April 19, 2019
Apprehensive woman discusses a medication with female doctor.

How Safe Are Anti-Anxiety Drugs?

by Stephanie Watson

While the epidemic of opioid overdoses in the United States usually takes center stage in news media reports, fewer alarms have been raised about a group of sedatives called benzodiazepines. Like opioids, benzodiazepines have a long list of side effects and a high potential for abuse and overdose.

The American Geriatrics Society (AGS) suggests that older adults avoid using benzodiazepines because of their increased sensitivity to the drugs and the harms associated with them. Still, the rate of benzodiazepine use in older adults remains high, according to a study in the July 2018 issue of Journal of the American Geriatrics Society.

A wide range of side effects

Benzodiazepines like lorazepam (Ativan), alprazolam (Xanax), diazepam (Valium), clonazepam (Klonopin), and temazepam (Restoril) depress the central nervous system and slow brain activity, which makes them helpful for treating anxiety as well as insomnia.

The drugs may be beneficial when taken intermittently for less than one month at a time. But their side effects are heightened in older adults because of age-related changes that cause the drugs to remain in their bodies longer and prolong their effects when compared with younger people. Potential side effects include slurred speech, confusion, headache, light-headedness, dry mouth, problems with movement and memory, lowered blood pressure, and slowed breathing. Sleepiness and lack of coordination are common in the first few days of starting the drugs as your body adjusts to them.

Benzos and Opioids: A Dangerous Mix

Are you taking both a benzodiazepine and an opioid at the same time? If so, your risk of a fatal overdose is four times that of people who are taking an opioid alone.

Benzodiazepines increase the risk for falls, car accidents, hip fractures, memory loss, overdose, and death. Long-term use has been associated with cognitive decline and dementia. Taking benzodiazepines for long periods can worsen anxiety and insomnia as well as lead to dependency on the drugs and a need for increasing dosages as tolerance develops.

Another danger of benzodiazepines is withdrawal symptoms if you abruptly stop taking them. If you’ve been taking the drugs for longer than three to four weeks, you’re likely to have symptoms ranging from sweating, headaches, dizziness, nausea, and palpitations to depression, delirium, hallucinations, and paranoia. Stopping benzodiazepines can also induce seizures one to 12 days after discontinuing the drugs. It’s important to taper off them over weeks or months under a doctor’s supervision if you choose to stop taking them. Psychotherapy can be helpful during this process.

Safer treatments for anxiety and insomnia

The best advice if you’re 65 or older is to heed the AGS’s recommendation to avoid taking benzodiazepines. Consider treating anxiety or insomnia without medicines first. Cognitive behavioral therapy (CBT) has a good track record when it comes to managing both disorders and is recommended by many experts as the first line of treatment. CBT is a form of psychotherapy that’s been shown to be effective for several types of anxiety disorders. It focuses on changing negative thinking patterns. CBT for insomnia (CBT-i) treats the underlying causes of sleep disorders and provides you with lifelong tools to use to improve your sleep. Yoga, tai chi, and meditation are also safe ways to relieve anxiety and sleep troubles.

If nondrug therapies don’t work, talk with your doctor about safer drug options. For example, an antidepressant with fewer side effects than a benzodiazepine might help improve anxiety or sleep.

When to try a benzodiazepine

If other therapies don’t help and your anxiety or sleep problems are affecting your quality of life, review the risks and benefits of taking benzodiazepines with your doctor. Make sure he or she is aware of all your current medications, including prescription and over-the-counter drugs, vitamins, and herbal supplements to avoid any drug interactions (see inset above). If you do need to take a benzodiazepine, use the drug for only a short time.

Your doctor should prescribe a benzodiazepine with an end date in mind. Studies have found that patients who are prescribed a large supply of the drugs are more likely to continue taking them long term. Prescribing the drug for a short duration, such as 14 days, gives you and your doctor the opportunity to discuss the drug’s therapeutic effects after that time and how you will taper off them. It’s important to remember that benzodiazepines may sometimes help in the short term, but they’re not a solution for persistent anxiety or insomnia.

This article first appeared in the January 2019 issue of UC Berkeley Health After 50.

Also see 15+ Sleep Remedies and What to Know About Panic Attacks.