Brain & Drugs
  • Benzodiazepines

    The prescription drug manipulation of the modern psyche began in earnest in the 1950's with the growing use of "speed' for weight loss among housewives, barbiturate sleeping pills, and the introduction of Librium, the first modern tranquilizer. Housewives, actors and singers in the 50's and 60's were introduced to uppers and downers as tools of coping with the demands and disappointments of modern life. Most of the action centered around four drug classes: amphetamines, barbiturates, librium and alcohol. Citizens and celebrities died with alarming regularity from mixtures and overdoses of these drugs. even if you survived with these pills, the long-term results were not good. Problems of addiction, brain dysfunction (often called "nervous breakdowns" and "mental illness") and accidents became increasingly prevalent. The combination of alcoholic beverages, “uppers,” “downers” and sleeping pills produced chemical chaos in the brains of users, often with tragic results.

    Librium was replaced by a new class of drugs, the benzodiazepines. Valium was the best selling member of this class for many years until problems associated with its use became well known. Other Valium-like drugs were developed as tranquilizers and sleeping pills, to large extent, replacing barbiturates that were fatal in overdose. A common prescription for twenty capsules of secobarbital could kill. Valium as a sedative-tranquilizer has been replaced by related drugs with new names but the same set of problems for the brain: some examples are Ativan, Xanax, Serax, Lorazepam and several sleeping pills such as Dalmane and Halcion. A more recent class of sleeping pills has been promoted as safer and more effective than old pills, but these claims are not supported by the evidence.

    Benzodiazepines are popular tranquilizer drugs that have important negative effects, cause death by overdose and create a well-concealed addicted population. Lembke et al reviewed the benzodiazepines problem: ”There has been little effort to address inappropriate prescribing of benzodiazepines — controlled substances such as alprazolam, clonazepam, diazepam, and lorazepam.

    The Food and Drug Administration (FDA) has approved benzodiazepines for a diverse set of clinical indications, including anxiety, insomnia, seizures, and acute alcohol withdrawal. These drugs are also prescribed off-label for many other conditions, such as restless legs syndrome and depression. Between 1996 and 2013 in the USA, the number of adults who filled a benzodiazepine prescription increased by 67%, from 8.1 million to 13.5 million, and the quantity of benzodiazepines more than tripled. Despite the increased risk of overdose in patients taking both benzodiazepines and opioids, rates of coprescribing increased from 9% in 2001 to 17% in 2013.3 Use of so-called z-drugs such as zolpidem and eszopiclone alone or in combination with opioids is also associated with increased mortality.

    Benzodiazepines have proven utility when they are used intermittently and for less than 1 month at a time. But when they are used daily and for extended periods, the benefits of benzodiazepines diminish and the risks associated with their use increase. Many prescribers don’t realize that benzodiazepines can be addictive and when taken daily can worsen anxiety, contribute to persistent insomnia, and cause death. Other risks associated with benzodiazepines include cognitive decline, accidental injuries and falls, and increased rates of hospital admission and emergency department visits.” (Anna Lembke, Jennifer Papac, Keith Humphreys. Our Other Prescription Drug Problem. NEJM 2018, Feb 22.)

    • You are viewing the Brain Drugs at Alpha Online. Understanding the human brain is essential to become a well-informed, modern citizen. Responsible adults need to become better informed about prescription drugs and exercise constraint when seeking and accepting prescriptions that alter brain function. The topics online are from the book, Human Brain, by Stephen Gislason MD, a physician-writer who is good at making complex subjects more understandable.

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