A silent addiction. Many people take benzodiazepine tranquilizers for long periods of time and do not realise that they are developing a dependence on it. Some people increase the dose because they have grown tolerant to the drug. It is important to uncover the causes of addiction. This drug has one of the most serious withdrawal syndromes and requires professional treatment.
What is a benzodiazepine?
This is a drug designed to treat anxiety and insomnia. It is also used for detoxification in treatment of alcoholism.
It is one of the most often prescribed drugs in the world.
Most common commercial brands: Trankimazin, Valium, Tranxilium, Rohipnol, Rivotril, Noctamid, Lexatin, Orfidal, etc.
How does it work?
Benzodiazepines act in the brain by situating itself in the receptors and activating a substance or neurotransmitter (an agent that transmits messages from one neuron to another) sending the message of inhibition, that is, communicating to the neurons to slow down the speed of transmission or to stop altogether; a message to calm and slow down. Clinically this is translated into a decrease in anxiety and increase of sedation. That is why it is a good drug to treat anxiety and insomnia.
Who is prescribed benzodiazepine?
It is prescribed to people with anxiety problems, insomnia, and also as treatment of pathologies that can cause muscle stiffness and convulsions (it also has a muscle relaxing and anticonvulsant effect). It must be prescribed carefully, for short periods of time and always under medical supervision since it has been proved that it is addictive. It is a very useful drug if properly used.
Negative secondary effects of benzodiazepines
Depending on the characteristics or on the dose, benzodiazepines can produce excessive sedation, sleepiness, difficulty in concentrating, coordination problems, muscular weakness and confusion. Benzodiazepines
can react with other drugs (sedatives, antidepressants, antihistamines, etc) increasing their effects and also with alcohol, accelerating and heightening the symptoms of alcohol overdose. It can also cause memory loss.
Benzodiazepines can cause memory loss , especially short term memory or episodic memory loss, but also serious memory gaps where the patient cannot remember something they did recently. Prolonged use of benzodiazepines can cause depression and emotional numbing, that is, not being able to properly feel emotions. An important secondary effect is the paradoxical
effect, which in some people increases nervousness and aggressiveness, especially in those who are anxious, hyperactive or have psychiatric problems. Combined with alcohol, it me some individuals highly aggressive.
Why benzodiazepines cause such dependence?
Firstly, it is their capacity to create tolerance, that is, the body gets used to it and you need a higher dose to achieve the same effect. Developing a tolerance to it depends primarily on the duration of its use. Generally the longer you use it, the greater the tolerance, the greater the need to increase the dose etc.
On the other hand there’s the key factor to addiction – the psychological factor. It is a drug that gives exactly what was promised; calms the anxiety and thus brings about positive reinforcement. The patient is clearly able to perceive the effects. This, together with tolerance, is the mechanism for generating dependence. Dependence on benzodiazepine can appear after one month or after several months. There is no definite time frame, it depends on the type of drug used, the dose and the characteristics of each person.
We must be able to differentiate between two different forms of dependence:
- Dependence on benzodiazepines prescribed by a physician
One is the dependence on benzodiazepines prescribed by a physician. There are patients who get addicted to the drug without even realizing it, in part because they develop a tolerance to it, and in part due to lax medical control. Many such patients have not been properly informed of the dangers of benzodiazepines and only realize they have a problem when they stop taking the drug due to losing the prescription, changing doctors or simply stopping the treatment. This is when the patient suffers a series of disorders that disappear when they take the drug, effectively closing the circle of addiction.
- Dependence on benzodiazepines acquired through recreational use
This type of use is becoming more popular in some countries. Normally it involves young people who buy benzodiazepines on the street (black market) with the intention to “get high”, and often combine it with other drugs. Sometimes drug addicts use it to palliate the stimulating effects of other drugs (cocaine, amphetamine, ecstasy) or to prolong or substitute the drugs they are addicted to (opiates, heroin, cannabis). Such users normally consume benzodiazepines in high quantities, causing serious withdrawal syndrome once the use is over.
Benzodiazepine withdrawal syndrome
Withdrawal syndrome can manifest itself after a long period of benzodiazepine use or abuse. In some cases withdrawal syndrome appears as early as after only one month of use of therapeutic doses.
Benzodiazepine withdrawal syndrome can present several symptoms to a greater or lesser extent:
Severe anxiety, agitation, irritability, insomnia, loss of appetite, aggression, nausea, vomiting, anxiety, confusion, convulsions, increase in body temperature and death. It is important to note that benzodiazepine withdrawal syndrome, as well as that of alcohol, can result in death.
These signs usually appear on the first day or during the first week after abstaining from benzodiazepines. It is important to note that some people do not develop abstinence syndrome, and some develop what we call rebound symptoms, that is, the symptoms they were prescribed benzodiazepines for. Whether or not the person will develop withdrawal syndrome does not strictly depend on the dose or the individual or the duration of drug use, although these are certainly the risk factors.
Treatment and dehabituation of benzodiazepine dependence
In general, before withdrawing from benzodiazepine, the patient must undergo an evaluation and the physician must inform him of the situation. To avoid the appearance of the abstinence syndrome, the dose must be lowered gradually and always under medical supervision.
What is the treatment like
The treatment consists of immediately reducing benzodiazepine intake in half. The remaining half will be withdrawn slowly over one or two months and the rest even slower. Depending on the supervision and patient evaluation, this period can be prolonged or shortened. In patients taking benzodiazepines with short half-life (that lasts less time inside the body, which is why it needs to be taken more often) the drug will be substituted for benzodiazepine with a longer half-life. Once stabilized, the drug will be progressively withdrawn. We may also use other drugs (stimulants and antiepileptics), alone or in combination with a low dose of benzodiazepine.
Benzodiazepines must be taken carefully and always under medical supervision. One should never self-medicate with benzodiazepines. If one decides to stop taking it, they should only do so under medical supervision…
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