Benzodiazepines are a class of psychoactive drugs that fall under the classification of a depressant or sedative. The class was first discovered accidentally by Leo Sternbach in 1955 when he synthesized chlordiazepoxide (Librium). The pharmaceutical company Hoffmann-La Roch later marketed the drug in 1960, while they discovered another benzodiazepine formulation known as diazepam (Valium). Other formulations of benzodiazepines include:
Benzodiazepines work by enhancing the effect of a particular neurotransmitter named gamma-aminobutyric acid (GABA). The specific receptor that benzodiazepines target is known as the GABA(A) receptor. When activated, this particular receptor produces hypnotic (sleep-inducing), sedative, anticonvulsant, anxiolytic (anti-anxiety) and muscle-relaxant properties. In some doses, there is an amnesic (memory-loss) effect that occurs, making the drug known for its high date-rape potential.
In most cases, these drugs are safe when used during short-term periods, even though abuse of the drug can lead to severe impairments and paradoxical effects. The long-term use in patients is still a very controversial subject, because of the many adverse effects associated with the drug. The notion that benzodiazepines can lead to physical dependence also undermines the validity of its medical uses, although it is still prescribed to patients in the United States to this day.
Benzodiazepines are considered Schedule IV controlled substances. This means these types of drugs have a low potential for abuse in when compared to other drugs or substances in the previous categories. This does not mean these drugs have the possibility of abuse; note that the text says when compared to drugs in previous categories, such as heroin, morphine, Vicodin and oxycodone. Drugs in the Schedule IV category are currently accepted as medical treatments in the United States.
Because of the wide range of properties that benzodiazepines possess, they can be prescribed for a number of disparate medical disorders. Most commonly they are prescribed for patients with severe anxiety, alcohol dependence, panic disorders, seizures, insomnia and agitation.
For panic disorders, benzodiazepines have a high efficacy, due to their anxiolytic properties. Although there is controversy surrounding the efficacy of benzodiazepines in long-term use, they have been proven to effectively treat anxiety when administered over short periods of time. They are extremely effective at alleviating anxiety at a rapid rate compared to other medicines prescribed to combat panic disorders.
Benzodiazepines are also commonly prescribed for generalized anxiety disorder (GAD) for much of the same reasons they are prescribed for panic disorders. The rapid onset of their anxiolytic properties completely eradicates feelings of nervousness and anxiety, but they are not as effective over long-term use.
Because benzodiazepines have strong hypnotic effects, they are commonly prescribed for patients suffering from insomnia. They are usually prescribed to use for about 2 to 4 weeks, otherwise patients may become dependent on them for sleep.
The anticonvulsant properties of benzodiazepines help treat patients who suffer from epileptic seizures. For the most part, hospitals will carry an intravenous solution of the drug in order to quickly and effectively stop a seizure. Failure to stop a seizure could result in many health complications or death.
Finally, benzodiazepines are used to treat the symptoms of alcohol withdrawal. They are the preferred choice in treating alcohol withdrawal syndrome, which can lead to death by seizure or severe delirium tremors. Alcohol withdrawal is one of the most serious forms of withdrawal; thus, benzodiazepines can serve as a lifesaver for those going through detox.
As a neurotransmitter, benzodiazepines aid the efficiency of the naturally-occurring brain chemical GABA. By doing so, benzodiazepines decrease the excitability of neurons, which leads to many of the calming effects associated with the drug. GABA and benzodiazepines both attach to a particular receptor called the GABA(A) receptor, which helps to conduct chloride ions across the cell membranes of neurons.
Moreover, when benzodiazepines attach to the GABA(A) receptor, it, in turn, promotes the binding of the neurotransmitter GABA. This serves to increase the total amount of chloride ions that cross the cell membrane of neuron. Subsequently, the membrane potential of each neuron becomes more negative, which makes it harder for the neuron to reach its action potential. An action potential is how neurons send messages to other neurons in the brain. Thus, by inhibiting communication between neurons, much of desired effects arise. Depending on what area of the brain the particular benzodiazepine is acting on, disparate effects are felt by the patient.
Benzodiazepines have a high risk for abuse, because chronic users often develop a tolerance and dependence to the drug. Tolerance refers to the fact that over time the pharmacological effect of the drug is greatly diminished with repeated use. Hence, it takes higher doses of the drug to attain the desired effect. Dependence is defined as the need to use a drug in order to maintain normal functionality. So, without the drug, the user would experience a number of withdrawal symptoms.
Most of the severe withdrawal symptoms come from an abrupt cessation of the drug use, so a gradual reduction regimen is usually advised. Withdrawal syndrome can last for months after quitting the drug, and, much like alcohol withdrawal syndrome, there is the possibility of death by seizures and intense delirium.
Furthermore, abuse of these drugs can lead to overdose. Although the potential of overdose is very low, many users that mix the drug with other narcotics have a much higher risk of overdosing. Alcohol, opioids and tricyclic antidepressants all serve to raise the toxicity of benzodiazepines. An overdose is usually marked by slurred speech, drowsiness, hypotension, nystagmus, coma, ataxia, respiratory depression and ultimately, cardiorespiratory arrest.
Benzodiazepines have a number of adverse effects that can lead to very dangerous outcomes. The most common adverse effects are related to their properties of muscle-relaxation and sedation. Dizziness, drowsiness and decreased concentration and alertness can lead many users to severely injure themselves in a car accident or a fall. Because benzodiazepines have many similar effects as alcohol, driving can be an extremely dangerous activity to participate in.
In some cases, benzodiazepines may have paradoxical effects, which are effects that are the antithesis of what usually should transpire while under the influence of the drug. Sometimes, epileptic patients will suffer from an increase in seizures, which can be deadly. For other patients, there is the possibility of an increase in violence, aggression, irritability, impulsivity and suicidal behavior; all of which can lead to very dangerous outcomes.
As mentioned before, a very serious condition can arise from prolonged dependence on benzodiazepines. Benzodiazepine withdrawal syndrome is defined as a number of symptoms that results from a person who is dependent on benzodiazepines reducing or ceasing the intake of the drug.
Some of the most serious symptoms that are associated with the syndrome include:
The last two symptoms are the most severe, for they both can result in death. When reducing or quitting benzodiazepines it is extremely important to consult with a healthcare professional in order to bypass some of the most severe withdrawal symptoms.
The best way to avoid seizures and death by benzodiazepine withdrawal is to attend an inpatient drug rehabilitation program. Most facilities have a number of healthcare professionals on-site, providing the safest atmosphere for getting clean from benzodiazepines. It is a long and arduous process when choosing to quit benzodiazepines, but it is worthwhile endeavor.
In most inpatient facilities, there are two features of the rehabilitative process: detoxification (detox) and treatment. Detox usually takes between 5 and 10 days, but with benzodiazepines it can take much longer, depending on the severity of the withdrawal symptoms. The healthcare professionals working at the facility will repeatedly check on the patient to gauge the level of withdrawal they perceive.
Once acute withdrawal symptoms are virtually nonexistent, the patient is cleared to begin the treatment portion of rehabilitation. The treatment section will usually transpire over the rest of the thirty day period spent in the rehab, although it is possible to stay at a rehab facility for up to 6 months.
The benefits of an inpatient facility include: group and individual therapy sessions; a number of activities that help promote well-being; providing the knowledge to cope with life stressors and triggers; and forming support groups that will help patients remain abstinent after they are released from the facility.
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