Benzodiazepines (psychotropic): uses, effects and risks

The history of the psychopharmacology it is full of curiosities and discoveries of various kinds.

Some of these discoveries being the product of arduous research and others derived from the observation of effects in the treatment of other disorders (such as tuberculosis or asthma), over time research has allowed the creation and use of substances that help us effectively treat multiple problems psychological. This is the case of benzodiazepines, one of the best known types of psychotropic drugs in the treatment of anxiety.

Benzodiazepines: what are they?

Benzodiazepines are a group of psychoactive drugs with mainly anxiolytic effect whose discovery was a great revolution in the anxiety treatment. Born in a time when barbiturates were indisputably the treatment of choice for anxiety-type problems despite the high risk of overdose and dependence, their high level of success in reducing symptoms with much lower risks and side effects quickly made them the most common type of psychotropic drug. consumed.

They are relaxing substances with a large number of clinical applications, despite the fact that like all psychotropic drugs, it presents a series of risks and side effects to take into account when applying. When consumed, they are usually administered orally, although in cases where rapid action is necessary, intravenous administration may be recommended (which is much faster).

The mechanism of action of benzodiazepines is based on their action as an indirect agonist of GABA or gamma-aminobutyric acid, a neurotransmitter that allows the correct management and does not overload the brain by reducing and hindering the transmission of nerve impulses. Specifically, benzodiazepines cause the GABA exerts a greater influence on the system, which being an inhibitory neurotransmitter produces a depressant effect on the nervous system. Taking into account that in the limbic system there are a large number of GABAergic receptors, the impact of benzodiazepines in treating anxiety processes and mood states is very high. In this way, the level of activation of the organism decreases, producing a relief of anxiety symptoms along with other effects such as muscle relaxation and sedation.

Types according to their half-life

There are different types of substance that are part of the group of benzodiazepines. Although they could be grouped in different ways, one of the most common classifications is the one that has in counts the half-life of the drug in the body, that is, the time it remains active within the organism.

In this way we can find three large groups of benzodiazepines, whose characteristics will make them more suitable for one or other situations.

1. Long-acting / short-acting benzodiazepines

These are substances that remain for a short time (less than twelve hours) in the body, and are not suitable for treating long-term anxiety disorders. However, These are the fastest-acting benzodiazepines, which are a great help to combat the appearance of sudden anxiety symptoms such as anxiety or problems that only require a momentary relaxation, such as difficulties to reconcile dream.

The main problem of this subgroup is that when the effects pass quickly, wanting to keep them the consumption of the substance will be more common, which is likely to end up generating dependence. In addition, they tend to cause a higher level of side effects. Some drugs in this group are triazolam or midazolam.

2. Long-life / long-acting benzodiazepines

This type of benzodiazepine has the great advantage that stays in the body for a long time, being helpful in anxiety disorders. In contrast, the fact that they remain so long in the body causes the effects of the doses to accumulate, which could have undesirable sedative effects.

In addition, they take time to take effect, so they are not indicated when an immediate response is needed. They can remain and act for more than thirty hours after consumption. Within this group is the best known anxiolytic, diazepam, along with others such as clonazepam.

3. Life / intermediate-acting benzodiazepines

At an intermediate point between the two previous types, mid-life benzodiazepines act early (although not as immediate as short-acting ones) over a relatively long period of time. They last between twelve and twenty-four hours. Alprazolam or lorazepam are some of the drugs in this group.

Polyvalent drugs: indications

As we have indicated previously, benzodiazepines have a large number of uses. Some of the main problems in which these drugs are used are as follows.

1. Anxiety disorders and episodes

The application for which benzodiazepines are best known, having been the pharmacological treatment of choice for these types of problems for many years (today they have been dethroned as the treatment of choice in multiple disorders). The type of benzodiazepine to be used in each type of disorder will depend on its characteristics..

