Benzodiazepines

Benzodiazepines (or benzos) are depressant drugs that slow down the messages travelling between the brain and the body. They are a group of nervous system depressants prescribed for the short-term treatment of stress, anxiety or insomnia, and are also known as “minor tranquillisers”, sedatives or sleeping pills.

In most countries benzodiazepines are available only on prescription and should be used under a doctor’s supervision. They can be highly addictive and can cause overdose, particularly when combined with alcohol or other drugs, and should not be used long term.

What are benzodiazepines?#

Benzodiazepines are medicines available only on prescription from a doctor. They are usually a short-term treatment to help calm the nervous system and promote sleep. They may be prescribed to:

• treat the symptoms of anxiety disorders
• relieve insomnia
• help with symptoms experienced by some people with cancer
• control epilepsy
• relax muscles during certain medical procedures (such as endoscopy)
• assist with alcohol withdrawal

They only treat the symptoms of these conditions and do not solve the underlying causes.

There are three broad types of benzodiazepine – long-acting, intermediate and short-acting. Short-acting medications tend to be more addictive and have a stronger withdrawal and “come down” effect. The same medicine is made by different companies and sold under various brand names. Common examples include:

• diazepam – long-acting
• nitrazepam – intermediate-acting
• oxazepam – short-acting
• temazepam – short-acting
• alprazolam – short-acting

How benzodiazepines work#

Benzodiazepines are central nervous system depressants, which means they slow down the messages between the brain and the body. They can be highly addictive, whether taken under medical supervision or used recreationally. It is generally recommended that they only be used for a short time – just days or weeks at a time.

Benzodiazepines are only a small part of overall treatment for stress, anxiety or insomnia. Other approaches include:

• psychological therapies such as cognitive behaviour therapy (CBT)
• techniques to lower stress levels (such as relaxation or breathing exercises)
• techniques to build self-esteem
• lifestyle changes (such as eating healthily or being physically active)

Recreational use#

Some people take benzodiazepines without a prescription for recreational use. They may use them to feel a sense of euphoria, or take them after stimulants to help with the “come down”. Using benzodiazepines without a prescription, or giving or selling them to someone else, is against the law in many places.

Benzodiazepines can be dangerous when mixed with other drugs (including alcohol) and put you at risk of overdose. Some people may give them to others intentionally or without their consent, such as by spiking a drink.

How benzodiazepines affect the body#

The effects depend on the strength of the dose, the physical make-up of the person taking them and their state of mind. Common effects include:

• relief from anxiety
• euphoria
• loss of inhibitions
• muscle relaxation
• sleepiness
• confusion, headache or dizziness
• dry mouth, blurred vision or nausea
• impaired coordination
• a sense of being disconnected or detached from reality
• diarrhoea or constipation

Long-term effects#

Using benzodiazepines regularly can lead to significant health problems, including:

• impaired thinking or memory loss
• anxiety and depression
• irritability, paranoia and aggression
• personality change
• weakness, lethargy and lack of motivation
• drowsiness and fatigue
• difficulty sleeping or disturbing dreams
• headaches and nausea
• skin rashes and weight gain
• addiction

Benzodiazepines and pregnancy#

There is a risk that benzodiazepines can be harmful to babies. If you are pregnant or breastfeeding, talk to your doctor before using them.

Storing benzodiazepines safely#

If you are prescribed benzodiazepines, store them safely and securely, and never allow others to use them.

Overdose#

Overdoses are usually marked by slow, shallow breathing, which may lead to unconsciousness, coma and potentially death. This is more likely if benzodiazepines are combined with other drugs such as alcohol, painkillers, certain antidepressants or antihistamines, and opioids.

Always check with your doctor or pharmacist whether you can safely use benzodiazepines with other medications. Overdose symptoms can include:

• over-sedation or sleep
• nausea and slurred speech
• problems thinking, concentrating or remembering
• jitteriness, excitability and mood swings
• aggression
• slow, shallow breathing
• unconsciousness or coma

If you suspect an overdose, call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance immediately. Ambulance officers do not need to involve the police.

Dependence and tolerance#

Taking benzodiazepines regularly can lead not only to physical dependence (addiction), but also to psychological dependence, where people feel they need the drug to cope with daily life.

After only a short time, a person can develop tolerance, meaning they need larger and larger doses to achieve the same effect. Some people may begin to experience tolerance after only a few days. Over time, the body comes to depend on benzodiazepines to function.

Withdrawal#

Withdrawal symptoms vary from person to person and depend on the type of benzodiazepine being taken. Always withdraw from benzodiazepines slowly, over a period of time, under medical supervision. Someone who suddenly stops after prolonged use is at risk of serious withdrawal symptoms, such as seizures.

Symptoms can last from a few weeks to a year and may include:

• headaches
• aching or twitching muscles
• dizziness and tremors
• nausea, vomiting and stomach pains
• bizarre dreams and difficulty sleeping
• fatigue and poor concentration
• anxiety and irritability
• altered perception or heightening of senses
• delusions, hallucinations and paranoia
• seizures

Treating benzodiazepine dependence#

Treatment options for drug dependence may include detoxification, individual counselling and group therapy. See your doctor for information and an appropriate referral, or contact a local alcohol and other drug service for support.

Key points#

• Benzodiazepines are central nervous system depressants usually prescribed as a short-term treatment to calm the nervous system and promote sleep.
• They treat symptoms only and do not solve the underlying causes of conditions like anxiety or insomnia.
• Common effects include loss of inhibitions, drowsiness and impaired coordination.
• Using benzodiazepines regularly can lead to dependence, tolerance and withdrawal symptoms.
• Overdose – more likely when taken with another drug such as alcohol – can cause slow, shallow breathing, coma and death.

Where to get help#