In our society today, where stress and mental strain are part of everyday life, I observe that many people turn to medication to calm themselves and alleviate anxiety. A commonly chosen option for this is benzodiazepines, often referred to as “benzos.” In this article, I would like to explore the effects, side effects, and potential dangers of benzodiazepines.
Benzodiazepines: Overview of All Topics
As someone who works intensively in the treatment of anxiety and panic disorders and interacts daily with those affected, I approach the use of benzodiazepines for managing these disorders with caution. My practical experience has shown that, while these medications can provide short-term symptom relief, they often lead to rapid and significant dependency. More importantly, they do not address the root cause of the issue. Prescribing these medications for anxiety is akin to trying to tame an overgrown garden merely by trimming the overgrown branches. While the garden may appear temporarily neat and under control, the roots of the weeds—the deeper issues—remain embedded. Without removing these roots, the weeds quickly regrow and overtake the garden again. Sustainable care requires more than superficial cuts; it calls for thorough work on the underlying cause.
In my work with the Bernhardt Method, I focus on leveraging the brain’s neuroplasticity—its remarkable ability to continuously change and develop—to foster positive thought patterns and weaken negative synaptic connections. This article provides insight into the world of benzodiazepines while also introducing an alternative method for managing anxiety and panic disorders that aligns with my approach.
Benzodiazepines: Key Points in 30 Seconds
Purpose: Commonly prescribed for anxiety and sleep disorders, as well as emergency medication.
Mechanism: These medications work by enhancing GABA function in the central nervous system, leading to reduced anxiety and calming effects.
Duration and Onset: Vary depending on the specific type of benzodiazepine and its half-life.
Risks and Side Effects: High risk of addiction, potential for psychological issues, and increased fall risk (especially in older patients) are serious concerns.
Recommended Duration: I advocate for extremely cautious and short-term use of benzodiazepines, if at all. These medications often relieve only symptoms without addressing the underlying causes of anxiety disorders. My approach focuses on utilizing the brain’s neuroplasticity to reduce the dominance of negative, anxiety-driven thoughts and retrain the brain towards positive thinking, which can lead to sustainable, side-effect-free change.
Managing Dependency: For existing dependencies, gradual dose reduction under medical supervision is necessary, along with treatment of the underlying causes and addiction factors.
What Are Benzodiazepines?
Benzodiazepines are prescription medications that play a central role in treating sleep and anxiety disorders. Statistics indicate that about a quarter of the population in the US will encounter some form of anxiety disorder during their lifetime, including sleep disorders, phobias, or panic attacks. In these cases, benzodiazepines are often prescribed due to their rapid effects, quickly alleviating anxiety and promoting relaxation.
The history of benzodiazepines began with the development of the active ingredient chlordiazepoxide in 1957, followed by the launch of Diazepam, better known as Valium®, in 1963. These drugs laid the foundation for the development of many other benzodiazepines.
Their broad application range includes anxiolytic (anxiety-relieving) and sleep-promoting properties, as well as uses for seizure control and muscle relaxation, making them a versatile tool in various medical and therapeutic settings. For treating anxiety disorders, benzodiazepines such as Diazepam (Valium®) and Lorazepam (Ativan®) are typically used. These medications typically take effect within about 20 minutes, providing relief from anxiety and inducing relaxation. Specific benzodiazepine analogs, like Zolpidem and Zopiclone, are primarily used for treating sleep disorders.
Overview of Benzodiazepine Applications
Purpose: Benzodiazepines are frequently prescribed for anxiety and sleep disorders, as well as for emergency use.
Mechanism: These medications work by enhancing GABA function in the central nervous system, leading to reduced anxiety and a calming effect.
Duration and Onset: Vary based on the specific benzodiazepine type and its half-life.
Risks and Side Effects: There is a significant risk of addiction, potential for psychological issues, and an increased risk of falls (especially in elderly patients), which are serious concerns.
