Some people may continue to use benzodiazepines for longer, even months or years. Some do so because they continue to find these drugs helpful and have agreed with their prescribing physician that the benefits of continuing to use them outweigh the risks. There are also those who continue to use benzodiazepines over a longer term because the prescribing doctor has not re-examined their continued use.
In this instance, ask another doctor to review your prescription. When used on occasion or daily for a few weeks, benzodiazepines have a low risk of addiction.
This risk increases, however, when benzodiazepines are taken regularly for more than a few weeks, especially when they are taken in higher than normal doses. People with a history of substance abuse should avoid or minimize use of benzodiazepines as they are at higher risk of becoming addicted. Signs of addiction include strong cravings for the effects of the drug, taking more of the drug than intended and continuing to use the drug despite the problems it may cause. Addiction may develop with or without physical dependence.
Physical dependence: When benzodiazepines are taken regularly over a long period of time, the body adapts to the presence of the drug. This is known as physical dependence. Physical dependence, on its own, is not the same as addiction. Signs of physical dependence include tolerance and withdrawal. Tolerance: People are said to have developed tolerance to a drug when the same dose, taken over time, no longer has the desired effect. With benzodiazepines, it is known that:.
Some people who develop tolerance may take higher and higher doses to feel the same intensity of effect as when they started taking the drug. These people may find it difficult to stop using benzodiazepines. Withdrawal: Withdrawal symptoms of benzodiazepines may be similar to the reasons why the drugs were prescribed in the first place. The severity of withdrawal symptoms depends on the type of benzodiazepine used, the amount used and length of time it is used, and on whether the drug is stopped abruptly.
Symptoms can include headache, insomnia, anxiety, tension, sweating, difficulty concentrating, tremor, sensory disturbances, fatigue, stomach upset and loss of appetite. Severe withdrawal symptoms from regular use of benzodiazepines in high doses may include agitation, paranoia, delirium and seizures. Withdrawal symptoms generally begin within a few days after treatment is stopped, and they may continue for two to four weeks or longer.
Once you have slept well for two or three nights in a row, try to get to sleep without taking the medication. If you have been taking benzodiazepines regularly for a few weeks or more, check with your doctor before reducing or stopping your medication. Most often, benzodiazepines are prescribed to help people get through stressful situations or to provide relief while waiting for other treatment to take effect.
When used in this way, on occasion or daily for a few weeks, most people can stop taking them without difficulty or withdrawal effects. Stopping use can, however, be hard for some people, even when the use is short term. Problems are most likely to occur when:. People who wish to stop using benzodiazepines after using them regularly over a longer term will need to cut back their use gradually over an extended period of time.
This approach reduces withdrawal effects and helps ensure success in stopping. Because the ideal process for cutting down varies depending on the benzodiazepine you are taking, the dose and the length of time you have been taking it, ask your doctor to help you set up a schedule. If the long-term use has been at high doses, stopping use requires medical supervision. These drugs may interact with other medications. If your doctor or dentist prescribes any medication, inform him or her about the drug you are taking.
Check with your pharmacist before using any over-the-counter medication, including herbal products, cold or allergy tablets, or cough syrups. When taken on their own, the risk of overdose with benzodiazepines is low; however, combining these drugs with other sedatives, such as alcohol, or with medications containing codeine or other opioid drugs, can result in overdose and possible death.
Symptoms of overdose include slurred speech, confusion, severe drowsiness, weakness and staggering, slow heartbeat, breathing problems and unconsciousness. Benzodiazepines can be dangerous when combined with alcohol.
Benzodiazepines increase the effects of alcohol, making you more sleepy, dizzy or lightheaded. One danger of this is the increased risk of stumbling, falling and related injuries. Another is the increased risk of overdose. Both alcohol and benzodiazepines slow down the central nervous system, which controls breathing. In overdose, breathing can stop. Drinking too many caffeinated beverages i. Street drugs, such as marijuana or cocaine, have effects that can worsen symptoms of anxiety and interfere with sleep—making you feel worse, rather than better.
Taking benzodiazepines to enhance the effect of other sedative drugs, such as opioids, is dangerous and increases the risk of overdose and injury. Benzodiazepines can affect your ability to drive a vehicle and increase the risk of a crash, especially if taken in combination with alcohol or other sedative drugs.
The risk is highest when you first start taking benzodiazepines, before you are used to their effect. Avoid driving or operating other machinery if you feel drowsy or slowed down. The risk of birth defects from taking benzodiazepines while pregnant is not known, though it is thought to be very small. Always talk to your doctor or pharmacist before combining medications. When mixed with alcohol, benzodiazepines can lead to fatal overdose.
Taking benzodiazepines with prescription pain or sleeping pills can also lead to fatal overdose. Antihistamines amplify their effects. Antihistamines—found in many over-the-counter sleep, cold, and allergy medicines—are sedating on their own. Be cautious when mixing with benzodiazepines to avoid over-sedation. Be cautious when combining with antidepressants.
