Benzodiazepines (psychodrugs): uses, effects and risks
The history of psychopharmacology is full of curiosities and discoveries of various kinds.
Since some of these discoveries are the product of arduous research and others derived from the observation of effects in the treatment of other disorders (such as tuberculosis or asthma), research has allowed the creation and consumption of substances that help us in a timely manner. effective to treat multiple psychological problems. This is the case of benzodiazepines, one of the most well-known types of psychotropic drugs in the treatment of anxiety .
Benzodiazepines: what are they?
Benzodiazepines are a group of psychotropic drugs with mainly anxiolytic effect whose discovery was a great revolution in the treatment of anxiety. Born at a time when barbiturates were indisputably the treatment of choice for anxiety-type problems despite the high risk of overdose and dependence, their high level of success in reducing symptoms with much lower risks and side effects made them quickly in the most consumed type of psychoactive drug.
These are relaxing substances with a large number of clinical applications, despite the fact that like all psychoactive drugs presents a series of risks and side effects to take into account when applying. At the time of consumption, they are usually administered orally, although in cases in which rapid action is necessary, intravenous administration (which is much faster) may be advisable.
The mechanism of action of benzodiazepines is based on their performance as an indirect agonist of GABA or gamma-aminobutyric acid, a neurotransmitter that allows proper management and does not overload the brain by reducing and impeding the transmission of nerve impulses. Specifically, benzodiazepines cause GABA to exert a greater influence on the system, which, being an inhibitory neurotransmitter, produces a depressant effect on the nervous system. Considering that in the limbic system there are a large number of gabaergic receptors, the impact of benzodiazepines when treating anxious processes and moods is very high. In this way the level of activation of the organism decreases, producing a relief of anxious symptoms along with other effects such as muscle relaxation and sedation.
Types according to their average life
There are different types of substance that are part of the group of benzodiazepines . Although they could be grouped in different ways, one of the most common classifications is that which takes into account the average life of the drug in the organism, that is, the time that remains active within the organism.
In this way we can find three large groups of benzodiazepines, whose characteristics will make them more suitable for some or other situations.
1. Life / short action benzodiazepines
These are substances that remain for a short time (less than twelve hours) in the body, not being adequate to treat anxiety disorders prolonged over time. But nevertheless, it's the benzodiazepines that act more quickly , with what they suppose a great help to fight the appearance of sudden anxious symptoms like the crisis of anxiety or of problems that only need a momentary relaxation, like the difficulties to conciliate the dream.
The main problem of this subgroup is that by passing the effects quickly, of wanting to maintain them, the consumption of the substance will be more usual, which is likely to end up generating dependency. In addition, they usually cause a higher level of side effects. Some drugs in this group are triazolam or midazolam.
2. Benzodiazepines of life / long action
This type of benzodiazepine has the great advantage that it stays in the body for a long time , being of help in anxiety disorders. On the other hand, the fact that they remain so in the body causes the effects of the doses to accumulate, which could have undesirable sedative effects.
In addition, they take some time to take effect, which is not indicated when an immediate response is needed. They can stay and act for more than thirty hours after consumption. Within this group is the most well-known anxiolytic, diazepam, along with others such as clonazepam.
3. Benzodiazepines of life / intermediate action
At an intermediate point between the two previous types , intermediate-lived benzodiazepines present an early (though not as immediate as short-acting) action for a relatively long period of time. They last between twelve and twenty-four hours. Alprazolam or lorazepam are some of the drugs in this group.
Some polyvalent drugs: indications
As indicated above, benzodiazepines have a large number of utilities. Some of the main problems in which these drugs are used are the following.
1. Disorders and episodes of anxiety
The application by which benzodiazepines are better known, having been the pharmacological treatment of choice for this type of problem for many years (nowadays they have been dethroned as the treatment of choice in multiple disorders). The type of benzodiazepine to be used in each type of disorder will depend on the characteristics of the disorder .