Recommended Duration: I advocate for very cautious and short-term use of benzodiazepines, if at all. These medications often provide only symptom relief without addressing the root causes of anxiety disorders. My approach focuses on harnessing the brain’s neuroplasticity to reduce the dominance of negative, anxiety-laden thoughts and retrain the brain toward positive thinking, leading to sustainable, side-effect-free change.
Managing Dependency: For existing dependencies, gradual dose reduction under medical supervision is necessary, along with treating underlying causes and addiction factors.
Benzodiazepine use carries a substantial addiction risk, even with short-term and low-dose use, leading to a critical view of their role in medical and therapeutic practice. Benzodiazepines are classified based on duration of action as short-, intermediate-, or long-acting drugs and are used as anxiolytics (for anxiety relief) or hypnotics (for sleep aid) according to their profile.
Ultra-Short-Acting Benzodiazepines: These have a half-life of less than five hours and are often used to address falling asleep or to calm patients before surgery.
Short-Acting Benzodiazepines: With a half-life of up to ten hours, these are commonly used for mild sleep disturbances.
Intermediate-Acting Benzodiazepines: These have a half-life of 12 to 24 hours, making them useful for individuals who struggle to stay asleep or wake frequently.
Long-Acting Benzodiazepines: With a half-life exceeding 24 hours, these are often used to treat severe anxiety, chronic tension, and specific forms of epilepsy.
Forms of Benzodiazepine Administration: An Overview
- Tablets:
- Standard form for many patients
- Extended-release tablets for delayed drug release
- Liquid Forms (Drops/Syrup):
- Ideal for individuals with swallowing difficulties
- Allows for fine adjustments in dosage
- Prefilled Syringes:
- Used for acute seizures
- Administered into the cheek for rapid absorption through the oral mucosa
- Nasal Sprays:
- Rapid absorption of the active ingredient through the nasal mucosa
- Rapid absorption of the active ingredient through the nasal mucosa
- Suppositories/Rectal Solutions:
- Suitable for patients with nausea and vomiting
- Rapid absorption through the intestinal mucosa
- Intravenous/Intramuscular Administration:
- Commonly used in hospitals
- Provides fast and effective treatment
Effects of Benzodiazepines
Benzodiazepines, often referred to as “benzos,” have a significant impact on the central nervous system. Their mechanism of action is based on interaction with GABA receptors in the brain. By binding to these receptors, benzodiazepines enhance the effects of gamma-aminobutyric acid (GABA), the brain’s primary inhibitory neurotransmitter. This enhancement results in reduced neuronal excitability, leading to calming, anxiety-relieving, and sleep-inducing effects.
GABA’s role in the nervous system is to dampen the transmission of nerve signals, producing a calming effect. Benzodiazepines intensify this inhibitory action, further reducing nerve cell excitability. This decreased neural activity manifests differently across various brain regions. For instance, the inhibition of nerve cells in the limbic system, which processes emotions like fear, leads to a reduction in anxiety. Similarly, inhibition in the brainstem produces calming and sedative effects, while inhibition in the spinal cord contributes to muscle relaxation. In treating seizures, certain benzodiazepines help restore balance between excited and inhibited nerve cells.
A specific aspect of benzodiazepines’ effects is their ability to cause anterograde amnesia, where patients may not recall events during the drug’s effective period. This hypnotic effect is particularly relevant in the use of benzodiazepines for anesthesia.
Common Side Effects and Interactions of Benzodiazepines
Although benzodiazepines act relatively quickly and provide rapid relief, they can have problematic side effects, particularly in older adults and with prolonged use. The most common side effects include drowsiness, dizziness, reduced coordination, and confusion. These effects increase the risk of falls and can lead to cognitive impairments.
In individuals over 65, benzodiazepines may trigger paradoxical reactions such as agitation, restlessness, and depressive states—the very symptoms benzodiazepines are meant to alleviate. These reactions could be mistakenly interpreted as signs of dementia. Other possible side effects include psychomotor slowing, reduced memory retention, and impaired learning ability. Especially with long-acting benzodiazepines, these effects may still be noticeable the following day. Reducing or discontinuing benzodiazepine use in older patients can significantly improve quality of life.
