Sedative-Hypnotic / BDZ Dependence

Sedative-Hypnotic / BDZ Dependence

Sedative-Hypnotic / BDZ Dependence

Sedative dependence develops with long-term use of benzodiazepines (BDZ), sometimes called “benzos,” a class of psychoactive drugs that are in the family of medicines commonly known as minor tranquilizers.

BDZ act on receptors on the central nervous system (CNS) resulting in sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant (anti-seizure), and muscle relaxant properties. These effects make BDZ useful for the short-term treatment of medical and psychiatric conditions such as alcohol dependence, seizures, anxiety disorders, panic, agitation, muscle spasms, and insomnia.

Prevalence

In the 19702, BDZ were the most prescribed drugs in the world — the so-called “benzodiazepine bonanza.” Approximately twice as many women as men are prescribed BDZ. It is hypothesized that this is largely because men usually turn to alcohol to cope with struggles whereas women resort to taking prescription drugs such as BDZ.

Symptoms of dependence on sedative, hypnotic or anxiolytic drugs:

BDZ dependence is a maladaptive pattern of BDZ use leading to clinically significant impairment or distress that is manifested by three or more of the following, occurring at any time in the same 12-month period:

  • Tolerance to increasing amounts of the drug
  • Withdrawal symptoms:

    • Sleep disturbance
    • Irritability
    • Increased tension and anxiety
    • Panic attacks
    • Hand tremor
    • Shaking
    • Sweating
    • Difficulty with concentration
    • Confusion and cognitive difficulty
    • Memory problems
    • Dry retching and nausea
    • Weight loss
    • Palpitations
    • Headache
    • Muscular pain and stiffness
    • Hallucinations
    • Seizures
  • Repeated use of BDZ to relieve or avoid withdrawal symptoms
  • Taking the substance often in larger amounts or over a longer period than was intended
  • Having a persistent desire to cut down on control substance use with unsuccessful efforts

Therapeutic dose dependence is the largest category of people dependent on BDZ. These individuals typically do not escalate their doses to high levels or abuse their medication. Smaller groups include patients escalating their dosage to higher levels and people who use BDZ recreationally.

Risk factors of dependence on sedative, hypnotic or anxiolytic drugs:

A minority of people, such as the elderly, can have disturbing reactions to BDZ such as worsened agitation or panic.

When combined with other CNS depressants such as alcoholic drinks and opioids like codeine, morphine, and heroin, the potential for fatal overdose increases.

BDZ dependence can cause impairment of social, occupational, and academic functioning and can lead to interpersonal problems.

Treatment for dependence on Sedative, Hypnotic or Anxiolytic drugs:

Management of BDZ dependence includes medication and psychological interventions.

  • Medication – Flumazenil is the antidote of choice for BDZ toxicity. A gradual reduction is the usual clinical course in weaning people off BDZ; however, even with this approach, a large proportion of people often fail to stop taking this addictive drug.
  • Psychological interventions – cognitive behavioral therapy and group or one-on-one support.
  • Hospitalization – may be required if withdrawal symptoms are severe and/or in the case of overdose.

Symptoms of dependence on sedative, hypnotic or anxiolytic drugs:

BDZ dependence is a maladaptive pattern of BDZ use leading to clinically significant impairment or distress that is manifested by three or more of the following, occurring at any time in the same 12-month period:

  • Tolerance to increasing amounts of the drug
  • Withdrawal symptoms:

    • Sleep disturbance
    • Irritability
    • Increased tension and anxiety
    • Panic attacks
    • Hand tremor
    • Shaking
    • Sweating
    • Difficulty with concentration
    • Confusion and cognitive difficulty
    • Memory problems
    • Dry retching and nausea
    • Weight loss
    • Palpitations
    • Headache
    • Muscular pain and stiffness
    • Hallucinations
    • Seizures
  • Repeated use of BDZ to relieve or avoid withdrawal symptoms
  • Taking the substance often in larger amounts or over a longer period than was intended
  • Having a persistent desire to cut down on control substance use with unsuccessful efforts

Therapeutic dose dependence is the largest category of people dependent on BDZ. These individuals typically do not escalate their doses to high levels or abuse their medication. Smaller groups include patients escalating their dosage to higher levels and people who use BDZ recreationally.

Risk factors of dependence on sedative, hypnotic or anxiolytic drugs:

A minority of people, such as the elderly, can have disturbing reactions to BDZ such as worsened agitation or panic.

When combined with other CNS depressants such as alcoholic drinks and opioids like codeine, morphine, and heroin, the potential for fatal overdose increases.

BDZ dependence can cause impairment of social, occupational, and academic functioning and can lead to interpersonal problems.

Treatment for dependence on Sedative, Hypnotic or Anxiolytic drugs:

Management of BDZ dependence includes medication and psychological interventions.

  • Medication – Flumazenil is the antidote of choice for BDZ toxicity. A gradual reduction is the usual clinical course in weaning people off BDZ; however, even with this approach, a large proportion of people often fail to stop taking this addictive drug.
  • Psychological interventions – cognitive behavioral therapy and group or one-on-one support.
  • Hospitalization – may be required if withdrawal symptoms are severe and/or in the case of overdose.