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What are the basics about anti-anxiety drugs? What are they for? Where did they come from? How do they work? How many people take them? What are the side effects during use?
Definition of Benzos
The term “benzos” is short for benzodiazepines, a class of anti-anxiety medication also known as minor tranquilizers, sedatives, BZDs, BZRAs, and others. These drugs are typically prescribed for anxiety disorders, panic attacks, insomnia, muscle spasms, and seizures. Nonbenzodiazepines (Z-drugs) is another class of sedatives which can have similar effects to benzodiazepines and can also be referred to as “benzos.”
Common Types of Benzos
Benzodiazepines | Nonbenzodiazepines (Z-drugs) |
alprazolam (Xanax) clonazepam (Klonopin) diazepam (Valium) lorazepam (Ativan) temazepam (Restoril) | eszopiclone (Lunesta) zaleplon (Sonata) zolpidem (Ambien) zopiclone (Zimovane) |
To view a complete list of benzos, visit our “Types of Benzos” page.
Treatment Uses
Benzos have a variety of therapeutic actions but can be broken down into five primary categories that Prof. Ashton described in her manual. These include:
anxiolytic (relief from anxiety)
hypnotic (improving sleep)
myorelaxant (muscle relaxation)
anticonvulsant (relief from convulsions)
amnesiac (loss of memory, single-use for medical procedures)
The immediate effects of most benzodiazepines can make a person feel relaxed and sometimes sleepy. Even a mild sense of euphoria. Many studies show that occasional, short-term use of benzodiazepines is effective for specific purposes including surgical procedures, alcohol withdrawal, and seizures.
Are They Dangerous?
While somewhat effective treating the above conditions, benzos can cause physical dependence when taken long-term. In October 2020, the U.S. Food and Drug Administration (FDA) issued a Black Box Warning to address “serious risks of abuse, addiction, physical dependence, and withdrawal reactions.” Withdrawal can include a laundry list of moderate to severe symptoms, which not only can be painful and debilitating, but can also last for months, even years. Benzos are also a leading cause of overdose death when combined with opioids and other narcotics.
Brief History
Benzodiazepines were originally developed by Leo Sternbach at Hoffman-La Roche in New Jersey. On February 24, 1960, the FDA approved the first benzo medication named chlordiazepoxide with the brand name of Librium. It was soon followed by diazepam, which many people know as Valium. Valium was the top-selling drug in the U.S. for 13 years, between 1969 and 1982.
As benzos became increasingly popular, a backlash also gained momentum in the ’80s. Long-term benzo users were suffering from severe withdrawal symptoms, and the media picked up their stories. In 1987, a new class of anti-depressants called Selective Serotonin Reuptake Inhibitors (SSRIs) entered the market, and the Prozac era took hold pushing benzos to the sidelines.
In 1981, pharmaceutical manufacturer Upjohn (now part of Pfizer) released alprazolam, and they marketed it under the catchy name of Xanax. While still a benzodiazepine, Xanax represented this new group of benzos that are even more potent than the ones in the 70s. Xanax is 20 times more potent than Valium.
By 1986, Xanax had overtaken Librium, Valium, and Prozac to become the best-selling drug in history. And by 2013, prescriptions for benzos in the U.S. climbed to 5.6% of the population. The market demand for general anxiety medications was valued at $3.2 billion in 2014 and is expected to rise to $3.7 billion by the end of 2020.
Benzos were back and with a vengeance.
How Do Benzos Work?
Long story short, we don’t really know. Research has provided some answers, but even after 50+ years there are still unanswered questions. The neurotransmitters glutamate and GABA appear to be the primary mechanisms of action. So let’s take a look at those here.
Think of glutamate as the gas pedal: it excites things into action. GABA, on the other hand, puts on the brakes. — Jennifer Leigh, Addictionblog.org
Glutamate is the most abundant neurotransmitter in the entire nervous system. It stimulates the neurons making them fire and helps brain development including learning and memory.
GABA, gamma-aminobutyric acid, is the primary inhibitory neurotransmitter in the brain. GABA produces a general calming effect on your central nervous system by settling down nerve cells that get over-excited. When your neurons get over-excited, you get anxious. The more GABA, the calmer you feel.
GABA receptors are the part of the neuron that can receive GABA neurotransmitters. So, only neurons with GABA receptors can be influenced by the calming effect of GABA, and if those receptors ever become damaged, then the nerve cells may not receive the calming message.
Benzos enhance the actions of GABA. Meaning, benzos increase the inhibitory effect of GABA on the neurons, therefore calming the brain and central nervous system. For this reason, benzodiazepines have been found useful in treating anxiety, insomnia, muscle spasms, epilepsy, alcohol detoxification, and is helpful in certain medical procedures.
