Benzodiazepines (psychopharmaceutical): Uses, Effects And Risks
The history of psychopharmacology is full of curiosities and discoveries of various kinds.
Some of these discoveries being the product of arduous research and others derived from the observation of effects in the treatment of other disorders (such as tuberculosis or asthma), over time research has allowed the creation and consumption of substances that help us in a way effective in treating multiple psychological problems. This is the case of benzodiazepines, one of the best-known types of psychotropic drugs in the treatment of anxiety
Benzodiazepines are a group of psychotropic drugs with mainly anxiolytic effects whose discovery represented a great revolution in the treatment of anxiety. Born at a time when barbiturates were unquestionably the treatment of choice for anxiety-type problems despite the high risk of overdose and dependence, their high level of success in reducing symptomatology with much lower risks and side effects made them quickly in the most consumed type of psychotropic drug.
These are relaxing substances with a large number of clinical applications, although Like any psychoactive drug, it presents a series of risks and side effects to take into account when applying. When consumed, they are usually administered orally, although in cases where rapid action is necessary, intravenous administration may be recommended (which is much faster).
The mechanism of action of benzodiazepines is based on their performance as indirect agonists of GABA or gamma-aminobutyric acid, a neurotransmitter that allows correct management and does not overload the brain by reducing and hindering the transmission of nervous impulses. Specifically, benzodiazepines cause GABA to exert a greater influence on the system, which, being an inhibitory neurotransmitter, produces a depressant effect on the nervous system. Taking into account that there are a large number of GABAergic receptors in the limbic system, the impact of benzodiazepines when treating anxiety processes and mood states is very high. In this way, the level of activation of the body decreases, producing relief from anxious symptoms along with other effects such as muscle relaxation and sedation.
There are different types of substances that are part of the benzodiazepine group Although they could be grouped in different ways, one of the most common classifications is the one that takes into account the half-life of the drug in the body, that is, the time it remains active within the body.
In this way we can find three large groups of benzodiazepines, whose characteristics will make them more suitable for one situation or another.
1. Short-acting/benzodiazepines
These are substances that remain for a short time (less than twelve hours) in the body, and are not suitable for treating long-term anxiety disorders. However, These are the benzodiazepines that act the fastest which is a great help to combat the appearance of sudden anxious symptoms such as anxiety attacks or problems that only require momentary relaxation, such as difficulties falling asleep.
The main problem with this subgroup is that as the effects wear off quickly, if you want to maintain them, the consumption of the substance will be more common, which is likely to end up generating dependence. In addition, they tend to cause a higher level of side effects. Some drugs in this group are triazolam or midazolam.
2. Long-acting benzodiazepines
This type of benzodiazepine has the great advantage that remains in the body for a long time, being helpful in anxiety disorders. On the other hand, the fact that they remain so long in the body means that the effects of the doses can accumulate, which could have undesirable sedative effects.
In addition, they take a while to take effect, so they are not indicated when an immediate response is needed. They can remain and act for more than thirty hours after consumption. Within this group is the best-known anxiolytic, diazepam, along with others such as clonazepam.
At an intermediate point between the two previous types, intermediate-life benzodiazepines present an early action (although not as immediate as short-acting ones) for a relatively long period of time. They last between twelve and twenty-four hours. Alprazolam or lorazepam are some of the drugs in this group.
Some polyvalent drugs: indications
As we have indicated previously, benzodiazepines have a large number of uses. Some of the main problems in which these drugs are used are the following.
The application for which benzodiazepines are best known, having been the pharmacological treatment of choice for this type of problem for many years (today they have been dethroned as the treatment of choice in multiple disorders). The type of benzodiazepine to use in each type of disorder will depend on its characteristics
For example, if rapid action is necessary in response to the emergence of an anxiety crisis, a short-lived benzodiazepine can be applied. In the presence of phobias with a high probability of the appearance of the phobic stimulus (such as social phobia), benzodiazepines with a medium or long life such as alprazolam can be used. In disorders such as generalized anxiety disorder or panic disorder, clonazepam, a long-acting version, tends to be one of the most effective.
2. Insomnia
One of the properties of benzodiazepines, which sometimes results in an unwanted side effect, is its sedative potential That is why they are useful when it comes to combating sleep problems.
Short-lived benzodiazepines such as triazolam are usually used when the difficulty is in falling asleep, but also some long-lived drugs such as fluracepam if the problem is frequent awakenings or maintaining sleep.
3. Mood disorders
Although in both depression and bipolar disorder there are other drugs that are prioritized over benzodiazepines, in some cases alprazolam or clonazepam are used since they allow the patient to calm down and reduce their distress.
4. Seizures, spasms and motor agitation
Epileptic-type seizures appear when one or more groups of neurons become hypersensitive and they get excited very easily. As we have previously indicated, the main mechanism of action of benzodiazepines is the potentiation of GABA as an inhibitor of neuronal excitation, so that by potentiating depression of the nervous system, benzodiazepines are useful for controlling seizures.
Other motor symptoms may also be mitigated due to the effect as a muscle relaxant and sedative.
5. Alcohol withdrawal syndrome
Abrupt cessation of alcohol consumption in subjects who have developed tolerance and dependence can produce withdrawal syndromes, whose symptoms may include anxiety, coordination problems and agitation. Both at the hospital and outpatient level, the use of benzodiazepines allows these symptoms to be controlled taking advantage of its sedative activity to reduce its intensity.
The use and administration of benzodiazepines have multiple advantages in a wide variety of disorders. However, its use is not without risks, having different characteristics that mean that its dose and time of use must be regulated.
1. Addiction
One of the main problems with this type of drugs is their addictive potential Although benzodiazepines are much less addictive compared to their predecessors, they are substances whose prolonged consumption can produce tolerance, dependence and even withdrawal syndromes.
In this regard, the longer the half-life in the body, the less consumption will be necessary to maintain its effects, so in general long-life benzodiazepines are the least addictive. It is necessary to correctly dose the amounts of benzodiazepine and the time to be consumed in order to avoid this type of problems.
2. Abuse and overdose
An overdose of these substances usually produces an exacerbation of the effects, causing deep depression of the nervous system. It does not usually have fatal repercussions unless the patients are very elderly and/or with concomitant medical problems.
3. Withdrawal syndrome
When it comes to withdrawal syndromes, it is common for symptoms opposite to those produced by the drugs to appear, a rebound effect that highlights the presence of insomnia, headaches, anxiety, cramps and even seizures. To avoid this, it is necessary to schedule its withdrawal with extreme caution.
4. Sedation, decreased concentration and performance
The sedation they produce is another of the problems that the use of benzodiazepines can cause Although in many cases they are used precisely for the purpose of relaxing and facilitating sleep states, on occasions when you only want to reduce anxiety, this effect can be harmful because it reduces the motor skill, concentration and effectiveness of the subject. in carrying out tasks.
5. Memory problems
The consumption of benzodiazepines can cause memory problems, especially when starting to be administered The type of problems they cause is usually difficulty acquiring and consolidating new information, as well as when remembering previous information.
6. Paradoxical reaction
In some cases and especially with the elderly, the use of benzodiazepines can cause an effect completely opposite to what is expected. In these cases due to an increase in the excitation of the nervous system, causing distress and agitation at both a cognitive and motor level
