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Holly Hardman is directing and producing a documentary film on benzodiazepines called “As Prescribed.” The film looks at the painful side effects and debilitating withdrawal symptoms individuals can experience when withdrawing from benzodiazepines like Xanax, Valium, Klonopin, Restoril and Ativan. Hardman is herself a survivor of benzodiazepine injury. It took her almost two years to taper off Klonopin. She experienced akathasia, the feeling that you are about to jump out of your skin, and aphasia, the inability to form words and sentences. Holly still has sporadic physical reactions from the withdrawal. “People are given these medications for normal life experiences and don’t realize what can happen.”
Hardman’s doctor assured her in the early 1990s that Klonopin was safe to take long-term for chronic fatigue syndrome. It wasn’t until 2012 that she discovered her persistent medical symptoms were the adverse side effects of Klonopin. “Hardman and other advocates against benzo overprescription want to get the message out benzos, like opioids, can be dangerous even when taken exactly as prescribed. . . . We shouldn’t assume these prescriptions are harmless.”
The Lown Institute noted in an article on benzodiazepines that there is a widespread but mistaken perception of benzodiazepines being “harmless quick fixes for insomnia and anxiety.” Over prescribing benzodiazepines (BZDs) commonly happens with elderly patients, who are often taking multiple medications. “Almost a third of older adults using benzos in 2008 were taking them long-term.” Elderly adults are also more likely to suffer negative side effects from BZD use.
In addition to the anecdotal evidence of the personal stories in the film, adverse effects from long-term benzodiazepine use are well documented in the research literature. Hata et al. authored “What can predict and prevent the long-term use of benzodiazepines?” in the Journal of Psychiatric Research. They said adverse effects of BZDs include: daytime drowsiness, light-headedness, ataxia (loss of full control of bodily movement), psychomotor disturbance, and anterograde amnesia (loss of the ability to form new memories). “Various studies suggest that long-term use may be harmful. Long-term use carries the risk of dependence, withdrawal syndrome, cognitive impairment, diminishing effect, tolerance, and difficulty in discontinuing treatment.”
Hata et al. also found older age to be one of the predictive factors for long-term use of BZDs. Additional factors predictive of long-term BZD use were: high dosage (equivalent to greater than 5 mg of diazepam per day), psychiatric prescribers (versus a PCP), and concurrent use of more than one benzodiazepine. “Continuation of BZDs for more than 36 months was observed in 57.8% of 3470 new users.” The authors noted where this was a significantly higher percentage of long-term users than what was found in a previous study. They speculated it might be because of the higher proportion of patients over the age of 65 in their study. Among the elderly, they found there was a statistically significant risk of serious falls, fractures and cognitive decline with BZDs.
In response to these risks, although several international clinical guidelines and expert consensus statements have been published that recommend limiting the long-term use of BZDs, especially in older patients, the prevalence of long-term use remains widespread. Thus, reducing the long- term use of BZD is an important worldwide issue.
When reviewing the Hata et al. research for Mad in America in “Preventing Long-term Benzodiazepine Use,” Hannah Emerson pointed out how the study supports the global efforts to limit the use of benzodiazepines and provides research that illustrates how to predict and prevent such use. She lamented that despite the widely known harmful effects of long-term BZD use, their long-term use continues unabated. However, “by augmenting a list of predictors for long-term BZD use and highlighting nuances that lead to discontinuation, studies like this serve to influence prescription practices to be better informed, designed, and executed.”
Crowe and Stranks did a meta-analysis of the effects of benzodiazepines on cognitive functioning in long-term current users. They also commented that while BZDs are useful in the short-term, “the published evidence indicates that when they are used for longer periods, they often culminate in significant harm.” Despite this, BZDs continue to be widely prescribed across the globe. They described some of the previous meta-analyses of long-term BZD use, which found there was significant impairment across all the measured cognitive domains, “including sensory processing, psychomotor speed, non-verbal memory, visuospatial processing, speed of processing, problem-solving, attention/concentration, verbal memory, general intelligence, motor control/performance, working memory, and verbal reasoning.”
Some previous meta-analyses found evidence of improvement for individuals in cognitive functioning following the discontinuation of BZDs. However, others discovered significant impairment persisted long after discontinuation. Wanting to incorporate studies published since the previous meta-analyses, Crowe and Stranks decided to do their updated review of the residual cognitive effects of BZDs in current users and those who had recently withdrawn from them.
“Statistically significant negative side effects were found for the cognitive domains of working memory, processing speed, divided attention, visuoconstruction, recent memory, and expressive language.” Cognitive deficits associated with BZD use persisted following withdrawal; and statistically significant negative effects were found with all cognitive domains except for executive functioning. When BZD use was followed up after withdrawal, cognitive deficits persisted in all cognitive domains except for sustained attention. These deficits were statistically significant and evident in some individuals 42 months post-withdrawal.
Crow and Stranks found the greatest deficits for long-term BZD use in the areas of working memory, processing speed, divided attention, visuoconstruction, recent memory and expressive language. Their findings largely confirm those found be previous meta-analyses. However their analysis found a larger magnitude of negative effects with working memory for current long-term BZD users. Findings for users who had withdrawn from long-term BZD use were consistent with the results of previous studies. They continued to have significant impairment in all areas of cognitive function.
In conclusion, the results of this meta-analytic study are important in that they corroborate the mounting evidence that a range of neuropsychological functions are impaired as a result of long-term benzodiazepine use, and that these are likely to persist even following withdrawal. Furthermore, the findings highlight the problems associated with long-term benzodiazepine therapy as well as the important clinical implications of these results.
So where can you turn for help? There are a number of resources out there. For BZD support groups, try Benzo Brains on YouTube; W-BAD (World Benzodiazepine Awareness Day); BenzoBuddies; benzo.org.uk; and others. Try another article on this website, “It Takes Away Your Soul,” where the above organizations and others are linked. Holly Hardman’s documentary, “As Prescribed,” has a website with a short trailer on the documentary.
If you are seriously considering an attempt at tapering off of BZDs, do your research first. Listen to some of Jocelyn Pedersen’s videos on Benzo Brains. Start with “What is Benzodiazepine Withdrawal Syndrome?” Join BenzoBuddies. Try the information on w-bad.org. W-BAD also has a YouTube channel.
Regularly you will hear about the Ashton Protocol or Ashton Method for benzodiazepine withdrawal. There are YouTube videos about Heather Ashton’s method; and a digital copy of The Ashton Manual is available on benzo.org.uk for free. There are links for all of these in “It Takes Away Your Soul.” Mad in America has also compiled a helpful annotated bibliography on “Withdrawal from Benzodiazepines.” In closing, here is a quote from Jocelyn Pedersen’s video, “What is Benzodiazepine Withdrawal Syndrome?”
If forty to eighty percent of people are potentially at risk for being this severely disabled, we really need to start weighing the risk versus the benefits of these drugs. . . . Is it worth it to be prescribing benzodiazepines?