For example, if rapid action is necessary in response to the onset of an anxiety attack, a short-lived benzodiazepine can be applied. In the presence of phobias with a high probability of the appearance of phobic stimulus (such as social phobia), half-life or long-life benzodiazepines such as alprazolam can be used. In disorders such as generalized anxiety disorder or panic disorder, clonazepam, a long-acting version, tends to be one of the most effective.

2. Insomnia

One of the properties of benzodiazepines, which is sometimes an unwanted side effect, is its sedative potential. That is why they are useful when it comes to fighting sleep problems.

Short-lived benzodiazepines such as triazolam are often used when the difficulty is in falling asleep, but also some long-lived drugs such as flurazepam if the problem is in frequent awakenings or maintenance of the dream.

3. Mood disorders

While both in depression and in Bipolar disorder There are other drugs that are prioritized over benzodiazepines, in some cases it is used alprazolam or clonazepam since they allow the patient to be reassured and reduce their anguish.

4. Seizures, spasms, and motor agitation

Epileptic-type seizures appear when one or more groups of neurons become hypersensitive and they get excited with great ease. As we have indicated previously, the main mechanism of action of benzodiazepines is the potentiation of GABA as an inhibitor of the Neural excitation, which, by enhancing the depression of the nervous system, benzodiazepines are useful to control seizures convulsive.

Other motor-type symptoms can also be mitigated due to the effect as a muscle relaxant and sedative.

5. Alcohol withdrawal syndrome

The abrupt cessation of alcohol consumption in subjects who have developed tolerance and dependence can lead to withdrawal syndromes, symptoms of which may include anxiety, coordination problems, and agitation. Both at hospital and outpatient level, the use of benzodiazepines allows to control these symptoms, taking advantage of its sedative activity to decrease its intensity.

Risks and associated side effects

The use and administration of benzodiazepines have multiple advantages in a wide variety of disorders. However, its use is not without risks, having different characteristics that cause its dose and time of use to be regulated.

1. Addiction

One of the main problems with this type of drug is its addictive potential. Although benzodiazepines are much less addictive compared to their predecessors, they are Substances whose prolonged use can lead to tolerance, dependence and even syndromes of abstinence.

In this regard, the longer the half-life in the body, the less consumption will be necessary to maintain its effects, so that in general the long-lived benzodiazepines are the least addictive. It is necessary to correctly dose the amounts of benzodiazepine and the time to be consumed in order to avoid this type of problem.

2. Abuse and overdose

An overdose of these substances usually produces an exacerbation of the effects, causing a deep depression of the nervous system. It is usually not life threatening unless the patient is very old and / or has concomitant medical problems.

3. Abstinence syndrome

With regard to withdrawal syndromes, symptoms opposite to those produced by drugs are common, a rebound effect that highlights the presence of insomnia, headaches, anxiety, cramps and even seizures. To avoid this, it is necessary to schedule its withdrawal with extreme caution.

4. Sedation, decreased concentration and performance

The sedation they produce is another of the problems that the use of benzodiazepines can entail. Although in many cases they are used precisely in order to relax and facilitate sleep states, on occasions when you only want to reduce the anxiety this effect can be detrimental because it decreases motor ability, concentration and the effectiveness of the subject in performing chores.

5. Memory problems

The use of benzodiazepines can cause, especially when starting to take, memory problems. The type of problems they cause is usually difficulty in acquiring and consolidating new information, as well as in remembering previous information.

6. Paradoxical reaction

In some cases and especially with the elderly, the use of benzodiazepines can cause an effect totally contrary to what is expected. In these cases due to an increase in the excitation of the nervous system, causing distress and agitation on both a cognitive and motor level.

Bibliographic references:

• Gómez, M. (2012). Psychobiology. CEDE Preparation Manual PIR. 12. CEDE: Madrid

• Salazar, M.; Peralta, C.; Pastor, J. (2011). Manual of Psychopharmacology. Madrid, Editorial Médica Panamericana.

• Stevens, J.C. & Pollack, M.H. (2005). Benzodiazepines in clinical practice: consideration of their long-term use and alternative agents. J Clin Psychiatry; 66 (Suppl 2): ​​21-7.