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People’s Pharmacy: Anti-anxiety drugs pose risks

Americans are anxious. That is the inescapable conclusion of a recent analysis of anti-anxiety drug use (JAMA Psychiatry, February). The study shows that more than 10 percent of women over 60 are taking such medications over a long time. (In men, the proportion is about 6 percent.)

The drugs are known by the almost unpronounceable name “benzodiazepines,” or benzos. Their individual brands have been household names since the 1960s, when Valium was featured (anonymously) on the Rolling Stones’ popular song “Mother’s Little Helper.” Other familiar brands include Ativan, Klonopin and Xanax. Generic names are now becoming well-known: diazepam, lorazepam, clonazepam, alprazolam and a number of others.

The finding that so many people are taking a benzodiazepine, whether for anxiety or insomnia, makes us anxious.

Experts in the field of neuropharmacology caution, “Benzodiazepines are drugs that should be used at most for a few days or weeks in selected patients, carefully monitored, and stopped as soon as possible” (JAMA Psychiatry, February). This warning is especially relevant for older people.

Doctors should generally avoid prescribing benzodiazepines for their senior patients because these medicines can make a person unsteady on her feet and contribute to potentially catastrophic falls. They also can lead to confusion and interfere with reflexes needed for activities like driving a car.

The scariest risk, in our opinion, is that long-term benzodiazepine use may increase the possibility that a person will develop Alzheimer’s disease. A study published in the BMJ (online, Sept. 9, 2014) concluded: “This case-control study based on 8,980 individuals representative of elderly people living in the community in Quebec showed that the risk of Alzheimer’s disease was increased by 43-51 percent among those who had used benzodiazepines in the past.”

This is not the first study suggesting a connection between benzodiazepine use and dementia. A French study found a similar relationship (BMJ online, Sept. 27, 2012).

More recently, a systematic review of 10 studies found an increased risk of dementia associated with benzo use in nine of them (Expert Opinion on Drug Safety, May).

The problem with benzos is that they are hard to stop once you have been taking such medications for more than several weeks or months. One person wrote: “I would like to warn your readers about the dangers of long-term use of benzodiazepines (tranquilizers like Klonopin, Valium, Ativan and Xanax). A psychiatrist prescribed Klonopin for me for a year because of an anxiety disorder. I became addicted to it and began to have severe withdrawal symptoms between doses. I tried to taper off the drug but was unsuccessful.

“Finally, I checked into a psychiatric hospital for detox. The withdrawal from this drug was horrible, with extreme agitation, sensitivity to light and noise, sweating, cold chills, muscle twitching and fear of being left alone. Some days, all I could do was sit and rock and cry.

“It has taken me a year to recover. Some people are extremely sensitive to these drugs and should not take them longer than several weeks.”

Benzodiazepines can be valuable drugs as long as they are treated with respect. Both prescribers and patients should approach such medications cautiously and recognize that long-term use poses serious risks, especially for older people.