According to the Anxiety and Depression Association of America (ADAA), anxiety is the most common mental illness in the United States, with an estimated 40 million adults age 18 and older currently living with an anxiety or panic disorder.
Similarly, the U.S. Centers for Disease Control and Prevention (CDC), reports that currently, about 50 million to 70 million adults in the U.S. struggle with insomnia and other sleep-related disorders.
Clearly, people with anxiety and insomnia make up a significant portion of the country’s population, which explains, at least in part, why 50 million prescriptions for benzodiazepines are written each year in the U.S. for the treatment of these disorders.
What Are Benzodiazepines?
Benzodiazepines are a class of central nervous system depressant drugs commonly used to treat anxiety and sleep disorders. But they may also be used to treat muscle spasms and seizures. Benzodiazepines are in the same category as barbiturates and alcohol because they work in similar ways.
While there are more than 2,000 different kinds of benzos, but the most widely known brands include Xanax, Klonopin, Ativan, Valium, Librium, and Halcion. Benzos are most commonly used to treat the symptoms of anxiety but are also frequently prescribed as a short-term treatment for insomnia and other sleep issues, with benzos like Halcion having been made specifically for that purpose.
In the 1960s and 1970s, barbiturates were the main class of drug used to treat both insomnia and anxiety, but many dangers were associated with their use, including extremely unpleasant side effects and a high risk of abuse, addiction, and overdose. By the 1980s, they were almost completely replaced by benzodiazepines.
However, while benzos may be effective as a short-term treatment for these disorders, they, too, have proven to be extremely addictive, with many dangerous side effects and a high potential for abuse and overdose.
While benzodiazepines were originally marketed as a safer alternative to barbiturates, many Americans grappling with anxiety and sleep disorders are now looking for a safer alternative to benzos.
Is Taking Benzodiazepines for Anxiety Effective?
Taking benzodiazepines for anxiety usually isn’t a first-line line treatment option for addiction. If you talk to your doctor about an anxiety problem and medication is your best option, they will likely start with an SSRI (selective serotonin reuptake inhibitor). SSRIs are antidepressants that increase serotonin levels in the brain, which can elevate your mood. While they are primarily used for depressive disorders, they can help ease anxiety by improving your mood, which can make you feel less overwhelmed by challenges in your life. SNRIs are similar, and they may also be used before benzodiazepines for anxiety.
Benzodiazepines may be used to treat severe anxiety and panic attacks that don’t respond to other medications. Benzodiazepines have proven to be effective in treating anxiety disorders. Fast-acting benzodiazepines may be used to treat panic attacks, causing quick relief. They may also be useful in cases where anxiety causes sleep problems like insomnia since they have hypnotic effects.
While benzodiazepines are effective, they aren’t usually the primary option because they have significant side effects like drowsiness and the potential for chemical dependence.
How Do Benzodiazepines Work?
Benzodiazepines work by slowing down activity in your brain to cause sedation, hypnosis, and relaxation. Like other depressants, benzos work with a chemical in your brain called gamma-Aminobutyric acid (GABA). GABA is an important chemical that occurs in your brain and helps to facilitate sleep, rest, and relaxation. It’s also important in calming you down when you are anxious or hyperalert, which is why it’s an important chemical in anxiety relief.
Benzodiazepines work by binding to GABA receptors at a binding site that is separate from GABA itself. Once bound, benzos will increase the potency of GABA. GABA normally works by opening a channel to a negative charge that slows down nervous system activity. Benzos work by keeping that channel open for longer, which enhances the depressant effects of the neurotransmitter.
Why Are Benzodiazepines Dangerous?
While benzodiazepines can be used to treat anxiety and other disorders effectively, there are several reasons someone may want to seek out other options. Benzodiazepines have an abuse and addiction liability. Using them consistently for long periods can cause you to develop a chemical dependence on the drug. There are also several side effects that some people may want to avoid. Here are some possible reasons you may want to consider alternatives to Ativan and other benzodiazepines:
- You are taking conflicting medications. Benzodiazepines shouldn’t be taken alongside certain drugs, including opioids and alcohol. Medications for certain skin irritations like ketoconazole or itraconazole should also not be mixed with benzos.
- You have certain conditions. Certain medical issues are contraindications of benzodiazepines, including asthma, sleep apnea, and other issues.
- You need to be alert. If you are driving or if you operate heavy machinery, depressants like benzodiazepines could be dangerous. Some avoid benzos just to avoid feelings of sedation throughout the day.