For example, if a rapid action is necessary in response to the emergence of an anxiety crisis, a short-lived benzodiazepine may be applied. In the presence of phobias with a high probability of appearance of the phobic stimulus (such as social phobia), medium or long-lived benzodiazepines such as alprazolam may be used. In disorders such as generalized anxiety disorder or panic disorder, clonazepam, a long-acting version, tends to be one of the most effective.
2. Insomnia
One of the properties of benzodiazepines, which sometimes results in an unwanted side effect, is its sedative potential . That is why they are useful when it comes to combating sleep problems.
Usually short-lived benzodiazepines such as triazolam are used when the difficulty is in the conciliation of sleep, but also some long-lived drugs such as fluracepam if the problem is in frequent awakenings or maintenance of sleep.
3. Mood disorders
Although both depression and bipolar disorder have other drugs that are prioritized over benzodiazepines, in some cases alprazolam or clonazepam are used since they allow the patient to be calmed down and their anguish diminished.
4. Seizures, spasms and motor agitation
Seizures of epileptic type appear when one or several groups of neurons become hypersensitive and they get excited very easily. As we have indicated previously, the main mechanism of action of benzodiazepines is the potentiation of GABA as an inhibitor of neuronal excitation, so that by potentiating nervous system depression, benzodiazepines are useful for controlling seizures.
Other motor-type symptoms may also be mitigated due to the effect as muscle relaxant and sedative.
5. Alcohol withdrawal syndrome
The abrupt cessation of alcohol consumption in subjects who have developed tolerance and dependence can produce withdrawal symptoms, among whose symptoms may be anxiety, coordination problems and agitation. Both at the hospital and outpatient level the use of benzodiazepines allows to control these symptoms , taking advantage of its sedative activity to reduce its intensity.
Risks and associated side effects
The use and administration of benzodiazepines present multiple advantages in a wide variety of disorders. However, its use is not free of risks, possessing different characteristics that cause it to have to regulate its dose and time of use.
1. Addiction
One of the main problems of this type of drugs is their addictive potential . Although in comparison with their predecessors, benzodiazepines are much less addictive, they are substances whose prolonged consumption can produce tolerance, dependence and even withdrawal syndromes.
In this aspect, the longer half-life in the organism, the less consumption will be necessary to maintain its effects, so that in general the long-lived benzodiazepines are the least addictive. It is necessary to correctly dose the amounts of benzodiazepine and the time that will be consumed in order to avoid this type of problem.
2. Abuse and overdose
An overdose of these substances usually causes an exacerbation of the effects , causing a deep depression of the nervous system. It usually has no fatal repercussions unless it is very elderly patients and / or with concomitant medical problems.
3. Withdrawal syndrome
With regard to withdrawal symptoms, symptoms often appear opposite to those produced by the drugs, a rebound effect that highlights the presence of insomnia, headaches, anxiety , cramps and even seizures. To avoid this, it is necessary to guide their withdrawal with extreme caution.
4. Sedation, decrease in concentration and performance
The sedation they produce is another problem that the use of benzodiazepines may involve . Although in many cases they are used precisely for the purpose of relaxing and facilitating sleep states, on occasions when you only want to reduce anxiety this effect can be detrimental because it decreases the motor skill, concentration and effectiveness of the subject in the accomplishment of tasks.
5. Memory problems
The consumption of benzodiazepines can cause, especially when starting to be administered, memory problems . The type of problems they cause is usually difficulty in acquiring and consolidating new information, as well as when remembering previous information.
6. Paradoxical reaction
In some cases and especially with the elderly, the use of benzodiazepines can cause an effect totally contrary to what is expected. In these cases by an increase of excitation of the nervous system, causing anguish and agitation both cognitively and motor .
Bibliographic references:
- Gómez, M. (2012). Psychobiology CEDE Preparation Manual PIR.12. CEDE: Madrid
- Salazar, M .; Peralta, C .; Pastor, J. (2011). Manual of Psychopharmacology. Madrid, Panamericana Medical Publishing House.
- Stevens, J.C. & Pollack, M.H. (2005). Benzodiazepines in clinical practice: consideration of their long-term use and alternative agents. J Clin Psychiatry; 66 (Suppl 2): 21-7.
