A 2009 survey by C. M. Cunningham and associates published in "Health Policy" indicated that 1 in 12 people used benzodiazepine drugs. Use was correlated with female gender, low income, older age and poor health. A similar survey by E. Esposito and colleagues conducted in 2009, and presented in "Epidemiologia e Psichiatria Sociale" noted that the most common use of benzodiazepines was for sleep disorders. In fact, these drugs are commonly used as hypnotic medications as they are considered safe and effective. For example, in 2007, M. De Vanna and co-workers tested the effects of lormetazepam (Loramet, Noctamid, etc.) in an at-risk population (older adults) with chronic insomnia. The results were published in "Clinical Drug Investigation" and revealed that benzodiazepines enhanced sleep without significant incident. Yet other studies have reported numerous side effects.
Psychomotor Performance
Benzodiazepines are known to affect psychomotor performance. A 2010 study by K. Tsunoda and associates, published in the "International Journal of Geriatric Psychiatry" looked at postural sway before and after chronic benzodiazepine administration. Patients were gradually tapered off the drug and body stability improved. These results suggested that the risk of falling and injury can be significantly reduced by using a different type of sleep medication.
Cognitive Function
The K. Tsunoda and associates study also looked at cognitive function. Drug withdrawal increased immediate memory, language and attention index scores. Similar results were reported by in 2010 by B. A. Kleykamp and colleagues in "Experimental and Clinical Psychopharmacology". These researchers noted that triazolam (Halcion) impaired episodic memory, divided attention, and awareness more than alcohol or placebo in healthy individuals. Larger effects would be expected in clinical groups.
Daytime Sleepiness
A 2009 experiment by J. Boyle and colleagues published in"Human Psychopharmacology" supported the K. Tsunoda study psychomotor performance and cognitive function results. These researchers also noted that benzodiazepine use during the night leads to sleepiness in the day. Healthy older people had shorter latencies to sleep during daytime nap opportunities following flurazepam (Dalmane, Dalmadorm) administration than placebo.
Withdrawal Syndrome
In 1994, H. Petursson nicely described the withdrawal syndrome associated with cessation of benzodiazpine treatment in the journal "Addiction." This cluster includes sleep disturbance, weight loss, panic attack, and poor concentration as well as irritability, anxiety, tremor, sweating, nausea, palpitation, headache, and pain. Petursson also noted that these symptoms fall into three distinct temporal patterns: First, mild effects such as insomnia appear within a few days. Next, intense effects like vomiting persist for a few weeks. Finally, recurrent effects including anxiety periodically appear until a new treatment is provided.
Illness Trigger
Effects indirectly related to the withdrawal syndrome described in the Petursson study are also apparent. A 2001 survey by M. Mattila-Evenden and colleagues published in the "Nordic Journal of Psychiatry" revealed the risks of benzodiazepine withdrawal. Thirty-two patients claimed that discontinuing benzodiazepines triggered the onset of mental illness. While underlying psychopathology was suspected, drug removal hastened appearance of the problems.
Drug Tolerance
Drug tolerance is common problem found with the use of many medications. Larger doses are often required to maintain drug effectiveness, and such tolerance can lead to overdose. Non-human subjects are typically used to assess tolerance because of the involved risks. A 2006 study by J. M. Fahey and associates offered in the journal "Brain Research" looked at benzodiazepine tolerance with regard to age. The data suggested that younger rats developed tolerance to lorazepam (Ativan, Temesta) while older rats did not. This research is especially relevant given that older people are more likely to use benzodiazepines.
References
- "Health Policy"; Patterns in the use of benzodiazepines in...; C. M. Cunningham et al.; April 20, 2010
- "Epidemiologia e Psichiatria Sociale"; Patterns of benzodiazepine use...; E. Esposito et al.; July 2009
- "Clinical Drug Investigation"; Role of lormetazepam in the treatment...; M. De Vanna et al.; 2007
- "International Journal of Geriatric Psychiatry"; Effects of...; K. Tsunoda et al.; January 6, 2010
- "Experimental and Clinical Psychopharmacology"; Dose effects of...; B. A. Kleykamp et al.; February 2010
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