Benzodiazepines are widely used to treat anxiety and/or insomnia. They include medications like Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), and Klonopin (clonazepam) that are used for anxiety and Restoril (temazepam) and Halcion (triazolam) that are used to help induce sleep.
Benzodiazepines may also be separated into those that are long acting (e.g., Valium and Klonopin) and those that are short acting (e.g., Xanax and Halcion). Long acting medications tend to remain in the body for extended periods of time (e.g., days) whereas short acting medications remain in the body for hours – hence you need to take the medication more than once a day to maintain effects.
Benzodiazepines are probably most effectively used as short-term management of anxiety and insomnia. As with any medication, there are trade offs that must be considered by both prescribers and consumers. First, there are withdrawal effects such as rebound anxiety after chronic use that makes discontinuation a problem. Second, these medications may have a deleterious effect on memory, cognition, and balance. Finally, the long-term efficacy of these medications is unproven for insomnia and questioned for anxiety.
The results of a recent study suggest a correlation between use of benzodiazepines and Alzheimer’s disease (Benzodiazepines may be linked to Alzheimer’s disease, Z. Kimietowicz, 2014, British Medical Journal, 349, g5555, PMID: 25208536). The findings were based on a retrospective population study of about 39,000 insured residents of Quebec over 66 years of age based on claims between 2000-2009.
Any use of benzodiazepines was associated with a greater risk of Alzheimer’s disease. Long-term use of benzodiazepines was more common in those with a diagnosis Alzheimer’s disease (32.9%) than for those without this diagnosis (21.8%) regardless of whether the medication was short or long acting. The association was stronger for long acting medications – possibly because of cumulative actions. The risk appeared to be associated with use for greater than three months. There was no association between Alzheimer’s disease and anxiety, depression, or insomnia.
Of course these findings do not suggest that benzodiazepine use causes Alzheimer’s disease. Unlike chronic use of drugs like alcohol or cocaine, there is no pathophysiologic mechanism for these medications to cause a decline in memory or degeneration of the brain. Instead these findings remind us that benzodiazepines are still commonly used to try to manage difficult behaviors in demented elderly despite warnings of adverse effects with chronic use and no clear demonstration of efficacy.
Benzodiazepines are best utilized as targeted medications for short-term management of anxiety. They may be effective for getting through a particularly bad day or a stressful event like going to the dentist or flying. They are not long-tem solutions for behavioral disturbances.