Benzodiazepine dependence or addiction to benzodiazepines is when one has developed one or more of tolerance, withdrawal symptoms, drug seeking behavior, such as ongoing use despite harmful effects, and maladaptive patterns of substance use , according to DSM-IV. In the case of benzodiazepine dependence, however, continued use seems to be associated with avoidance of unpleasant withdrawal reactions rather than from a pleasing drug effect. Benzodiazepine dependence develops with long-term use, even at low therapeutic doses, without the described dependency behavior.
Dependence, or what is sometimes referred to as psychological dependence, includes people misusing or craving drugs to not relieve withdrawal symptoms, but experiencing euphoric or intoxicating effects. It is important to distinguish between addiction and substance abuse of benzodiazepines and normal physical dependence on benzodiazepines. Increased GABA A inhibition caused by benzodiazepines is removed by the development of body tolerance to drug effects; the development of tolerance occurs as a result of neuro-adaptation, resulting in a decrease in GABA inhibition and increased stimulation of the glutamate system; This adaptation occurs as a result of the body trying to overcome the depressant effects of the central nervous system of the drug to restore homeostasis. When benzodiazepines are discontinued, these neuroadaptations "mask open" leading to hyper-stimulation of the nervous system and the emergence of withdrawal symptoms.
Therapeutic dose dependence is the largest category of people who depend on benzodiazepines. These people usually do not increase their doses to high levels or abuse their drugs. Smaller groups include patients increasing their doses to higher levels and drug abuse as well. It is not clear exactly how many people are illegally abusing benzodiazepines. Tolerance develops within days or weeks into anticonvulsant, hypnotic muscle relaxation and after 4 months there is little evidence that benzodiazepines retain their anxiolytic properties. Some authors, however, disagree and feel that benzodiazepines retain their anxiolytic properties. Long-term benzodiazepine treatment may still be needed in certain clinical conditions.
Dependence and abuse of benzodiazepines has been a concern since 2002. Based on the US findings of the Treatment Episode Data Set (TEDS), the annual compilation of patient characteristics in substance abuse treatment facilities in the United States, acceptance for "major sedatives" (including, but not limited to , benzodiazepine-type) drug use increased 79% from 1992 to 2002. Thus, the DAWN and TEDS data sets demonstrated clearly that this tranquilizer/hypnotic abuse is on the rise, and causes concern.
The number of benzodiazepine recipes has decreased, mainly due to dependency concerns. In the short term, benzodiazepines can be effective drugs for acute anxiety or insomnia. With long-term use, other therapies, both pharmacologically and psychotherapy, become more effective. This is partly due to the greater effectiveness over time of other forms of therapy, and also because of the eventual development of pharmacological tolerance of benzodiazepines.
Video Benzodiazepine dependence
Definisi
Dependence of benzodiazepines is a condition resulting from repeated use of benzodiazepine drugs. This may include both physical dependence and psychological dependence and is characterized by a withdrawal syndrome at a decrease in blood plasma benzodiazepine levels, for example, during a dose reduction or a sudden withdrawal.
Maps Benzodiazepine dependence
Signs and symptoms
Benzodiazepine dependence signs and symptoms include feelings of inability to overcome without drugs, failed attempts to reduce or discontinue use of benzodiazepines, tolerate the effects of benzodiazepines, and withdrawal symptoms when not taking the drug. Some of the possible withdrawal symptoms include anxiety, depression, depersonalization, derealization, sleep disturbances, hypersensitivity to touch and pain, tremors, tremors, muscle aches, pains, twitches, and headaches. Dependence and dependence Benzodiazepines have been linked to suicidal behavior and self-injury, especially in young people. The Ministry of Health's substance abuse guidelines recommend monitoring for mood disorders in those who depend on or withdraw from benzodiazepines.
Benzodiazepine dependence is a frequent complication for those prescribed or used for more than four weeks, with physical dependence and withdrawal symptoms being the most common problem, but also sometimes drug-seeking behavior. Withdrawal symptoms include anxiety, perceptual disorders, all-sensory distortions, dysphoria, and, in rare cases, psychosis and epileptic seizures.
Elderly
Long-term use and dependence of benzodiazepines is a serious problem in the elderly. Failure to treat benzodiazepine dependence on the elderly can lead to serious medical complications. Parents have less cognitive reserves and are more sensitive to short (eg, between withdrawal doses) and the protracted withdrawal effects of benzodiazepines, as well as good side effects from short-term and long-term use. This can lead to excessive contact with their doctor. Research has found that attracting elderly people from benzodiazepines leads to a significant reduction in doctor visits per year, presumably, due to the elimination of drug side effects and withdrawal effects.