If you’d like to avoid prescription medications altogether, there may be therapeutic alternatives that don’t require you to take drugs. However, it’s important to consult with your doctor to find the treatment options that work best for your needs.
Why Are Benzodiazepines Dangerous?
While benzos can be very useful drugs when taken strictly as directed, they are dangerous to the point that even misuse can have severe consequences, including a rapid escalation to addiction.
Benzos are not meant to be taken long-term. They are usually prescribed either as a low dose to be taken as needed in the case of a panic attack or for a period of about seven-to-10 days if treating insomnia. Users will quickly build up a tolerance for the medications if they are taken regularly for more than that time.
When someone takes a benzo for longer than prescribed, even if it’s still the same dose, they can become tolerant to the point of dependence in less than a month. If they are abusing it in large amounts, it can happen much faster, sometimes in under two weeks.
Aside from the high risk of addiction, many of the common side effects associated with benzos can range from unpleasant to actively dangerous, including:
- Major changes in appetite
- New or worsening depression or suicidal thoughts
- Increased aggression
- Memory problems
- Gastrointestinal problems
- Frequent headaches
- Impaired coordination
- “Hangover” drowsiness
Hangover drowsiness, which are strong feelings of sedation that can continue into the next day if a benzo has been taken the night before, can be extremely dangerous and often leads to car accidents or other risky situations that require alertness.
Other dangers of benzodiazepines include something called the “rebound effect,” when someone has grown tolerant to the point of paradoxical reactions, namely, their symptoms of anxiety or insomnia return, usually with much more intensity. This can manifest as hyperactivity, vivid nightmares, extreme aggression and hostility, panic attacks, paranoia, and sleep deprivation.
Finally, benzodiazepines have some of the most life-threatening withdrawal symptoms someone can experience and include hallucinations, delirium, disassociation, psychosis, and grand mal seizures. Someone who has been abusing large amounts of benzodiazepines in a fairly short period is also likely to experience benzodiazepine withdrawal syndrome, which both worsens already-present symptoms and can also cause atypical ones as well.
What Are Safer Alternatives for Treating Anxiety?
The main alternative to treating anxiety that is considered safer than benzodiazepines is a class of medications called selective serotonin reuptake inhibitors (SSRIs). These are primarily prescribed as antidepressants, but they can also be used to help with anxiety disorders.
The main benefit of using antidepressants is that they are not addictive and, therefore, have an extremely low abuse potential. However, unlike benzos, they are not fast-acting and can take as long as six weeks to become effective, and in the meantime, they can actually make someone’s anxiety worse before starting to improve it.
Antihistamines, while typically used as over-the-counter allergy medications, are also often recommended as a safer treatment for anxiety. Like SSRIs, they are not considered to have addictive qualities and, like benzodiazepines, they work very quickly, typically within 30 minutes. The most significant disadvantage of treating anxiety with antihistamines is that their main side effect is sedation, which can lead to the same unsafe conditions as the drowsiness caused by benzodiazepines.
Many medical professionals also recommend a non-medication approach to safely treating anxiety through the use of cognitive behavioral therapy to help someone address the potential underlying issues behind their anxiety.
Other holistic treatments that have been found to help with the symptoms of anxiety include yoga, regular exercise, practicing mindfulness, and addressing environmental factors that could be contributing to a person’s anxiety, including a lack of adequate sleep or proper nutrition.
What Are Safer Alternatives for Treating Insomnia?
When it comes to treating insomnia, nonbenzodiazepine sedatives, also known as “Z-drugs,” like Lunesta, Ambien, and Sonata are used by millions of people in the U.S. and have been aggressively marketed as both safer and more effective than benzodiazepines.
However, while benzodiazepine use does carry a greater risk than using Lunesta, they share many dangers. Non-benzo sedatives have both abuse and addiction potential and are also not meant for long-term use for the same reasons as benzodiazepines.
In fact, although overwhelmingly perceived as the safer and more efficient form of sleep medication by both doctors and patients, sedatives like Ambien and Lunesta are actually nearly just as dangerous as benzos while also often extremely ineffective at inducing sleep. Recent medical research has even compared Z-drugs to having a placebo effect more than any actual benefits.
Even with antihistamines, there is still the same danger of oversedation, and, much like with anxiety, the safest alternatives for treating insomnia do not involve medication. Someone can instead try actively adopting good “sleep hygiene” and identifying potential causative factors contributing to insomnia, such as dietary issues and possible environmental factors.
People who are looking for safe alternatives to treating insomnia can also likewise benefit from regular exercise, yoga, practicing meditation and mindfulness, and use natural supplements like melatonin or valerian.