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ADDITIONAL INFORMATION
14 Minutes
CONTENTS
Benzodiazepines treat anxiety, insomnia and seizures yet carry potential side effects like all medications. These medications demonstrate strong initial effectiveness but extended or incorrect usage results in multiple physical and psychological health problems.
Available estimates show that the lifetime prevalence of benzodiazepine use disorder remains below 1% although the precise current prevalence is not known [1]. In a general population survey by Gallup of 4148 subjects in 2018 in Great Britain, 7.7% had taken benzodiazepines within the last year (male: female ratio 106: 212) [2].
All benzodiazepine users need to understand the potential side effects because they can substantially affect their daily activities and general health.
Medical professionals prescribe benzodiazepines or “benzos” as medications to treat anxiety disorders and insomnia along with other health problems. They work as part of the tranquillizer drug group. These drugs function by targeting the central nervous system so they generate relaxation effects throughout the brain along with the body. Healthcare providers use these medications to treat panic attacks along with generalized anxiety disorder and acute stress during brief treatment periods.
Medical professionals use benzodiazepines to treat seizure conditions as well as muscle spasms and symptoms from alcohol withdrawal. Doctors prescribe benzodiazepines to deliver quick symptom relief because of their rapid sedative properties which help restore normal daily functioning.
Benzodiazepines demonstrate excellent short-term effectiveness but expose patients to danger when used over extended periods or when administered outside appropriate medical oversight. Healthcare providers conduct a careful assessment of potential benefits alongside potential risks because of the concomitant use of certain medications when making prescriptions.
Multiple benzodiazepine medications exist which demonstrate diverse levels of potency and action durations. Some of the most commonly prescribed include:
Diazepam (Valium): Doctors prescribe this medication to alleviate anxiety along with muscle spasm symptoms and alcohol withdrawal effects. Because the substance remains active through its extended half-life it persists within bodily systems for extended periods.
Alprazolam (Xanax): Doctors regularly prescribe alprazolam for treating both anxiety and panic disorders. Due to its rapid onset of action, healthcare professionals prefer Alprazolam (Xanax) for treating acute anxiety episodes.
Lorazepam (Ativan): Doctors prescribe Lorazepam (Ativan) for anxiety and insomnia and as a sedative agent during medical procedures.
Clonazepam (Klonopin): This medication serves mainly to treat seizure disorders and panic attacks. Clonazepam outlasts several benzodiazepine medications in its duration of action.
Temazepam (Restoril): Doctors prescribe this medication to address short-term sleep difficulties including insomnia.
Benzodiazepines operate through their connection with brain molecules labelled GABA-A receptors. The human brain relies on GABA (gamma-aminobutyric acid) as its principal neurotransmitter for inhibition which reduces brain function and produces calming effects [3].
Benzodiazepines boost GABA function which leads to reduced brain activity. Benzodiazepines produce sensations of peace and drowsiness.
The same mechanism which helps benzodiazepines treat anxiety and sleep disorders also leads to their side effects. Suppressed brain activity allows these medications to interfere with crucial cognitive abilities which include memory processing and attention maintenance as well as movement coordination. The medication affects mood stability and people develop tolerance through continuous use because the body needs increased doses to maintain initial effects.
Benzodiazepines also reduce levels of neurotransmitters which control physical coordination along with mental clarity and emotional stability. The central nervous system effects of benzodiazepines create potential side effects which include dizziness, drowsiness, and impaired judgment. As people take the drug for extended periods the brain adjusts to its sedative properties which results in some users developing memory issues or confusion.
Using benzodiazepines alongside other central nervous system depressants including alcohol raises the risk of side effects. Patients must adhere to exact dosage directions because taking benzodiazepines with alcohol or other drugs without medical advice can lead to dangerous interactions.
Benzodiazepines deliver effective short-term solutions for anxiety and sleep problems when users take these drugs according to medical directions. These drugs enhance GABA neurotransmitters which function to suppress brain activity. A relaxation response results in decreased anxiety, muscle relaxation, and sedation.
Their sedative characteristic affects people differently by reducing coordination ability alongside delayed reaction times and diminished mental function. Prescribed doses of benzodiazepines still require you to avoid tasks that need complete focus or physical coordination including driving and heavy machinery operation.
Benzodiazepines provide therapeutic benefits but users will experience multiple short-term side effects. Some of the most common include [4]:
Drowsiness or Sedation: People undergoing benzodiazepine treatment commonly experience sedation or diminished alertness because these drugs produce a calming brain effect. Their sedative brain effects make benzodiazepines popular treatments for insomnia.
