Tuesday, June 24, 2008

Benzodiazepines

The family of drugs called benzodiazepines is prescribed so often that pharmacists report that it is the third most prescribed type of medication. The first ans second type are painkillers and heart medications.
But it is only one of the types of medications used in psychiatry. It is usually prescribed to decrease anxiety and/or help with sleeplessness. Before we go any further, let us identify them with their chemical and trade names:

Alprazolam (Zanax)
Bromazepam (Lectopam)
Chlordiazepoxide (Librium, Apo-chlordiazepoxide, Melidium, Novopoxide, Solium)
Diazepam (Valium, Apo-diazepam, E-Pam, Novodipam, Vivol)
Flurazepam (Dalmane, Apo-flurazepam, Novoflumam, somnol, Som-pam)
Lorazepam (Ativan, Apo-lorazepam, Novolorazem)
Oxazepam (Serax, Zapex, Apo-oxazepam, Novoxapam, Ox-pam)
Temazepam (Restoril)
Triazolam (Halcion)

So we may question which sudden plague has hit us for anxiety and insomnia to be so common?
Benzodiazepines have their place in modern pharmacies. Before their discovery, doctors were sometimes using barbiturates but they had good reasons to be reticent to prescribe them. Indeed, barbiturates are more toxic than benzodiazepines and the brain soon tolerates them. Tolerance is a gradual adaptation of the brain chemistry so that over time the effect of a constant regular dose decreases. For a continued result, the dosage would have to increase gradually but this practice is dangerous.
Benzodiazepines are minor tranquilizers which decrease agitation and nervousness, slow down mental activity, increase drowsiness and relax muscles. But the sleep they provide is not as good as normal sleep because it contains less “rapid eye movement” sleep.
It is important to find the reason causing anxiety or insomnia and aim to solve the problem that way. As for insomnia, healthy sleep habits like going to bed at a regular time should be observed.
Patients taking benzodiazepines should avoid alcohol . Indeed, alcohol increases the effect of benzodiazepines and benzodiazepines increase the effect of alcohol. The patient may have to avoid driving or operating machinery depending on the medication and its effect on him.
Nowadays, we question the justification for prescribing benzodiazepines to the aged because they can be injured when they fall at night.
But some real problems do occur for which a benzodiazepine is useful. Chronic anxiety can be paralysing. A panic attack can be very embarrassing for the patient and bewildering to witnesses. Sometimes, other therapies are usefull but require time. Benzodiazepines do exist, they are effective and can, for example, be used temporarily while the root of the problem is being addressed.
Benzodiazepines are safe on the liver and the kidney. A dependence may occur when the patient gets used to the mental comfort brought by the medication. Caution is therefore in order and when the medication is decreased it should be done gradually.
When Valium became available in the early 60s, it was prescribed too often. Doctors were relieved to have a safe substance which was effective in decreasing anxiety. Patients were coming back for more and were spreading the word that they felt better thanks to pills. Drug companies had found a profitable product with a soaring demand. Then, in medical conventions, doctors wondered whether the trend would have serious repercussions. There was a need to be far more circumspect before reaching for the prescription pad. Benzodiazepines are not a solution to boredom, irresponsibility, fear, insomnia and anxiety. It also came to light that benzodiazepines have a potential for abuse so measures must be taken by doctors, pharmacists and nurses to limit misuse.
Today, the benzodiazepine family is larger. It continues to help thousands of people every day. But it is desirable that patients be informed on the effects of their medications and wish to return to reality as soon as possible. The pleasant benzodiazepines are only a tool to get back to real life and its challenges.

1 comment:

Sylvestre said...

For more information about the history of benzodiazepines, I recommend the book "the age of anxiety" by Andrea Tone. The author will be present on Thursday Feb 12, 2009 at Paragraph bookstore, 2220 McGill College at 6:30 PM to promote her new book.