Benzodiazepines are one of the most commonly prescribed drugs in the United States. A recent study from January 2019 found that prescriptions for benzodiazepines in outpatient medical settings doubled from 2003 to 2015. Furthermore, half of all benzodiazepine prescriptions came from patients’ primary care providers.
Benzodiazepines treat a variety of medical conditions including both physical and mental illnesses. Even though so many individuals are prescribed this class of drugs, they may not know exactly how benzodiazepines work. When these prescriptions are abused, there can be grave consequences. Understanding the mechanism of action of benzodiazepines is critical to upholding their safety and efficacy.
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How Benzodiazepines Work
Benzodiazepines work by regulating an extremely important signaling pathway in the brain. Namely, after a person ingests a benzodiazepine, it is metabolized by the body and modulates a protein on the surface of brain cells known as the gamma amino butyric acid (GABA)-A receptor.
GABA receptors normally bind to the most common neurotransmitter in the central nervous system known as GABA. When bound to its receptor, GABA exerts a calming effect on both the brain and central nervous system. If benzodiazepines are present in a person’s system, this calming effect is magnified and lasts longer than if GABA was present alone.
Effects of Benzodiazepines
Because of their calming effect, benzodiazepines can be used to treat many different conditions. Benzodiazepines’ mechanism of action is generally the same regardless of the condition they are prescribed. Typical effects associated with benzodiazepine use include feeling calm, relaxed, and tired. Benzodiazepines are prescribed to individuals for several common conditions including:
- Anxiety treatment: There are both short and long-acting benzodiazepines that can help treat anxiety, severe anxiety or panic disorders depending on the needs of the patient. Additionally, many benzodiazepines are fast-acting meaning that they can relieve anxiety symptoms in a short amount of time. Since benzodiazepines help slow down the central nervous system, they “trick” the body into being more relaxed and less anxious. This can be extremely helpful for individuals with debilitating anxiety or panic attacks (e.g. Alprazolam, Chlordiazepoxide, Clonazepam, Diazepam, Lorazepam, Oxazepam).
- Insomnia treatment: Many of the same benzodiazepines that are prescribed to treat anxiety can also treat co-occurring insomnia or a completely separate diagnosis of insomnia. Though all the causes of insomnia are not well understood, some types of insomnia can be directly caused by stress. Thus, by producing a relaxing and calming effect, benzodiazepines help individuals relax and reduce their stress levels with the overall goal of attaining a more quality sleep. Benzodiazepines that are faster acting but are eliminated from the body more quickly are generally quite effective at improving insomnia symptoms (e.g. Clonazepam, Lorazepam, Temazepam, Triazolam).
- Seizure disorder: Some benzodiazepines may be prescribed to individuals who struggle with seizures. Severe seizures can be uncontrollable and cause severe physical injury. A benzodiazepine, in this case, could help prevent bodily injury by relaxing a person’s muscles before, during and after a seizure (e.g. Clonazepam, Diazepam, Lorazepam).
- Muscle spasms: Similar to patients with seizures, an individual who suffers from muscle spasms may also benefit from benzodiazepine treatment. Namely, due to the relaxing effects of this drug class, individuals can get relief from tense muscles.
- Drug or alcohol withdrawal treatment: Benzodiazepines may even be prescribed to individuals actively withdrawing from alcohol withdrawal. Particularly for severe alcohol withdrawal, patients may benefit from a benzodiazepine to ease some uncomfortable symptoms. As a result, individuals may feel more relaxed and that they can make it through the initial withdrawal process (e.g. Chlordiazepoxide, Diazepam, Oxazepam).
Agarwal, Sumit; Landon, Bruce. “Patterns in Outpatient Benzodiazepine Prescribing in the United States.” JAMA, January 25, 2019. Accessed October 25, 2019.
Griffin, CE.; et al. “Benzodiazepine pharmacology and central nervous system-mediated effects.” Ochsner J., 2013. Accessed October 25, 2019
Harvard Health. “Benzodiazepines (and the alternatives).” March 15, 2019. Accessed October 25, 2019.
NPR. Steep Climb In Benzodiazepine Prescribing By Primary Care Doctors. January 25, 2019. Accessed October 25, 2019.