All Side Effects of Benzodiazepines at a Glance
Drowsiness: Frequent tiredness and drowsiness
Dizziness: Feeling of instability and disorientation
Reduced Coordination: Difficulty with movement coordination
Confusion: Mental disorientation and confusion
Increased Fall Risk: Particularly high in older adults
Cognitive Impairments: Limitations in thinking processes and memory performance
Paradoxical Reactions: Agitation, restlessness, and depressive states, especially in seniors
Psychomotor Slowing: Delays in mental and motor reactions
Reduced Memory Retention: Impaired ability to store new information
Long-Term Cognitive Impairments: Potential link to dementia risk
Withdrawal Symptoms upon Discontinuation: Anxiety, sleep disturbances, irritability, headaches, increased sensitivity, tingling sensations, tinnitus, dizziness, concentration issues, perception distortions
Rebound Effect: Recurrence of original symptoms after discontinuation
Risks in Pregnancy: Potential fetal abnormalities, risks for the unborn child or infant, such as drowsiness and respiratory depression
Impaired Driving Ability: Increased risk of accidents, especially when combined with alcohol
Interactions with Other Substances:
When benzodiazepines are taken with other sedative substances, this can lead to severe and dangerous consequences. Combining benzodiazepines with substances like alcohol, barbiturates, opiates, certain antidepressants, or antihistamines significantly intensifies their depressive effects on the nervous system. In extreme cases, this enhancement can lead to respiratory arrest or even cardiac arrest.
It is crucial that both patients and healthcare professionals are aware of these potential interactions and take appropriate precautions. The simultaneous use of benzodiazepines with other sedative substances should always occur under strict medical supervision to minimize the risk of severe side effects.
When benzodiazepines should absolutely be avoided
In certain medical conditions and specific circumstances, taking benzodiazepines is not advisable and can even be dangerous. These medications may cause risky interactions with other drugs or worsen existing health conditions in severe cases.
Severe Lung Diseases (e.g., Advanced COPD): Extra caution is needed for patients with severe lung conditions. Benzodiazepines can impair respiratory function, and when combined with opioids, they can exacerbate breathing issues.
Ataxia: For individuals with ataxia, benzodiazepines are unsuitable, as they can further worsen movement and coordination problems caused by nerve or brain damage.
Myasthenia Gravis: People with myasthenia gravis, an autoimmune disorder causing muscle weakness, should avoid benzodiazepines. The muscle-relaxing effects of these drugs can negatively impact their symptoms.
Substance Use Disorders: In individuals with a history of addiction, using benzodiazepines carries a high risk. Due to their strong potential for dependency, people with a history of alcohol, drug, or medication abuse are particularly vulnerable.
Allergies to Benzodiazepines or Their Ingredients: Lastly, benzodiazepines should be avoided in cases of known allergies to these drugs or their components.
Risks: Long-Term Effects and Dependency Risk of Benzodiazepines
Long-term use of benzodiazepines can lead to tolerance, dependency, and withdrawal symptoms. The risk of dependency is particularly high when these medications are taken in high doses or over extended periods. Abrupt discontinuation can cause severe withdrawal symptoms, including anxiety, sleep disturbances, irritability, headaches, increased sensitivity to light and sound, tingling, tinnitus, dizziness, concentration difficulties, and perceptual distortions. In some cases, sudden discontinuation can even lead to seizures.
The likelihood of withdrawal symptoms increases with the duration of use, higher doses, and long-acting benzodiazepines. Milder forms of withdrawal include the so-called rebound effect, where symptoms similar to the original treated issues, like sleep problems or anxiety, briefly reappear after stopping benzodiazepines. This can tempt patients to resume medication, especially if they are not informed about this effect.
Managing Benzodiazepine Dependency
A thorough and immediate treatment approach is essential when dealing with benzodiazepine dependency. For those affected, a gradual and controlled tapering process is often the safest and most effective way to reduce these medications, rather than stopping abruptly. Abrupt cessation could lead to intense withdrawal symptoms, so a gradual reduction is recommended. This tapering process is particularly important as benzodiazepines can remain in the body for a prolonged period. Benzodiazepine withdrawal may therefore take longer than alcohol withdrawal, possibly spanning several weeks until the body is fully cleared.
