How does benzodiazapene withdrawal affect the brain?

Benzodiazepines (BZD)

Benzodiazepines are among the most widely prescribed drugs in the world. The best-known representative of this group of substances is diazepam, which was brought onto the market in 1963.

Short version:

  • Benzodiazepines dock on the so-called GABA receptors in the brain and there intensify the effect of gamma-aminobutyric acid - in short: GABA (abbreviation of the English term "gamma-aminobutyric acid").
  • GABA is the most important inhibitory messenger substance (neurotransmitter) in the human central nervous system.
  • It suppresses the generation and transmission of excitation in the nerve cells and thus acts as a kind of brake in the brain.

How do benzodiazepines work?

By intensifying these depressant processes, the benzodiazepines develop a number of effects. This is how they work in general

  • anxiolytic
  • muscle relaxing
  • antispasmodic (anticonvulsant)
  • calming (sedating)
  • sleep inducing (hypnotic)

, whereby the many different representatives of this group of substances differ in their profile of action.

For which diseases are benzodiazepines used?

There are benzodiazepines in which the anxiolytic component is particularly pronounced and which are therefore primarily used to treat anxiety disorders.

The benzodiazepines used as sedatives and sleeping pills also differ from preparation to preparation - especially in terms of their strength and duration of action. They are divided into three groups:

  • short acting benzodiazepines the doctor prefers to prescribe for those who have difficulty falling asleep
  • moderately effective benzodiazepines are used for people who have trouble sleeping through the night
  • long-acting benzodiazepines are also suitable as sedatives during the day

Side effects of benzodiazepines

The typical side effects of benzodiazepines can be explained by the depression of the central nervous system. This includes

  • fatigue
  • Drowsiness
  • Impairment of concentration and performance
  • dizziness
  • Reduced ability to react (can affect the ability to drive)

Alcohol can increase both the effects and the side effects. Benzodiazepines also change the architecture of sleep, in particular by reducing the depth of sleep.

Can Benzodiazepines Be Addictive?

The biggest problem, however, is the risk of - physical and psychological - addiction, which increases with increasing dosage and duration of use. To minimize the risk of addiction, it is recommended to use benzodiazepines as sleeping pills and sedatives To be taken for a maximum of four weeks, under appropriate medical supervision.

Although the benzodiazepines are now being prescribed, at least by doctors in German-speaking countries, much more cautiously than they were a few years ago, they are still considered to be the drugs with the world's highest rate of abuse.

Stopping benzodiazepines: what should you watch out for?

It is also important not to stop taking the medication suddenly. Because this can lead to the sleep disorders occurring again, not infrequently in an intensified form. In order to prevent such a "rebound insomnia" and the withdrawal symptoms (fear, restlessness, tremors, nightmares) that can also occur if the therapy is terminated too quickly, benzodiazepines must be tapered off. This means that the dose is reduced to zero over several days or weeks.

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Ulrich Kraft, doctor and medical journalist
Editorial editing:
Mag. (FH) Silvia Hecher, MSc

Status of medical information:

Herdegen T: short textbook pharmacology and toxicology. Thieme Verlag, Stuttgart, 2nd updated edition 2010

Gräfe KH: Dual series of pharmacology and toxicology. Thieme Verlag, Stuttgart, 1st edition 2011