Dizziness or Light-headedness: Benzodiazepines create blood pressure drops which make people feel dizzy or lightheaded when they stand up too fast.
Memory Problems: Benzodiazepine use over short periods can disrupt both your memory formation and information retrieval capabilities. Most people experience this effect temporarily although it still raises concern for a number of individuals.
Coordination Problems: Central nervous system depressant medications lead to impaired physical coordination which manifests as clumsiness or unsteadiness.
Mild Euphoria or Disinhibition: A calm sensation or mild euphoria makes some people feel both more relaxed and social. People misuse benzodiazepines because these medications create feelings of calmness and mild euphoria.
Dry Mouth or Blurred Vision: Although these side effects appear in some people their occurrence is rare.
The majority of short-term side effects from benzodiazepines disappear as the medication leaves the body. Careful adherence to your doctor’s instructions will prevent these effects from becoming worse.
Physical dependence represents the primary risk factor for long-term usage of these medications. People need larger doses of benzodiazepines over time because their bodies adjust to the drug’s presence. When someone who has developed a dependence on a drug reduces their intake or stops using it entirely they may experience withdrawal symptoms.
Using drugs extensively throughout time creates tolerance because they steadily lose effectiveness as treatment progresses. Patients may require higher doses because of tolerance which increases their chances of drug misuse and fatal overdoses.
Continuous drug use produces both dependency and gradual damage from which the brain’s cognitive abilities begin to deteriorate. Long-term benzodiazepine uses causes memory problems and learning difficulties and could increase the risk of developing serious disorders including dementia. Scientists have yet to completely understand the processes involved but research supports the findings that extended benzodiazepine use modifies brain structure in regions vital for memory and decision-making function.
Extended benzodiazepine usage produces considerable physical and psychological health effects.
Some of the most notable long-term effects include:
Cognitive Impairment: Continuous use results in cognitive problems that affect memory retention as well as concentration and decision-making abilities. These brain effects disturb normal daily activities and institutions’ social as well as work functions.
Depression and Anxiety: Benzodiazepines treat anxiety but prolonged use produces the opposite effect by creating more anxiety and depression symptoms. People who rely on this medication over time may find their brains become dependent on it for mood management which makes managing emotions difficult without the drug.
Physical Health Issues: Extended benzodiazepine use causes muscle weakness together with fatigue as well as balance and coordination problems. The physical side effects become particularly dangerous for older adults because they increase their chances of experiencing falls which can lead to fractures.
Sleep Disruptions: The prescription of benzodiazepines to treat sleep problems becomes counterproductive through long-term use because it leads to disrupted sleep patterns. When patients stop taking their medication, they often experience rebound insomnia which leads to worse sleep quality.
Benzodiazepine overdose stands as one of their most critical risks. Although rare during prescribed usage benzodiazepines pose higher overdose risks when misused or combined with other substances such as alcohol or opioids.
An overdose can lead to life-threatening consequences, including:
Respiratory Depression: A benzodiazepine overdose poses the highest threat when it causes breathing to slow down or stop completely. Without immediate medical intervention, this condition can cause unconsciousness or result in death.
Coma or Unresponsiveness: Severe overdose cases frequently result in unaffected patients entering comatose states while they lose responsiveness to all outside stimuli.
Hypotension (Low Blood Pressure): An overdose can cause blood pressure to drop sharply which creates shock and causes organ failure without proper treatment [3].
The simultaneous use of benzodiazepines and alcohol or other central nervous system depressants greatly heightens the possibility of a deadly overdose. Combined use of these substances produces synergistic effects which intensify sedation while complicating the medical reversal of the overdose.
The combination of benzodiazepines with other drugs is dangerous and particularly fatal when mixed with alcohol. As a central nervous system depressant alcohol creates severe sedation when used with benzodiazepines which leads to dangerous respiratory depression and death. Fatal drug overdoses worldwide often result from this particular drug combination.
When benzodiazepines mix with opioids which belong to the central nervous system depressant class they create a particularly hazardous situation. Recent years have seen numerous overdose deaths because of benzodiazepine and opioid combinations. The combination of these two drugs produces deep respiratory depression that requires immediate medical intervention to reverse.
Benzodiazepine treatments work for numerous patients but prolonged use increases side effects risk in specific patient groups. Specific groups such as elderly patients and pregnant women combined with people who have prior medical conditions encounter higher benzodiazepine risk levels.