Psychological support and complementary interventions are also crucial elements throughout the therapeutic process.
Important:
If you are currently taking psychiatric medications, please refrain from discontinuing them on your own.
Such a step should always be taken in consultation with your primary care physician and under their supervision to ensure a safe and successful withdrawal process.
Alternative Methods for Anxiety Disorders
In light of the previous discussion about benzodiazepines and their role in treating anxiety disorders, I would like to introduce an alternative approach: the Bernhardt Method. Developed jointly with my wife Daniela Bernhardt at the Institute for Modern Psychotherapy in Berlin, this method offers an innovative approach to overcoming anxiety, fundamentally different from the short-term symptom relief provided by benzodiazepines.
My book, How to calm Anxiety which has received worldwide recognition, introduces this method to a broad audience. It is based on the understanding that the brain, contrary to previous assumptions, possesses an impressive ability to change and adapt, known as neuroplasticity. This knowledge opens new perspectives in anxiety therapy, extending beyond traditional methods like medication.
While benzodiazepines may provide quick relief, they are often criticized for not addressing the deep-seated causes of anxiety and for carrying high risks of side effects and dependency. In contrast, the Bernhardt Method aims to change the neural foundations of anxiety. We have found that with this approach, over 70% of our patients were able to completely overcome their panic attacks in fewer than six sessions—testament to the effectiveness of this method.
The Bernhardt Method does away with traditional exposure therapies and medications, instead employing specific mental exercises and techniques based on modern brain research. These exercises are designed to retrain the brain, reducing anxiety and panic in the long term. By encouraging the brain to develop and reinforce positive thought patterns, we support our patients in overcoming their fears permanently. It’s important to remember that anxiety disorders are often a kind of service from your psyche. Your subconscious is trying to draw attention to a situation in your life that may need to change.
Ultimately, it’s neither society, a doctor, nor your family that determines what you do or don’t do in life. You alone control whether you take certain medications, stay in an unsatisfying relationship, pursue an unfulfilling career, or remain in an environment that doesn’t offer you the respect and love you deserve.
This isn’t about assigning blame, but rather showing you a way out of fear and insecurity to end your suffering once and for all. This step toward a free and fulfilling life requires a willingness to take full responsibility for your own life and leave behind the fear of change. Many people stay in intolerable life circumstances out of fear of change, but it doesn’t have to be that way.
For those interested in a profound and lasting solution to their anxiety disorders and looking for an alternative to traditional medication treatments, I offer an in-depth look at the “10-Sentence Method,” a key technique in the Bernhardt Method. This method has already helped numerous people effectively manage their anxiety disorders. To learn more, I recommend reading our article on the 10-Sentence Method.
Conclusion: Better Long-Term Healing than Short-Term Relief
As an expert in anxiety management, I have observed that while benzodiazepines can provide quick relief from anxiety symptoms, they often only offer a short-term solution. These medications may temporarily reduce symptoms, but they don’t address the root of the problem. Additionally, this quick fix comes with numerous side effects, as I have discussed in detail here. Anyone considering benzodiazepines should carefully weigh whether the short-term relief is truly worth the potential risks and long-term consequences.
Fortunately, alternative approaches, such as the Bernhardt Method I developed, offer a long-term solution for anxiety disorders. These methods require commitment and effort, but they focus on addressing the deeper causes of anxiety rather than merely alleviating symptoms. For those seeking lasting change and real progress in managing their anxiety, the Bernhardt Method provides a hopeful and effective path.
I warmly invite you to learn more about the Bernhardt Method and discover how it can help you effectively overcome anxiety disorders. Our online therapy provides you with the tools and insights necessary to move toward a life with less anxiety.
One of my favorite quotes from Albert Einstein captures this perfectly: “The definition of insanity is doing the same thing over and over and expecting different results.”
Troy A.
Tampa, Florida