Short and Long-Term Effects of Benzodiazepines
Benzodiazepines, commonly referred to as “benzos,” are a class of prescription drugs that function as central nervous system (CNS) depressants.1 Medical professionals prescribe benzodiazepines to treat a range of conditions, most commonly for anxiety disorders and panic disorders, but also for seizure disorders, insomnia and other sleep disorders, muscle spasms, and alcohol withdrawal.1
Benzodiazepines are widely prescribed in the United States. Valium (diazepam), Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and Restoril (temazepam) are the most prescribed and illicitly used benzodiazepines.2 Benzodiazepines are generally safe when taken as prescribed by a doctor, but even at therapeutic doses, they can result in tolerance and dependence, where withdrawal symptoms appear after a person stops taking them or significantly. According to the 2020 National Survey on Drug Use and Health, an estimated 4.8 million people in the U.S. aged 12 years or older misused benzodiazepines in the past year.3
This page details how benzodiazepines work, the short- and long-term side effects of benzodiazepines, and how to get help if you or a loved one might be struggling with benzodiazepine misuse or addiction.
What Do Benzodiazepines Do to the Brain?
Benzodiazepines work by stimulating receptors that act as binding sites for the body’s primary inhibitory neurotransmitter, gamma-aminobutyric acid (GABA).2 Taking benzodiazepines facilitates the binding of GABA at the receptors located throughout the CNS, leading to an increase in inhibitory tone.4 In other words, benzodiazepines can calm an otherwise overexcited CNS. When inhibitory tone is increased, CNS excitatory tone is decreased, leading to sedation and feelings of relaxation.2, 5
The Drug Enforcement Administration (DEA) classifies benzodiazepines as a Schedule IV substance, meaning that they have a lower potential for misuse than Schedule I-III substances.2, 6 However, benzodiazepine misuse is relatively common and data suggests that a person with any prescription for anxiety medication has 1.9 times greater odds of past-year benzodiazepine misuse and 2.6 times greater odds of a substance use disorder involving sedatives.7
Benzodiazepine tolerance and dependence can occur even when used as prescribed. Tolerance is a naturally occurring neuroadaptation where the brain is attempting to compensate for the constant presence of the drug which results in a person requiring more of a drug to experience the desired effects. With benzodiazepines, tolerance is a main driving factor of dependence.1 Abruptly stopping or trying to cut back on benzodiazepine use after a person develops a physiological dependence results in unpleasant and potentially harmful, even life-threatening, withdrawal symptoms.1, 4 Seizure is a particular concern associated with benzodiazepine withdrawal.1 Other withdrawal symptoms can include anxiety, agitation, hallucinations, insomnia, increased heart rate and blood pressure, shakiness, severe cravings, and more.8
Side Effects of Benzodiazepines
Benzodiazepines are generally safe when taken as prescribed by a medical professional for short periods, typically no longer than a few weeks.1, 4 All benzodiazepines have similar effects on the brain and body.4 The side effects of benzodiazepines can vary based on factors such as dose, potency, half-life, and how long the drug is used.1, 4
Speaking to your doctor and thoroughly reading the drug label provided with your medication can provide a complete list of potential benzodiazepine side effects that can occur with the specific drug you are taking.
Some common adverse effects of benzodiazepines include:9
- Issues with memory and movement
- Poor concentration
- Slurred speech
- Reduced blood pressure
- Slowed breathing
Elderly people who take benzodiazepines are at increased risk of experiencing psychomotor impairment, which can lead to falls that may cause serious causing femur or hip injuries. The elderly are also more likely to experience motor vehicle accidents as well as experience cognitive issues and memory problems resulting from benzodiazepine use.1, 4
Combining benzodiazepines with alcohol, opioids, or other benzodiazepines or sedatives can intensify the sedative effects and can result in life-threatening overdose, slowing or stopping a person’s breathing and heart rate.9
Rebound effect is another aspect of withdrawal. As with other withdrawal symptoms, rebound effect occurs when dosage is reduced too rapidly or stopped completely. Rebound involves the recurrence of symptoms of the disorder, and the symptoms are more severe than they were prior to treatment. It may cause serious and even fatal adverse effects, but that is only in a small subset of individuals. With benzodiazepines, common examples of rebound are anxiety and insomnia rebound. Fortunately, rebound symptoms are temporary and reversible.15
Paradoxical Effects of Benzodiazepines
Usually when people take benzodiazepines, they experience a calming effect from the drug. However, there are additional effects individuals may experience with the use of benzodiazepines called paradoxical effects.
Though relatively uncommon, paradoxical effects may include irritability, increased excitement, hostility, aggression, and impulsivity.4 Very rarely, paradoxical disinhibition may result in attacks of violence or rage. These adverse effects of benzodiazepines may be the result of a decrease in inhibition of behavioral tendencies that are usually suppressed by social restraints (similar to what can occur with alcohol).4
Long-Term Effects of Benzos
Benzodiazepines are widely prescribed, and their effects are typically produced almost immediately, thus making them likely to be prescribed for short-term, intermittent use.4 People who use benzodiazepines may develop tolerance, although how quickly and to what extent depends on the specific drug and the length of time it was used. Tolerance to the hypnotic effects of benzodiazepines may happen quickly while tolerance to the anxiolytic effect tends to develop more slowly. However, benzos tend to lose their efficacy after 4-6 months of regular use.4
With the potential for the development of tolerance, and the loss of effectiveness of the drug, long-term use can be problematic for those who are using benzos—even more so when the drug is being misused. Long-term use can impact people differently, with some experiencing more severe consequences than others
Some potential long-term sides effects of benzodiazepine abuse and use may include:10,11
- Cognitive impairment
- Cognitive decline
- Dementia in the elderly
Long-term side effects of benzodiazepine abuse can vary based on the drug that is being used and the length of time it has been used.
Mental health may be affected by long-term use of benzodiazepines. Because benzos are often prescribed for anxiety and depression, those mental health disorders may be exacerbated by the reduction or stopping of use, as seen through the rebound effect. However, mental health disorders often occur at the same time as substance use disorders, and it can be difficult to identify which occurred first, and whether one caused the other. Instead, co-occurring orders are common and should both be treated simultaneously to give individuals the best chance at recovery.
Additional effects from long-term benzo use may include indirect consequences outside of health, including negative impact on finances, relationships, employment, and other responsibilities and commitments.
If you or someone you care about are struggling with benzodiazepine use, help is available. Benzodiazepine addiction treatment can help people stop using benzodiazepines and other substances to regain control of their life.
If you are ready to quit using benzodiazepines, you may benefit from medical detox, as withdrawal symptoms can be unpleasant and in some cases, life-threatening.8, 13 Medical detox can help you withdraw from substances as safely and as comfortably as possible and facilitate your transition into ongoing treatment.14
While there is no one-size-fits-all approach, treatment may include a combination of behavioral counseling, medication, co-occurring disorder treatment, follow-up care, and more.13 Should your benzodiazepine misuse occur in conjunction with the use of other substances, treatment will address multiple addictions.13
Treatment may be available at a rehab center near you or out of state. You can learn more about treatment options by contacting your primary care physician (PHP) or a mental health practitioner. You can also contact American Addiction Centers (AAC) when you call . AAC is a leading provider of evidence-based treatment and can answer your questions about addiction, verify your insurance, and more.