Elderly People: Benzodiazepine side effects pose a greater threat to older adults than to other age groups. The body processes drugs at a slower rate because our metabolic rate decreases with age. The aging body processes drugs more slowly which leads to drug accumulation that raises the elderly’s risk of sedation and confusion and increases their chances of falling and developing severe cognitive decline. Underlying health issues such as heart disease or liver problems which older people often experience can intensify benzodiazepine effects on them.
People with Liver or Kidney Disease: Benzodiazepines undergo metabolism in the liver through which they transform before the kidneys eliminate them from the body. People having liver or kidney dysfunction experience extended drug effects because their bodies cannot clear medications properly. People with liver or kidney dysfunction need careful dosage monitoring because their condition leads to stronger sedative effects and possible drug toxicity [4].
Pregnant and Breastfeeding Women: During pregnancy and breastfeeding benzodiazepines should only be prescribed when absolutely essential. During foetal development, these medications cross the placenta which can result in birth defects or newborn withdrawal symptoms. Benzodiazepines administered to breastfeeding mothers can enter breast milk which may result in sedation of the nursing infant.
The FDA formerly classified most benzodiazepines as category D medications which suggests foetal risk yet they might be used during pregnancy if the benefits outweigh the risks because every minute of maternal seizures raises foetal mortality by 10% [5]. That said, benzodiazepine treatment results in laryngospasm and bronchospasm in fewer than 1% of neonatal patients [5].
When treating these vulnerable patients’ physicians must perform detailed assessments of benzodiazepine risks and benefits and explore alternative treatment options when available.
Older adults along with patients who have existing medical conditions face increased severe effects when they use benzodiazepines over extended periods. The elderly face heightened cognitive decline risks including memory problems and confusion which become more worrying when they occur alongside normal aging. Extended usage of these drugs intensifies existing problems that result in dementia and creates a higher risk of falls and fractures because coordination becomes impaired.
Extended benzodiazepine use creates higher mental health disorder risks including depression and anxiety among these patient populations. Elderly patients face increased risk of these conditions so benzodiazepines start as beneficial but later produce a harmful cycle that worsens symptoms.
Benzodiazepines can worsen existing symptoms or create harmful interactions with medications for patients who suffer from chronic ailments such as heart disease or diabetes along with respiratory disorders. The respiratory system becomes more depressed by benzodiazepines which leads to severe breathing problems for people with existing respiratory conditions.
People who take benzodiazepines can use specific strategies to reduce side effects and maintain safe drug use. Doctors help reduce treatment risks when patients maintain close communication to adjust their medication.
Follow Prescribed Dosages: Taking your medication exactly as your doctor prescribed helps you avoid side effects. You must get medical advice before increasing your medication dose. If patients follow their prescribed instructions when taking benzodiazepines, they will lower their chances of building tolerance or becoming dependent.
Short-Term Use: Benzodiazepines require usage only during brief periods for safety reasons. After your insomnia or anxiety stabilizes you need to talk to your healthcare provider about other treatment options. Several non-drug methods exist including cognitive behavioural therapy (CBT) which help manage both anxiety and sleep disorders and prove safe because they avoid benzodiazepine side effects.
Gradual Reduction: Users who have been taking benzodiazepines for an extended period should never stop taking them without medical supervision. If you stop taking benzodiazepines suddenly your body may experience withdrawal which includes symptoms like irritability tremors and anxiety. Work with your doctor to design a gradual cessation schedule which helps your body adjust properly.
Avoid Mixing with Other Substances: Benzodiazepines should not be combined with alcohol or other central nervous system depressants because it leads to severe dangerous side effects which can cause respiratory depression or overdose.
Through proper dosage management and active treatment changes you can minimize the dangers linked to long-term benzodiazepine use.
Several treatment alternatives exist which you should consult about if benzodiazepine usage creates risk or side effects for you. Certain people find alternative medications provide superior treatment for anxiety disorders and insomnia as well as various other medical conditions.
Antidepressants (SSRIs or SNRIs): Health professionals usually prescribe these drugs to treat anxiety and depression because they present less risk of dependence than benzodiazepines. People must wait for extended periods for full effectiveness but find antidepressants such as SSRIs and SNRIs represent the preferable long-term treatment choice because of their safety profile.
Cognitive Behavioural Therapy (CBT): CBT functions as a verified non-medication treatment for anxiety and insomnia which helps patients learn coping strategies while teaching them better sleep practices. People seeking enduring solutions to their problems can find this treatment effective because it avoids medication risks.
