They are a group of psychotropic drugs with a mainly anxiolytic effect, the discovery of which was a great revolution in the treatment of anxiety. Born in a time when barbiturates were indisputably the treatment of choice for anxiety-type problems despite the high risk of overdose and dependence, their high level of success in reducing symptoms with much lower risks and side effects made them quickly into the most widely used type of psychotropic drug.
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 the 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.
These are relaxing substances with a large number of clinical applications, despite the fact that, like all psychotropic drugs, it presents a series of risks and side effects that must be taken into account when applying it. 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 action as an indirect agonist of GABA or gamma-aminobutyric acid, a neurotransmitter that allows proper management and does not overload the brain by reducing and hindering the transmission of nerve impulses. Specifically, benzodiazepines cause GABA to exert a greater influence on the system, which, as it is 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 in treating anxiety processes and mood states is very high. In this way, the level of activation of the organism decreases , producing a relief of anxiety symptoms along with other effects such as muscle relaxation and sedation.
Types according to their half-life
There are different types of substance that are part of the group of benzodiazepines. 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 in the body.
In this way we can find three large groups of benzodiazepines, whose characteristics will make them more suitable for one or other situations.
Short-lived / 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, it is the benzodiazepines that act more quickly, which is a great help to combat the appearance of sudden anxiety symptoms such as anxiety attacks or problems that only require a momentary relaxation, such as difficulties with To fall asleep.
The main problem of this subgroup is that when the effects pass quickly, if they want to maintain them, the consumption of the substance will be more common, which is likely to end up generating dependency. In addition, they tend to cause a higher level of side effects. Some drugs in this group are triazolam or midazolam .
Long-life / long-acting benzodiazepines
This type of benzodiazepine has the great advantage that it remains in the body for a long time, being helpful in anxiety disorders. In contrast, the fact that they remain so long in the body causes the effects of the doses to accumulate, which could have undesirable sedative effects.
In addition, they take time 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.
Life / intermediate-acting benzodiazepines
In the middle between the two previous types, the intermediate-life benzodiazepines show an early action (although not as immediate as the 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.
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 as follows.
Anxiety disorders and episodes
The application for which benzodiazepines are best known, having been the pharmacological treatment of choice for these types of problems for many years (today they have been dethroned as the treatment of choice in multiple disorders). The type of benzodiazepine to be used in each type of disorder will depend on its characteristics.
For example, if rapid action is necessary in response to the onset of an anxiety attack, 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), half-life or long-life benzodiazepines 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.
One of the properties of benzodiazepines, which is sometimes an unwanted side effect, is their sedative potential. That is why they are useful when it comes to fighting 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 flurazepam if the problem is in frequent awakenings or maintenance of sleep.
Although in both depression and bipolar disorder there are other drugs that are prioritized over benzodiazepines, in some cases alprazolam or clonazepam is used as they allow the patient to be reassured and reduce their anxiety.
Seizures, spasms, and motor agitation
Seizures of the epileptic type appear when one or more groups of neurons become hypersensitive and are easily excited. As we have indicated previously, the main mechanism of action of benzodiazepines is the potentiation of GABA as an inhibitor of neuronal excitation, thus, by enhancing the depression of the nervous system, benzodiazepines are useful to control seizures.
Other motor-type symptoms can also be mitigated due to the effect as a muscle relaxant and sedative.
Alcohol withdrawal syndrome
The abrupt cessation of alcohol consumption in subjects who have developed tolerance and dependence can produce withdrawal syndromes, among whose symptoms may be anxiety, coordination problems and agitation. Both at the hospital and outpatient level, the use of benzodiazepines makes it possible to control these symptoms, taking advantage of their sedative activity to reduce their intensity.
Risks and associated side effects
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 cause its dose and time of use to be regulated.
One of the main problems with this type of drug is its addictive potential. Although benzodiazepines are much less addictive compared to their predecessors, they are substances whose prolonged use can lead to 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 that in general the long-lived 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 problem.
Abuse and overdose
An overdose of these substances usually produces an exacerbation of the effects, causing a deep depression of the nervous system. It is usually not life threatening unless the patient is very old and / or has concomitant medical problems.
With regard to withdrawal syndromes, symptoms opposite to those produced by drugs are common, 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.
Sedation, decreased concentration and performance
The sedation they produce is another of the problems that the use of benzodiazepines can entail. Although in many cases they are used precisely in order to relax and facilitate sleep states, on occasions when you only want to reduce anxiety, this effect can be detrimental because it decreases motor ability, concentration and the effectiveness of the subject. in performing tasks.
The use of benzodiazepines can cause memory problems, especially when starting to be administered. The type of problems they cause is usually difficulty in acquiring and consolidating new information, as well as in remembering previous information.
In some cases and especially with the elderly, the use of benzodiazepines can cause an effect totally opposite to what is expected. In these cases, due to an increase in the excitement of the nervous system, causing anxiety and agitation both at a cognitive and motor level.