You may need to adjust your dose accordingly. The benzodiazepines work because they slow down the nervous system. Paradoxical reactions are most common in children, the elderly, and people with developmental disabilities. They include:. Anyone who takes benzodiazepines can experience unpleasant or dangerous side effects. But certain individuals are at a higher risk:.
People over Older adults are more sensitive to the sedating effects of benzodiazepines. Even small doses can cause confusion, amnesia, loss of balance, and cognitive impairment that looks like dementia. Benzodiazepine use in the elderly is associated with an increased risk of falls, broken hips and legs, and car accidents.
People with a history of substance abuse. Pregnant and breastfeeding women. Benzodiazepine use during pregnancy can lead to dependence in the developing baby, with withdrawal following birth.
Benzodiazepines are also excreted in breast milk. Therefore, pregnant women need to have a thorough discussion about the risks and benefits of these medications with their prescribing doctor. If medication is necessary, the goal is the smallest effective dose. Benzodiazepines cause drowsiness and poor coordination, which increases your risk for accidents at home, at work, and on the road.
When on benzodiazepines, be very careful when driving, operating machinery, or doing anything else that requires physical coordination. Many medications originally approved for the treatment of depression are also prescribed for anxiety.
In comparison to benzodiazepines, the risk for dependency and abuse is smaller. SSRIs have been used to treat generalized anxiety disorder GAD , obsessive-compulsive disorder OCD , panic disorder, social anxiety disorder, and post-traumatic stress disorder.
Although physical dependence is not as quick to develop with antidepressants, withdrawal can still be an issue. If discontinued too quickly, antidepressant withdrawal can trigger symptoms such as extreme depression and fatigue, irritability, anxiety, flu-like symptoms, and insomnia.
Antidepressants can make depression worse rather than better for some people, leading to an increased risk of suicide, hostility, and even homicidal behavior. While this is particularly true of children and young adults, anyone taking antidepressants should be closely watched. Signs that medication is making things worse include anxiety, panic attacks, insomnia, hostility, restlessness, and extreme agitation—particularly if the symptoms appear suddenly or rapidly deteriorate.
If you spot the warning signs in yourself or a loved one, contact a doctor or therapist immediately. If you are concerned that a friend or family member is contemplating suicide, see Suicide Prevention. The suicide risk is greatest during the first two months of antidepressant treatment. Buspirone, also known by the brand name BuSpar, is a newer anti-anxiety drug that acts as a mild tranquilizer.
Buspirone relieves anxiety by increasing serotonin in the brain—as the SSRIs do—and decreasing dopamine. Compared to benzodiazepines, buspirone is slow acting—taking about two weeks to start working. Since the risk of dependence is low and it has no serious drug interactions, buspirone is a better option for older individuals and people with a history of substance abuse.
However, its effectiveness is limited. Beta blockers—including drugs such as propranolol Inderal and atenolol Tenormin —are a type of medication used to treat high blood pressure and heart problems. However, they are also prescribed off-label for anxiety. Beta blockers work by blocking the effects of norepinephrine, a stress hormone involved in the fight-or-flight response. The use or misuse of drugs and alcohol can worsen symptoms of anxiety. Your primary care provider is the best place to start that journey.
Benzodiazepines also treat severe muscle spasms, tremors and acute seizures. Benzodiazepines, such as Xanax and Klonopin, provide rapid relief from a panic attack.
Providers may also prescribe them to prevent cases of acute anxiety like those stemming from a plane ride, for those with a fear of flying, or the moments leading up to a surgery. Unlike other anti-anxiety medications, benzodiazepines are controlled substances. You can develop a tolerance to benzodiazepines and a dependence to them over time. Additionally, trying to suddenly stop taking a benzodiazepine can cause life-threatening withdrawal that may include seizures.
For these reasons, providers typically prescribe benzodiazepines at low doses for limited amounts of time. Buspirone may help patients think more clearly and relax with less worry. It may also help anxiety symptoms like irritableness, sweating and trouble sleeping. Alonzo cautions about consuming alcohol and grapefruit or grapefruit juice when taking buspirone.
Common side effects of buspirone may include dizziness, nervousness, drowsiness and lightheadedness. Hydroxyzine, also known under the brand names Atarax and Vistaril, is an antihistamine that has an effect on regulating the chemicals in your brain, which helps control anxiety on a short-term basis.
These medications have a calming effect on the brain, and providers may prescribe it prior to a surgery to ease nerves and help sleep. The effects of hydroxyzine can happen quickly, unlike buspirone, which may take time to become effective. Hydroxyzine and buspirone are not controlled substances. They also do not cause tolerance, dependence or withdrawal. Meclizine, also an antihistamine , is most often used to treat motion sickness and dizziness.
The drug, sold under the brand name Antivert , can also treat nausea and dizziness during panic attacks.
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