Unfortunately, this process also has a tendency to down-regulate the GABA receptors over time which is one of the primary factors causing dependence. We will discuss more on this in Basics of BIND..
GABA does seem to get all the press when it comes to benzos, but it’s not the complete picture.
…benzodiazepine actions are by no means confined to a particular neurotransmitter or brain pathway. — Prof. Ashton
Prof. Aston’s paper titled “Protracted Withdrawal Syndromes from Benzodiazepines,” published in 1991, is a great resource here. In that paper, she notes that GABA inhibits both the nervous activity in the brain and the release of excitatory neurotransmitters such as acetylcholine, noradrenaline, dopamine, and serotonin. The clinical effects of benzos are most likely a result of a combination of these reactions.
Benzo Usage
According to IMS Health, 36 million people in the U.S. were taking anti-anxiety drugs in 2013. For benzodiazepines alone, according to the American Journal of Public Health, 13.5 million adults filled prescriptions in 2013.
Here are how the numbers break down (IMS Health)…
Total number of people in the U.S…
Taking psychiatric drugs: 79 million
Taking antidepressants: 41 million
Taking anti-anxiety drugs: 36 million
Taking ADHD drugs: 10 million
Taking antipsychotics: 7 million
Total number of people in the U.S. taking anti-anxiety medication who are…
5 years old or younger: 727,304
6–12 years of age: 790,149
13–17 years of age: 650,273
18–24 years of age: 1,660,953
25–44 years of age: 8,944,200
45–64 years of age: 14,439,465
65+ years of age: 9,691,791
It is estimated that at least five million people in the U.S. and U.K. alone are on benzos long-term and have the potential for withdrawal complications.
References
Ashton, C. Heather. Benzodiazepines: How They Work and How to Withdraw (aka The Ashton Manual). 2002. Accessed April 13, 2016. http://www.benzo.org.uk/manual/.
Ashton, C. Heather. “The Bridge Project, Bradford: Speech by Professor C Heather Ashton, DM FRCP: Annual Meeting, December 2011.” Benzo.org.uk. Accessed January 27, 2017. https://www.benzo.org.uk/chabradford.htm.
Ashton, C. Heather. “Protracted Withdrawal Syndromes from Benzodiazepines.” Journal of Substance Abuse Treatment 8 (1991): 19-28. https://www.benzo.org.uk/ashpws.htm.
Bachhuber, Marcus A., Sean Hennessy, Chinazo O. Cunningham and Joanna L. Starrels. “Increasing Benzodiazepine Prescriptions and Overdose Mortality in the United States, 1996-2013.” American Journal of Public Health (AJPH) (April 2016). Accessed April 7, 2018. doi:10.2105/AJPH.2016.303061.
Byrne, A. “Benzodiazepines: The End of a Dream.” Australian Family Physician 23(8)(Aug 1994):1584-5. Accessed April 17, 2018. https://www.ncbi.nlm.nih.gov/pubmed/7980158.
Commonwealth of Pennsylvania. Prescribing Guidelines for Pennsylvania: Safe Prescribing Benzodiazepines for Acute Treatment of Anxiety & Insomnia. Updated May 15, 2017. Accessed April 7, 2018. http://www.health.pa.gov/My%20Health/Diseases%20and%20Conditions/M-P/opioids/Documents/PA%20Guidelines%20on%20Benzo%20Prescribing.pdf.
Edwards, Elaine, “Bad Side-Effects of Drugs Such as Valium A ‘Medical Disaster’,” Irish Times, October 10, 2016, Accessed October 10, 2016, https://www.irishtimes.com/news/health/bad-side-effects-of-drugs-such-as-valium-a-medical-disaster-1.2824495.
Foster, D E. Benzo Free: The World of Anti-Anxiety Drugs and the Reality of Withdrawal. Erie, Colorado: Denim Mountain Press, 2018. https://easinganxiety.com/book.
“Global General Anxiety Disorder Market Worth USD 3,775 Million and CAGR 2.4% by 2021,” Zion Market Research, November 18, 2016, Accessed November 19, 2016, http://www.medgadget.com/2016/11/global-general-anxiety-disorder-market-worth-usd-3775-million-and-cagr-2-4-by-2021.html.
IMS Health. Vector One: National (VONA) and Total Patient Tracker (TPT) Database (2013). Extracted April 2014. Quoted in CCHR International. “Total Number of People Taking Psychiatric Drugs in the United States.” Accessed April 3, 2018. https://www.cchrint.org/psychiatric-drugs/people-taking-psychiatric-drugs/.
Wikipedia, “Leo Sternbach.”
For Information Purposes Only – Not Medical Advice
All information presented on Easing Anxiety is for informational purposes only, and should never be considered medical or health advice. Withdrawal, tapering, or any change in dosage of benzodiazepines or any other prescription drugs should only be done under the direct supervision of a licensed physician.
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