazepines can help with problems falling asleep. They usually start working within thirty minutes and remain active for about 2 to 6 hours. The most common shorter-acting benzodiazepines are listed below, with (sometimes old) trade names in brackets:
- Brotizolam (Lendormin);
- Flunitrazepam (Rohypnol);
- Loprazolam (Dormonoct);
- Midazolam (Dormicum);
- Nitrazepam (Mogadon);
- Temazepam (Normison);
- Zolpidem (Stilnoct);
- Zopiclone (Imovane).
For problems staying asleep, long-acting benzodiazepines are prescribed. These medicines usually start working after an hour and their effects last about 8 to 12 hours.
The most common long-acting benzodiazepines are listed below, with trade names in brackets:
- Diazepam (Valium, Stesolid);
- Flurazepam (Dalmadorm);
- Lorazepam (Temesta);
- Lormetazepam (Noctamid);
- Nitrazepam (Mogadon);
- Oxazepam (Seresta).
Benzodiazepines for anxiety or agitation
Benzodiazepines have a calming effect and level down emotions. That makes them most effective for treating chronic anxiety or stress. Against panic attacks, they are less effective. Here too you get used to the medicine over time and can develop a dependence on it. The recommended maximum duration of using benzodiazepines for treating anxiety problems is two months. Afterwards, reducing and stopping benzodiazepines should always be done in consultation with a doctor.
Below are the most commonly prescribed benzodiazepines for anxiety and agitation, with trade names in brackets:
- Alprazolam (Xanax);
- Bromazepam (Lexotanil);
- Chlordiazepoxide (Librium);
- Clobazam (Frisium);
- Clorazepate (Tranxène);
- Diazepam (Valium);
- Lorazepam (Temesta);
- Oxazepam (Seresta);
- Prazepam (Reapam).
Side effects of benzodiazepines
Some people experience side effects from using benzodiazepines. These are the most common side effects:
- Drowsiness, sleepiness;
- Being less alert, concentration problems;
- Weak muscles;
- Not wanting to interact with people;
- Memory problems;
- Low sex drive;
- A feeling of emptiness;
- Underestimating dangerous situations;
- Difficulty breathing;
- More prone to trip or fall;
- Coordination problems.
Get in touch with your doctor/psychiatrist/pharmacist if you are concerned about any side effects that you are experiencing.
Reducing and stopping benzodiazepines
To prevent dependence and addiction, it is important to not use benzodiazepines for too long. Talk to your doctor or psychiatrist about how best to come off benzodiazepines. It is safest to gradually lower the dose, so you do not get withdrawal symptoms too much.
A number of common physical withdrawal symptoms are:
- Stomach problems;
- Feeling ill;
- Visual problems;
A number of common psychological withdrawal symptoms are:
- Sleeplessness (insomnia);
- Memory and concentration problems;
- Depressive problems;
- Hypersensitivity to light, sound or touch.
Withdrawal symptoms usually go away after several weeks. Sometimes they last longer, and sometimes you do not get them at all. If you have any problems or concerns, always talk to your doctor or pharmacist. Is reducing the medicines difficult for you? Then tapering strips can help you out. Learn more at taperingstrip.org.
Do benzodiazepines affect other medicines?
Always tell your doctor about all the medication you are currently taking before you start or stop using another medicine. Also mention any supplements that you take, if any, or homeopathic medicines. There is always a chance that your current medication does not mix well with some other medicine. Benzodiazepines can make you sleepy, and other medicines can make this worse, such as:
- Certain painkillers;
- Valerian root;
- Antihistamines / allergy pills;
- Beta blockers.
Does alcohol affect benzodiazepines?
Alcohol and benzodiazepines (tranquillisers and sleeping pills) are a bad combination. They amplify each other’s sedative (calming) effect, with can sometimes have unpredictable consequences. Besides heavy sleepiness it can also promote aggression and hostility. So mixing alcohol and benzos is strongly discouraged.
Can you drive when you are on benzodiazepines?
The use of tranquillisers and sleeping pills reduces your reaction time and judgement capacity and can make you sleepy. Whether you can drive depends on the dosage and the time since last you took it. For more advice on driving and medication, go to the British website of mind.org.
Can you take benzodiazepines during pregnancy?
Always discuss your medication with a doctor and/or obstetrician (midwife) when you are pregnant or planning to become pregnant. Generally, benzodiazepines can be used during pregnancy: no special measures are required for normal dosages. However, at higher dosages, with prolonged use, or when combined with other medication, the unborn child can get dependent on the medicine. Once it is born the child can suffer withdrawal symptoms.
This website (in English and Spanish) offers more information on benzodiazepines (and other medication) during pregnancy.
Prof. dr. Jim van Os, Chair Division Neuroscience, Utrecht University Medical Centre. He is also Visiting Professor of Psychiatric Epidemiology at the Institute of Psychiatry in London. Jim works at the interface of ‘hard’ brain science, health services research, art and subjective experiences of people with ‘lived experience’ in mental healthcare.
Jim has been appearing on the Thomson-Reuter Web of Science list of ‘most influential scientific minds of our time’ since 2014. In 2014 he published his book ‘Beyond DSM-5‘, and in 2016 the book ‘Good Mental Health Care’.
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