A secret weapon to safely stopping benzodiazepines

Benzodiazepines are among the most commonly prescribed drugs worldwide. Lorazepam (Ativan), diazepam (Valium), and alprazolam (Xanax) are examples of drugs classified as benzodiazepines. Z drugs are similar in their pharmacology — they also bind to and activate the brain’s benzodiazepine receptors — and include zolpidem (Ambien) and eszopiclone (Lunesta).

Although benzodiazepines and Z-drugs are useful therapeutics, often prescribed for insomnia, muscle spasms, anxiety, and seizures, they are ideally used for short-term use only, as they are notoriously addictive. Unfortunately, many people stick with them long-term — up to 15 percent of people, studies say.

Tolerance and the potential for withdrawal occur within two weeks of someone starting to use them daily. With tolerance, the drug’s therapeutic effects wear off and patients must take increasingly higher doses to achieve relief. When people suddenly stop these drugs, withdrawal can occur, and symptoms include anxiety, panic, and insomnia.

In severe cases, withdrawal from benzodiazepines and Z drugs can be life-threatening, causing seizures and hallucinations. No wonder many people who are trying to quit quickly give up the fight and are resigned to sticking with it for the long haul.

On Benzodiazepines and Z-Drugs: The Good and the Bad

These drugs work by activating benzodiazepine receptors in the brain. When used for short periods of time, they can be very helpful with the problems they are designed to treat, such as insomnia or panic.

However, they can also come with a whole host of problems. Common side effects include slurred speech, memory loss, confusion, drowsiness, and an increased risk of falls. Auto accidents due to slowed reaction time or over sedation can occur. As people become tolerant and the dose is increased to obtain greater therapeutic benefit, the side effects also become worse. Some people even begin to crave these drugs, using more than prescribed or becoming addicted to them.

In the elderly, these drugs can be downright dangerous. Several major psychiatric and medical organizations have issued societal guidelines discouraging its use in older adults because it increases the risk of hip fractures, worsens the risk of dementia, and promotes confusion, to name a few.

They are also very risky in people with co-occurring substance use disorders. Benzodiazepines and Z-drugs interact with opioids and other sedative drugs, and their combination leads to overdose and death.

There are many reasons why long-term users of benzodiazepines or Z-drugs are advised to stop. Because of the risk of side effects in aging brains, everyone over the age of 65 should do everything possible to stop taking these drugs. Also, when people develop an addiction to alcohol, illegal drugs, or the benzodiazepine itself, they may be instructed to taper even if they have been taking them for a long time and are still suffering from the condition that prompted them to start treatment.

But here’s the rub — due to the fact that they cause tolerance, withdrawal, and addiction, quitting is often a lot easier said than done. Weaning success rates are low: Less than a sixth of people were able to quit in patients receiving usual care in a UK study where people were simply given instructions by their GP on how to slowly wean off.

study results

It is clear that we need to know more about how to make the process of coming off, also known as “cancellation”, easier. slowing the rate of phasing, with dose reductions of only 10 to 25 percent of the dose every two to three weeks; drug support by prescribing alternative drugs; and psychological support, such as cognitive-behavioral or supportive therapy, are all being studied.

A new study wanted to find out whether supportive therapies would improve overall success rates in stopping long-term (more than four weeks) daily use of benzodiazepines or Z-drugs — something that hadn’t been measured before. To do this, the researchers pooled the results of several published clinical studies and conducted a meta-analysis.

They found that adding supportive therapy to a slow taper (in this study, 10 to 50 percent dose reduction all at once over four to 12 weeks) doubled people’s chance of quitting by four weeks (hazard ratio of 2) and tripled their odds for longer than four weeks (risk ratio 3). Three-quarters of the group that received support were able to quit after four weeks, and almost half of the sample were still drug-free at long-term follow-up.

Surprisingly, medical support—with melatonin, paroxetine, and/or switching to another benzodiazepine—was helpful in the short term to dissuade people, but had no significant effect in long-term follow-up care compared to standard of care.

What psychological support looks like

So what was the nature of the psychological support? Some of the studies used cognitive behavioral therapy-based interventions (Gosselin 2006, Voshaar 2003, Baillargeon 2003), while two others used a simpler intervention involving education, reassurance, and an individualized contraindications plan administered by trained providers, plus (Vincens 2006) . or minus (Vincens 2014) bi-weekly follow-up. In summary: The support techniques were uncomplicated.

A weakness of the study was that most of the included patients did not have any other psychiatric comorbidities such as dementia, severe psychiatric disorders or substance use disorders, and most patients were not taking any other psychoactive medications. People with mental health problems may need more intensive treatment, but it is not yet known how successful they are in quitting with or without psychological support.

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For those of us who work in the mental health field, it might not be surprising to hear that psychological support makes a huge difference. However, studies like these are important because they show that what we are doing works. People who want or need to stop taking benzodiazepines can Do it with proper help — and it may only require a handful of visits to a trained family doctor or mental health provider.

As a culture, we must be careful to minimize our use and prescription of benzodiazepines and Z-drugs, and only use them when absolutely necessary. This will save lives, reduce morbidity and lower costs for healthcare systems.

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