Benzodiazepines are one of the most wonderful drugs in the armamentarium of psychiatric medication. They have been used in psychiatry for various indications such as alcohol withdrawal syndrome, short term relief of anxiety and sleeplessness, to counter the side effects of some of the other medication, as an antiepileptic medication. They act magically in syndromes such as catatonia. They are lifesaving drugs in some of the seizures. However, they are also the medicines which are very commonly abused by patients due to some of their obvious effects. In lay usage, these are mostly used as sleeping pills and quick fix for anxiety. Most of the doctors prescribe this class of medication to give an immediate relief to the patients. However, some of the patients continue to use these pills over a prolonged period of time without realizing the long term impact on their bodies and minds.
Some of the commonly used benzodiazepines are –
- Alprazolam
- Midazolam
- Etizolam
- Lorazepam
- Clonazepam
- Diazepam
- Chlordiazepoxide
- Nitrazepam
- Clobazam
These are available at a modest price with different brand names in the market. Ideally, chemists should dispense these medications with a valid, duly stamped prescription from a registered medical partitioner, ONLY for the time duration mentioned in the prescription. From patient’s perspective, these should be strictly taken for the time period prescribed because self-medicating with these for extended timeframe may result in severe mental and physical health issues. Side effects of these medication, if taken for more than 4 weeks are –
- Habit Forming, also knows as tolerance, which means one needs to gradually increase the dose to constantly achieve the same effect achieved previously with a lower dose.
- A characteristic withdrawal syndrome in noticed if a dose is skipped in between. Withdrawals manifest as restlessness, palpitations, tremors, sweating, inability to focus on the task at hand, irritability and anger, sleeplessness. Patient may have a seizure if he skips or stops a high dose abruptly.
- Forgetfulness in day-to-day affairs.
- Disinhibition leading to social awkwardness.
- Overtalkativeness manifesting as purposeless repetition of same thoughts, ideas, topics.
- Motor incoordination manifesting as clumsiness which makes an individual prone to falls and accidents.
- High doses for a long time can cause depression as these are CNS depressants.
So, if the side effects are so dangerous and so many, why are these pills even prescribed by the doctors. Well, these medications give immediate relief to highly anxious patients and are extremely safe if taken for 2 to 4 weeks without any chronic side effects. The adverse impact is only seen if they are taken for longer period without the supervision of a psychiatrist. Unlike, other psychiatric medications which take 4 to 6 weeks to fully show their positive effect, benzodiazepines take just a few minutes to act upon our neural chemistry to set it right. But at the same time, the impact of a benzodiazepine is short lived and wanes out quickly, and that’s precisely the reason why they are so frequently misused and abused by anxiety patients.
Let us understand this with the help of an analogy. If a patient has fever, we first like to evaluate it and find the cause of it. If it is a viral flu, which is a self limiting illness, we just give paracetamol and let the illness takes its own course to settle. However, if it is a bacterial infection, we need to give the patient antibiotics so that we don’t just cure the fever with paracetamol but we also target the root cause of the infection with the antibiotics. At the same time, we want to know, what kind of bacteria it is so that we can choose the right antibiotic for it. The choice of our prescription will depend on the fact whether it is Tuberculosis, Typhoid, Pneumonia, Cholera, Meningitis, etc although paracetamol will be given in all these cases for a short period of time. Someone, who chooses to just take paracetamol may not totally understand the kind of complication he may have in the longer run! Also, though his fever will subside on the day he takes the paracetamol pill, but later it will come back each and every other day because the infection is still harbouring in his body.
Benzodiazepines are exactly like paracetamol which take care of anxiety and sleep for a brief period and do not target the root cause of the problem. Here, the added disadvantage of benzodiazepines is that they are habit forming and full of side effects in the longer run.
The best way to deal with anxiety and sleep issues is to get the patient evaluated by a psychiatrist who can gauge the intensity and the severity of the problem and guide the patient to start the right medication at the right time. The journey of mental disorders treatment with the psychiatrist doesn’t end there. It also includes the guidance when and how to stop the treatment. Because one just cant keep taking some pills after a certain timeframe.
As a psychiatrist, the most tedious personal experience in the clinics has been to wane people off the sleeping pills. It is unfortunate that people keep using these pills for many years out of their ignorance. Anxiety, Depression and Sleep issues need to be taken seriously and treated with the right medication. Please see your psychiatrist before you think of taking sleeping pills the next time.
Wishing you the best of mental health today and always!
Dr Apala Aggarwal Tuteja