Benzodiazepines (psychotropic drugs): uses, effects and risks.

One of the main anxiolytics. We explain all its characteristics and side effects.

The history of psychopharmacology is full of curiosities and discoveries of various kinds.

Some of these discoveries being the product of arduous research and others derived from the observation of effects in the treatment of other disorders (such as tuberculosis or asthma), over time research has allowed the creation and consumption of substances that effectively help us to treat multiple psychological problems. This is the case of benzodiazepines, one of the best known types of psychotropic drugs for the treatment of anxiety..

Benzodiazepines: what are they?

Benzodiazepines are a group of psychotropic drugs with a mainly anxiolytic effect. whose discovery was a major 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 symptomatology with much lower risks and side effects quickly made them the most widely consumed type of psychotropic drug.

They are relaxing substances with a large number of clinical applications, despite the fact that, like all psychotropic drugs, they can be used in a variety of ways. like all psychotropic drugs, they present a series of risks and side effects to be taken into account to take into account at the time of application. When consumed, they are usually administered orally, although in cases where rapid action is required, intravenous administration (which is much faster) may be recommended.

The mechanism of action of benzodiazepines is based on their action as an indirect agonist of GABA or gamma-aminobutyric acid, a neurotransmitter that allows the correct management and not overloading of the brain by reducing and hindering the transmission of nerve impulses. Specifically, benzodiazepines cause GABA to exert a greater influence on the system, which, being an inhibitory neurotransmitter, produces a depressive effect on the nervous system. Taking into account that the limbic system has a large number of GABAergic receptors, the impact of benzodiazepines in the treatment of anxious processes and moods is very high. In this way, the level of activation of the organism decreases, producing a relief of the anxious symptomatology together with other effects such as muscular relaxation and sedation.

Types according to their half-life

There are different types of substances that are part of the benzodiazepine group.. Although they could be grouped in different ways, one of the most common classifications is the one that takes into account the half-life of the drug in the body, i.e. the time it remains active in the body.

Thus we can find three large groups of benzodiazepines, whose characteristics will make them more suitable for one or another situation.

1. Benzodiazepines with short life/shorter action

These are substances that remain in the body for a short time (less than twelve hours) and are not suitable for treating anxiety disorders that last for a long period of time. However, these are the benzodiazepines that act most quickly, but they areThey are a great help in combating the appearance of sudden anxious symptoms such as anxiety crises or problems that only require momentary relaxation, such as difficulties in falling asleep.

The main problem with this subgroup is that as the effects wear off quickly, if they are maintained, the consumption of the substance will be more habitual, which is likely to lead to dependence. In addition, they tend to cause a higher level of side effects. Some drugs in this group are triazolam or midazolam.

2. Long-acting/lifetime benzodiazepines

This type of benzodiazepine has the great advantage that it it remains in the organism for a long timeIt is helpful in anxiety disorders. On the other hand, the fact that they remain in the body for so long means that the effects of the doses can accumulate, which could have undesirable sedative effects.

In addition, they take time to take effect, so they are not indicated when an immediate response is needed. They can remain and act for more than thirty hours after consumption. Within this group is the best known anxiolytic, diazepam, along with others such as clonazepam.

3. Benzodiazepines of intermediate life/action

In an intermediate point between the two previous typesThe intermediate acting benzodiazepines have an early onset of action (although not as immediate as the short-acting ones) over a relatively long period of time. They last between twelve and twenty-four hours. Alprazolam or loracepam are some of the drugs in this group.

Multipurpose drugs: indications

As mentioned above, benzodiazepines have a large number of uses. Some of the main problems in which these drugs are used are the following.

1. Anxiety disorders and episodes

The application for which benzodiazepines are best known, having been the pharmacological treatment of choice for this type of problem for many years (today they have been dethroned as the treatment of choice in many disorders). The type of benzodiazepine to be used in each type of disorder will depend on the characteristics of the disorder..

For example, if rapid action is required in response to the emergence of an anxiety crisis, a short-lived benzodiazepine may be used. In the presence of phobias with a high probability of occurrence of the phobic stimulus (such as social phobia), medium- or long-lasting benzodiazepines such as alprazolam can 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 is sometimes an undesirable side effect, is their sedative potential, is their sedative potential. This is why they are useful in combating sleep problems.

Short-lived benzodiazepines such as triazolam are usually used when the difficulty is in the reconciliation of sleep, but also some long-lived drugs such as fluracepam if the problem is in frequent awakenings or sleep maintenance.

3. Mood disorders

Although in both depression and bipolar disorder there are other drugs that are prioritized over benzodiazepines, in some cases alprazolam or clonazepam are used because they allow the patient to calm down and reduce their anxiety.

4. Seizures, spasms and motor agitation

Epileptic seizures occur when one or more groups of neurons become hypersensitive. and are very easily excited. As we have indicated above, the main mechanism of action of benzodiazepines is the potentiation of GABA as an inhibitor of neuronal excitation, so that by potentiating the depression of the nervous system, benzodiazepines are useful for controlling convulsive crises.

Other motor symptoms may also be mitigated due to their Muscle relaxant and sedative effect.

5. Alcohol withdrawal syndrome

Abrupt cessation of alcohol consumption in subjects who have developed tolerance and dependence may produce withdrawal syndromes, whose symptoms may include anxiety, coordination problems and agitation. The use of benzodiazepines at both inpatient and outpatient levels allows these symptoms to be controlled, taking advantage of their activity to control the symptoms.by taking advantage of their sedative activity to reduce their intensity.

Risks and associated side effects

The use and administration of benzodiazepines have multiple advantages in a great variety of disorders. However, their use is not free of risks, as they have different characteristics that make it necessary to regulate their dosage and time of use.

1. Addiction

One of the main problems of this type of drugs is their addictive potential.. Although benzodiazepines are much less addictive than their predecessors, they are substances whose prolonged use can produce tolerance, dependence and even withdrawal syndromes.

In this regard, the longer the half-life in the body, the less consumption will be necessary to maintain their effects, so that in general, long-lasting benzodiazepines are the least addictive. It is necessary to correctly dose the amounts of benzodiazepine and the time to be consumed in order to avoid this type of problems.

2. Abuse and overdose

An overdose of these substances usually results in an exacerbation of the effectsThe effects of these substances are usually exacerbated by an overdose, leading to a profound depression of the nervous system. It does not usually have fatal repercussions unless the patients are very old and/or have concomitant medical problems.

3. Withdrawal syndrome

With regard to withdrawal syndromes, the opposite symptoms to those produced by the drugs often occur, a rebound effect with insomnia, headaches, anxiety, cramps and even convulsions.cramps and even convulsions. In order to avoid this, it is necessary to withdraw them with extreme caution.

4. Sedation, decreased concentration and performance

The sedation they produce is another of the problems that the use of benzodiazepines can cause.. Although in many cases they are used precisely with the purpose of relaxing and facilitating sleep states, in the occasions in which only anxiety is to be reduced, this effect can be detrimental because it decreases motor skills, concentration and the effectiveness of the subject in the performance of tasks.

5. Memory problems

The consumption of benzodiazepines can provoke, especially at the beginning of their administration, memory problems.. The type of problems they cause is usually difficulty in acquiring and consolidating new information, as well as in 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 due to an increase in the excitation of the nervous system, causing anguish and agitation at both cognitive and motor levels..

Bibliographical references:

• Gómez, M. (2012). Psicobiología. Manual CEDE de Preparación PIR.12. CEDE: Madrid

• Salazar, M.; Peralta, C.; Pastor, J. (2011). Manual de Psicofarmacología. Madrid, Editorial Médica Panamericana.

• 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.