Lifestyle Changes: Different stress management techniques including meditation practice yoga and maintaining regular workout routines can provide relief from symptoms of both anxiety and insomnia. People suffering from chronic anxiety should use these treatments alongside therapy or medicine to obtain better overall results.
Safe benzodiazepine use depends on taking the exact doctor-prescribed dose without any self-made changes. Doctors prescribe benzodiazepines to be taken precisely according to their instructions. Whenever you have questions about how much medication to take or when to take it contact your healthcare provider to get clear guidance.
When doctors determine benzodiazepine doses, they consider the medication type, the medical condition being treated along with how the patient responds to the treatment. Patients receive Xanax (alprazolam) in very small doses but may require higher doses of Valium (diazepam) for particular conditions.
When prescribing benzodiazepines for temporary treatment, doctors will begin treatment with the smallest dose that works and modify this amount based on patient response. To prevent dependence and minimize side effects doctors prescribe lower doses when patients need long-term treatment. Routine medical appointments help doctors maintain treatment effectiveness for individual patient requirements.
The proper dosage needs adjustment based on what medication is prescribed as well as the patient’s age and medical status.
Here’s a quick look at typical doses for some of the most common benzodiazepines:
Alprazolam (Xanax): Patients with anxiety should start treatment with a dose between 0.25 and 0.5 mg taken three times daily. Patients with panic disorders should consider dose adjustments up to 1–2 mg daily.
Diazepam (Valium): Anxiety treatment with this medication requires a daily dose ranging from 2 to 10 mg administered 2 to 4 times. Doctors prescribe larger doses to treat muscle spasms and seizures.
Lorazepam (Ativan): Patients with anxiety should take 1–2 mg of lorazepam daily split into two or three doses [6].
These are generally accepted doses used for young and otherwise healthy adults. You should consult your doctor regarding the minimum safe and effective dose required for you.
1. Kang M, Galuska MA, Ghassemzadeh S. Benzodiazepine Toxicity. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482238/
2. Dunbar GC, Perera MH, Jenner FA. Patterns of Benzodiazepine use in Great Britain as Measured by a General Population Survey. British Journal of Psychiatry. 1989;155(6):836-841. doi:10.1192/bjp.155.6.836
3. Mind.org. The benefits and risks of benzodiazepines. https://www.mind.org.uk/information-support/drugs-and-treatments/sleeping-pills-and-minor-tranquillisers/side-effects-of-benzodiazepines/
4. Cleveland Clinic. Benzodiazepines (Benzos). https://my.clevelandclinic.org/health/treatments/24570-benzodiazepines-benzos
5. Bounds CG, Patel P. Benzodiazepines. In: StatPearls. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470159/
6. UpToDate. Benzodiazepine use disorder. https://www.uptodate.com/contents/benzodiazepine-use-disorder
Although benzodiazepines rarely cause hallucinations, they can happen, especially with high doses or prolonged use. People sometimes develop visual or auditory hallucinations from using a drug when they combine it with other substances or experience withdrawal from it. Unusual sensations or perceptions require immediate medical attention from your healthcare provider. Hallucinations might indicate a mental health problem exists within someone.
Although benzodiazepines treat anxiety disorders, they can cause rebound anxiety in certain people when they suddenly stop using them. Moreover, as tolerance develops to certain drugs, patients need higher doses to achieve the original effects but this process may intensify their anxiety symptoms. Stopping benzodiazepine medication may lead to severe anxiety symptoms. Patients need to team up with their doctors to monitor treatment-related anxiety level fluctuations.
The primary side effect experienced by users of benzodiazepines is drowsiness or sedation. The brain activity deceleration from benzodiazepines leads to excessive sleepiness. Doctors prescribe benzodiazepines for insomnia and anxiety because of their sedative properties. While benzodiazepines might help people fall asleep when they start using them, they also cause an eventual decline in sleep effectiveness because users build up tolerance which necessitates larger doses for equivalent sleep-promoting effects. Your doctor must provide clearance before you operate machinery or drive while taking benzodiazepines.
Benzodiazepines might lead to constipation but this side effect happens less frequently. Benzodiazepines tend to slow gastrointestinal (GI) function resulting in delayed digestion which can produce constipation. The occurrence increases when patients take benzodiazepines at higher doses or over prolonged durations. Anyone experiencing bowel habit changes from benzodiazepine use should consult their doctor who might suggest dietary adjustments or hydration along with other treatment options.
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