Benzodiazepines are prescribed for anxiety, but can cause more problems than they solve, argues Ben O’Mara
Adjunct Research Fellow, Swinburne University of Technology
Benzodiazepines (such as Valium and Xanax) are depressant prescription drugs used most commonly for anxiety. But evidence suggests dependence on these medications is increasing and side effects are common, so we increasingly need to look to alternative therapies.
Benzodiazepines cause sedation by slowing down nerve activity in the central nervous system and the messages travelling between the brain and the body. They became a popular prescription drug for treating anxiety in the US, and many Western countries, after their creation in 1955.
They’re prescribed for managing panic attacks, excessive worry or fear and other signs of stress and anxiety, and to help with sleep. Other conditions treated with benzodiazepines include alcohol withdrawal, relief from muscle stiffness and tightness caused by central nervous system pathology, and epilepsy.
Concern about risks and problems associated with benzodiazepines has increased in recent years. Around seven million scripts for benzodiazepines have been written each year in Australia since 2002. Benzodiazepines contributed to over half of all pharmaceutical drug overdose deaths in Victoria in 2015.
Evidence also suggests people are using benzodiazepines in the long term, for which they’re generally not recommended. And benzodiazepines were the pharmaceutical drug associated with the highest rates of ambulance attendances in Melbourne between 2000 and 2009.
What are the health risks?
Many risks and harms are associated with taking benzodiazepines. The risk of developing dependence on benzodiazepines is higher the longer the drug is used. Dependence can occur quickly and be difficult to treat. Withdrawal from benzodiazepines is challenging, too.
More research is needed to determine how many people are dependent on benzodiazepines in Australia. However, evidence of prescriptions written for benzodiazepines and ambulance attendances and overdose deaths associated with their use suggest more people need to know benzodiazepine use carries a risk of side effects, including dependency.
Other side effects include drowsiness, depression, headaches, tiredness but difficulty sleeping, irritability, personality changes, impaired thinking, paranoia, reduced sex drive and fertility problems.
While violence and aggression associated with benzodiazepines is rare, it can be of a high severity. Mixing benzodiazepines with alcohol and other drugs can lead to overdose and death. In the US, for instance, nearly 30% of fatal overdoses from opioids (such as codeine) involve benzodiazepines.
What treatments can be used instead?
The Royal Australian College of GPs recommends benzodiazepines be used only in the short term and after a comprehensive medical assessment. The assessment should include consideration of risks and benefits from using the drug, as well as alternative approaches. More work could be done during assessments by both patients and doctors to consider alternative approaches given recent evidence of harms associated with benzodiazepine use.
Non-drug-based alternatives are recommended as the first option for treating stress, anxiety and trouble sleeping. Having a well-balanced diet, exercising regularly and using cognitive behaviour therapy are proven to be more effective at treating stress, anxiety and difficulty sleeping than benzodiazepines. Non-drug-based alternatives don’t have the negative side effects of benzodiazepines, either.
For some people, use of benzodiazepines with supervision by a doctor could better meet their health needs. Some mental health conditions are severe and likely to be short-term.
Alternatives are best explored when a person reviews their need for help managing stress, anxiety or insomnia with a health professional. This discussion should also consider ways of handling the health condition in the long term.
Cognitive behaviour therapy
Cognitive behaviour therapy (CBT) is very effective for helping people to manage anxiety and stress and to sleep better. People use the therapy to develop practical skills for more helpful ways of thinking, feeling and behaving. Dealing differently with sources of stress and anxiety helps to reduce worry and improve wellbeing.
Cognitive behaviour therapy for insomnia (CBT-i) was developed specifically for helping people sleep. CBT-i uses stimulus control (stopping things like watching television and use of computers in bed), sleep restriction, relaxation techniques, cognitive therapy and sleep hygiene education.
In sleep hygiene education, people learn about habits and behaviours that help with better sleep. These include avoiding long naps in the day time, exercising regularly, having a regular wake-up time throughout the week and limiting alcohol consumption.
People can try CBT through sessions with a counsellor, group education and self-help materials. Normally, consultation with a GP is the first step for a referral to a counsellor or mental health specialist.
Online platforms are promising for reaching and supporting people with anxiety and depression who might not otherwise receive help.
Regular physical activity can help improve energy levels, sleep and moods.
Beyondblue forums offer suggestions for people experiencing anxiety and depression who may find it difficult to start exercising and stay motivated.
Magnesium relaxes muscles. When vitamin B and calcium are at low levels in the body, increasing magnesium can help to relax tight muscles and reduce the risk of anxiety and difficulty sleeping. Green vegetables, such as spinach and broccoli, and nuts, seeds and unprocessed cereals are foods rich in magnesium.
Consuming less nicotine, caffeine and stimulant drugs also helps reduce stress as these trigger the adrenal gland. (The adrenal gland releases hormones that can help the body react rapidly and move fast away from danger.)
A well-balanced diet with plenty of vegetables, fruits, legumes, lean proteins like fish, and whole grains is important for good mental health. Kimchi, sauerkraut, pickles and similar foods may also have a positive impact on mood and energy levels. These foods are fermented and therefore contain bacteria that can affect mood and energy levels.
Adjunct Research Fellow, Swinburne University of Technology, is affiliated with the Alcohol and Drug Foundation where he works as a science writer.
Dr Shauna Sherker from the Alcohol and Drug Foundation co-authored this article.