Starting in the 19th century, anxiety, nervousness and general unease which might keep a person from falling asleep, were treated by highly toxic (and lethal) barbiturates. In 1960, when introduced, benzodiazepine had a shorter window of performance so they were seen as safer (Ashton, 2002). Since then this class of drug has been overprescribed and abused (Gatsby. 2000). Complicating the matter is the length of time doctors are letting patients stay on these drugs. Further the withdrawal symptoms are so severe they exceed that of heroin and can lead to death. A fate worse than heroin (Gatsby, 2000).
How Benzodiazepine Works
The actions in the body are virtually the same for all benzodiazepines (currently there are 24 being produced). Therapeutically ‘benzo’s” are swallowed in pill form and used for five different areas: anxiolytic-relief of anxiety, hypnotic-for sleep, myrorelaxant-muscle relaxation, anticonvulsant and amnesic (impairment of memory) (Ashton, 2002).
A good example of what happens when a person becomes anxious or has a panic attack. However you can use any of the therapeutic purposes above. When a person gets anxious or in the extreme, has a panic attack, the brain goes into over drive and tells the transmitters that have the “quieting” chemicals, called Gaba, into action. These respond by sending messages to the brain cells to slow down or to stop and because, as earlier stated, the number of brain cells responsive to these transmitters is high then it has a quietening effect on the brain (Ashton, 2002).
Benzodiazepines act like those chemicals made by the body for “quietening” effects. When these are added to those produced naturally, by the body, it means that there are a greater number of transmitters sending out messages to the brains resulting in a serious slow down or shut down of these brain cells. As a result of the number cells being slowed down the brains output of “excitatory” transmitters is reduced. These excitatory transmitters control alertness, memory, co-ordination, emotional responses, heart rate, and blood pressure. The failure to produce enough excitatory transmitters thereby affects the body’s normal working (Ashton, 2002).
Prolonged Use Implications and Withdrawal
The UK Committee on Safety of Medicines in 1988 recommended that benzodiazepines should in general be reserved for short-term use of 2-4 weeks only (Gatsby, 2000). Prolonged use of benzodiazepines forces the brain to make physical changes to overcome the effects of the drug which is known as “tolerance” (Doweiko,2014) which then results in GABA, as mentioned, the natural calming chemical produced by the brain, becoming less effective. Over use can cause withdrawal symptoms even while still taking the drug (Ashton, 2002).
Directly or indirectly, benzodiazepines, in fact influence almost every aspect of brain function.(Ashton, 2002) When a person tries to stop using the drug, after long term use, these adaptations produced when becoming tolerant forces the brain to go into overdrive. With nothing to oppose the reaction the results are anxiety, memory problems, panic attacks, paranoia, and agoraphobia. A combination of these symptoms is known as the “withdrawal syndrome” (Ashton, 2002)Physically the withdrawal can cause headaches, pain and stiffness, tingling and numbing sensations blurred visions Tinnitus, hypersensitivity to light sound touch taste and smell, nausea, vomiting and diarrhea, fits and seizures(Gatsby 2000) potentially leading to death (Lann, Molina, 2009).
Eventually, if the patient is alive and most will be, the brain will return to producing the natural GABA state at which time the withdrawal will be complete. The time to get back to natural GABA activity varies from person to person and explains why the withdrawal process is an individual thing (Ashton, 2002).
Conclusion
It is evident benzodiazepines are more than “mother’s little helper”. There are serious and long-term consequences to over use and abuse of this drug. It will be up to the therapeutic community to disseminate this information and perhaps even change legislation where the patient has more options than a medical doctor whom at present and for whatever reason, may be over-prescribing a very potent drug class (Gatsby, 2000).
References
Ashton, C. H. 2007 Benzodiazepines: How they work and how to withdraw. Retrieved from http://www.benzo.org.uk/manual/bzcha01.htm
Doweiko, H. 2014. Concepts of Chemical Dependency (9th Ed.). Stanford CT: Cengage. ISBN-13: 9781285455136. Retrieved from http://gcumedia.com/digital-resources/cengage/2014/concepts-of-chemical-dependency_ebook_9e.php
Gatsby, G E 2000 Benzodiazepines: Time for action and accountability! Retrieved from http://www.benzo.org.uk/gadsby.htm
Lann M A1, Molina D K 2009 A fatal case of benzodiazepine withdrawal. .American Journal of Forensic Medicine and Pathology. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/
