Why Skittishness Over Prescribing Benzodiazepines Can Harm Patients
Benzodiazepines are widely misunderstood. Even some practitioners and care providers are experiencing confusion in the midst of what can be described as an anti-benzodiazepine movement that's spurred by media, social media, and scary-on-the-surface FDA black box warnings. Like all FDA-approved prescription medications, "benzo tablets" have their place. For care providers, getting rid of the fear-induced stigma can be critical for ensuring that patients who stand to benefit from these medications can get them. Let's talk about what people are getting wrong about benzodiazepines.
What We're Getting Wrong About Benzodiazepines
Some experts view benzodiazepines and medications acting on benzodiazepine receptors as having limited benefit with significant risks. As we'll discuss in a moment, risks must be taken into account when prescribing benzos. However, evidence is also clear that benzodiazepines can serve as critical protocols for people with acute situational anxiety, chronic anxiety disorders, insomnia, alcohol withdrawal syndrome, and catatonia. Additionally, there's evidence that benzos can be useful adjunct treatments in cases of mania and depression in medically ill patients. According to a 2022 paper highlighting why benzodiazepines remain important therapeutic options in psychiatric practice, care providers need to know that:
While tolerance potentially develops to sedation and psychomotor impairment, tolerance does not develop to a benzodiazepine's anxiolytic effect.
Claims that benzodiazepines increase the risk of dementia are not supported by recent data. This is a common assertion based on the fact that benzos can impair cognitive function in some patients.
Contrary to popular opinion, benzodiazepines are not actually frequently misused. They also aren't getaways to misuse of other substances in patients without substance use disorders.
Benzodiazepine overdoses are not typically lethal unless alcohol, opioids, or other substances are involved.
Appropriate Applications for Benzos
Benzodiazepines are considered by the World Health Organization (WHO) to be essential medicines. Some of the advantages of using benzos in acute settings include their fast-starting action, efficiency, minor number of collateral effects, and minimum acute toxicity. Here's a look at some specific circumstances where benzos have proven to be essential life-saving medications.
Anxiety and Panic Disorders
Anxiety disorders are serious, destructive illnesses that require serious and appropriately aggressive treatment. It's also important to remember that the mechanisms driving anxiety are biological in nature. This fact makes benzodiazepines incredibly useful for patients dealing with acute anxiety and panic disorders.
Current research shows that evidence-based pharmacotherapies and benzodiazepine agonists that are approved by the FDA for treating panic may be helpful in the treatment of treatment-resistant panic disorder that ultimately increases a patient's risk for suicidal ideation. According to this same body of research, evidence shows that benzodiazepines may have a long-term tolerability edge over SSRIs, SNRIs, and TCAs because they aren't known to cause weight gain or sexual dysfunction. Finally, the research concludes that concerns that benzodiazepines disrupt the effectiveness of evidence-based psychotherapies for panic has not been confirmed in recent anxiety clinical trials.
Catatonia
Benzodiazepines should be considered first-in-line treatments for catatonia and other psychiatric disorders of the same extreme caliber. In fact, data shows that benzodiazepines dramatically reduce morbidity associated with catatonia. Lorazepam should specifically be viewed as the first-line treatment for catatonia.
Acute Psychotic States
Generally, benzodiazepines are used in emergency and in-patient psychiatric settings to treat acute agitation associated with manic and psychotic states. For patients who will benefit, benzodiazepines can also be prescribed on an outpatient basis for severe anxiety and panic that may not be responding to behavioral therapy and other protocols. In these cases, benzodiazepines must be used with caution and monitored carefully.
Profound Sleep Issues and Insomnia
Benzodiazepines may be beneficial for treating severe insomnia and sleep problems associated with psychiatric conditions or mania. In fact, research shows that benzos may halt the progression of insomnia into mania in bipolar 1 patients. Care providers who have treated BP1 know about the extreme sleep disturbances that these patients experience. Studies have found that 69% to 99% of bipolar individuals report a lessened need for sleep during a manic episode. Additionally, insomnia disorder frequently manifests within the context of bipolar depression. At the same time, insomnia is linked with a greater depression severity in bipolar disorder.
Being Clear on the Risks of Benzos
Overdose is a risk with benzodiazepines. The National Institute on Drug Abuse shares that nearly 14% of overdose deaths involving opioids also involved benzodiazepines. People who take benzos are also at risk for mood shifts, tremors, heightened anxiety, and difficulty tolerating intense withdrawal symptoms. Clinician skill plays a vital role in preventing benzodiazepine misuse and abuse.
Tapering strategies are suggested for avoiding sudden withdrawal that can potentially be fatal. Recommend tapering strategies include using the same medication for tapering, switching to a longer-acting equivalent, or using adjunctive medications to help mitigate potential withdrawal symptoms. Doses can initially be reduced by 25% to 30% before being tapered down another 5% to 10% daily, weekly, or monthly based on how the patient is tolerating symptoms. Tapering schedules should be individualized based on lifestyle, temperament, environmental stressors, reasons why benzodiazepines were prescribed, and the availability of personal and clinical support. For complex cases, stabilizing at a 50% reduction for several months could be necessary.
Do you prescribe benzodiazepines? At Priceless Copy, we can educate and inform your patients on the benefits and risks of these medications. We offer a complete range of mental health marketing services from article writing to social media marketing.
