Benzodiazepines can bring fast relief from severe anxiety or sleeplessness. But they quickly lose their effect, can cause dependence within weeks and are risky for older adults, which is why guidelines recommend only short courses.
Imagine being given diazepam during a terrible week of panic attacks. It works within an hour. Months later, you are still taking it every night, it no longer helps much, and when you try to stop, the anxiety comes back worse than ever.
What benzodiazepines are
Benzodiazepines are sedative medicines that enhance the effect of GABA, a calming chemical messenger in the brain. Common examples include diazepam, lorazepam, alprazolam, clonazepam, temazepam and chlordiazepoxide. They differ in how quickly they work and how long they last.,Related medicines sometimes called “Z-drugs”, such as zopiclone and zolpidem, are used for sleep and have similar risks.
Appropriate uses
- Short-term relief of severe, disabling anxiety, usually for no more than two to four weeks
- Short-term treatment of severe insomnia
- Stopping prolonged seizures, often in emergencies
- Managing alcohol withdrawal under medical supervision
- Sedation before some medical procedures
- Muscle spasms in some situations
Why they are short-term only
The body quickly becomes used to benzodiazepines, so their effect fades over weeks. This is called tolerance. At the same time, the body adapts to their presence, so stopping can cause withdrawal symptoms. Dependence can develop in as little as a few weeks of regular use.,For long-term anxiety or insomnia, other treatments, such as talking therapies, antidepressants for anxiety and cognitive behavioural therapy for insomnia (CBT-I), are more effective and safer.
Side effects
- Drowsiness and slowed reactions
- Poor memory and concentration
- Unsteadiness and falls
- Low mood or emotional blunting
- Rarely, paradoxical agitation or aggression
Risks in older adults
Older adults are especially sensitive to benzodiazepines. They are linked to confusion, falls, hip fractures and road accidents. Many guidelines recommend avoiding them in older people where possible, and reviewing anyone who has taken them long term.
Dangerous combinations
Benzodiazepines combined with opioids, gabapentinoids, alcohol or other sedatives can dangerously slow breathing and have contributed to many overdose deaths. If you are prescribed more than one sedating medicine, ask for a medicines review.
Driving and work
Benzodiazepines can affect your ability to drive, operate machinery and do safety-critical work, sometimes the next day after a night-time dose. In some countries, driving with certain benzodiazepines above set levels in your blood is an offence. Check with your healthcare provider and follow local rules.
Stopping safely
Never stop suddenly after regular use, as severe withdrawal can cause anxiety, insomnia, tremor and, rarely, seizures. A gradual reduction plan, sometimes switching to a longer-acting benzodiazepine such as diazepam, is usually recommended.,The pace of reduction should be agreed with you and adjusted to how you feel. For people who have taken benzodiazepines for months or years, tapering may take several months. Support from your healthcare provider, a pharmacist or a specialist service can make it more manageable.
Alternatives for anxiety and sleep
- Cognitive behavioural therapy, including CBT for insomnia
- Some antidepressants for long-term anxiety
- Regular exercise, limiting caffeine and alcohol
- Relaxation and breathing techniques
- Good sleep routines
- Treating underlying causes such as pain or sleep apnoea
Pregnancy and breastfeeding
Benzodiazepines taken regularly late in pregnancy can cause drowsiness, breathing difficulties and withdrawal symptoms in the newborn baby. If you are pregnant or planning a pregnancy and take a benzodiazepine, talk to your healthcare provider about the safest plan; do not stop suddenly on your own.
Questions to ask your healthcare provider
- How long should I take this for?
- What is the plan for stopping?
- Is it safe with my other medicines?
- What other treatments could help my anxiety or sleep?
Frequently asked questions
Are benzodiazepines addictive?
They can cause dependence and, in some people, addiction, especially with long-term or high-dose use.
Can I take them occasionally?
Occasional, short-term use under medical advice carries lower risks. Discuss it with your healthcare provider.
Can I drink alcohol with them?
No. Alcohol greatly increases sedation and breathing risks.
But they are the only thing that helps me sleep
That is a common feeling, especially after long-term use. Withdrawal can temporarily worsen sleep, but with a gradual plan and other approaches, many people sleep as well or better once they have stopped.
Your next step: If you have taken a benzodiazepine or Z-drug for more than four weeks, ask your healthcare provider about a review and a plan.
Related: Insomnia and sleep hygiene · Sleeping pills: risks and better options
Sources: National Institute for Health and Care Excellence, Royal College of Psychiatrists, British National Formulary (BNF), US Food and Drug Administration boxed warning on benzodiazepines (2020).
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