What do I need to know about benzodiazepines?

By | March 11, 2015

The benzodiazepines often work like a double-edged sword — highly effective in the right situation but also with hazards of their own. They work rapidly, efficaciously, and with a minimum of side effects if dosed properly. They can take a mind which feels like a hurricane in progress and settle it quickly to feel like a reasonably clear day. Benzodiazepines tend to work less well with time and may require greater dosages to achieve the same effect. Without starting a second medication which can be used more longitudinally and with a greater safety margin. Stopping benzodiazepines can be difficult and can risk creating rebound anxiety. As long as you know about the risks of dependency (it can be hard to get off of them without a careful, willful, downward taper of medication), withdrawal (it can be uncomfortable, if not life threatening, to discontinue them cold turkey), and long-term side effects of regular high-dose usage (like memory impairment), then the benefits can be maximized via judicious therapeutic use. I tend to prefer the longer-acting benzodiazepines, such as clonazepam, as they avoid the more sudden shifts in blood level and the accompanying rebound symptoms of anxiety that can occur. Starting a benzodiazepine immediately for relief at the same time as starting an serotonin reuptake inhibitor for longer term irrigation can allow a doctor to begin to wean a patient off of the benzodiozepine in several weeks after the serotonin reuptake inhibitor has taken root. This strategy works well and without undue complications most of the time.


Selections from the book: “100 Questions & Answers about Anxiety”, Khleber Chapman Attwell, MD, MPH, 2005.