Tobacco and alcohol are the most common substances that parents get dependence or abuse. The next most common substance that parents develop drug dependence or abuse is benzodiazepines. Drug-induced cognitive problems can have serious consequences for the elderly and may cause confusion and "pseudo-dementia". Approximately 10% of elderly patients who refer to the clinic of memory actually have the most drug-induced induced cause is benzodiazepines. Benzodiazepines are also associated with an increased risk of traffic accidents and falls in the elderly. Long-term effects of benzodiazepines are not fully understood in the elderly or in any age group. The long-term use of benzodiazepines is associated with attentional and visuospatial functional disorders. Withdrawal from benzodiazepines can lead to increased alertness and decreased forgetfulness in the elderly. Withdrawal led to a statistically significant increase in memory function and performance-related skills in those who had successfully withdrawn from benzodiazepines, while those who continued to use benzodiazepines experienced worsening symptoms. People who withdraw from benzodiazepines also feel their sleep is more refreshing, making statements like " I feel sharper when I wake up " or " I feel better, more awake "or" It used to take me an hour to fully wake up. "This shows that benzodiazepines can actually make insomnia worse in the elderly.
Cause
Tolerance occurs in muscle-relaxed, anticonvulsant, and sleep-induced effects of benzodiazepines, and after discontinuation of benzodiazepine withdrawal syndrome. This may cause benzodiazepines to be taken longer than desired, as people continue to use drugs over long periods of time to suppress withdrawal symptoms. Some people abuse benzodiazepines with very high doses and devote a lot of time to do so, meeting diagnostic criteria in DSM IV for substance abuse and dependence. Another group of people including those undergoing low to moderate doses of benzodiazepines who do not abuse their benzodiazepines but develop benzodiazepine tolerance and dependence. A large number of people who use benzodiazepines for insomnia increase their doses, sometimes above the dose levels prescribed therapeutically. Tolerance to the anxiolytic effects of benzodiazepines has been clearly demonstrated in mice. In humans, there is little evidence that benzodiazepines retain their anti-anxiety effects after four months of ongoing care; there is evidence to suggest that long-term use of benzodiazepines may actually worsen anxiety, which in turn may lead to dose escalation, with one study finding 25% of patients increasing their dose. Some authors, however, consider benzodiazepines to be effective over the long term; however, it is more likely that these drugs serve to prevent the effects of withdrawal of rebound anxiety. Tolerance to the anticonvulsant effect and muscle relaxation of benzodiazepines occurs within a few weeks in most patients.
Risk factors
Risk factors for benzodiazepine dependence are long-term use beyond four weeks, high dose use, the use of potent short-acting benzodiazepines, dependent personalities, and trends for drug abuse. Use of short-acting benzodiazepines causes repeated recurrence effects that are alleviated by subsequent doses, which strengthen individual dependence. Physical dependence develops faster with the potential of higher benzodiazepines such as alprazolam (Xanax) compared with lower benzodiazepine potentials such as chlordiazepoxide (Librium).
Symptom severity is worse with high-dose use, or with high potential benzodiazepines or short half-lives. Other tolerant hypnotic tranquilizers, such as barbiturates or alcohol, increase the risk of benzodiazepine dependence. Similar to the use of opioids for pain, therapeutic use of benzodiazepines rarely causes substance abuse.
Mechanism
Tolerance and physical dependency
Tolerance develops rapidly with sleep effects of benzodiazepines. The anticonvulsant and muscle-relaxing effects last for several weeks before tolerance develops in most individuals. Tolerance results in desensitization of GABA receptors and increased sensitization of excitatory, glutamate-like neurotransmitter system such as NMDA glutamate receptors. This change occurs as a result of the body trying to overcome the effects of the drug. Other changes that occur are the reduction in the number of GABA receptors (downregulation) as well as the possibility of long-term changes in the encoding of brain cell gene transcription. The different speeds at which tolerance occurs in the therapeutic effect of benzodiazepines can be explained by the rate of change in the range of neurotransmitter systems and subsystems altered by the use of chronic benzodiazepines. Various neurotransmitter systems and subsystems can reverse tolerance at different speeds, thus explaining the nature of some of the persistent withdrawal symptoms. As a result of the growing physical dependence due to tolerance, the benzodiazepine withdrawal syndrome characteristics often occur after drug removal or dose reduction. Changes in neuropeptide expression such as corticotropin-releasing hormone and neuropeptide Y may play a role in benzodiazepine dependence. Individuals taking daily benzodiazepine drugs have a lower sensitivity to additional doses of additional benzodiazepines. Tolerance to benzodiazepines can be demonstrated by injecting diazepam into long-term users. In normal subjects, growth hormone increases occur, whereas in individuals tolerant to benzodiazepine, this effect is dull.
Animal studies have shown that repeated withdrawal from benzodiazepines leads to more severe withdrawal symptoms, including an increased risk of seizures; This phenomenon is known as kindling. The Kindling phenomenon has been determined for repeated withdrawal of ethanol (alcohol); alcohol has a mechanism of tolerance and withdrawal that is very similar to benzodiazepines, which involve GABAa, NMDA, and AMPA receptors.
Shifting of benzodiazepine receptors to an inverse agonist state after chronic treatment causes the brain to become more sensitive to excitatory or stimulatory drugs. Excessive glutamate activity can lead to excitotoxicity, which can lead to neurodegeneration. The NMDA subtype glutamate receptor is noted for its role in causing excito-neurotoxicity. The AMPA glutamate receptor subtype is believed to play an important role in neuronal twigs as well as excitotoxicity during withdrawal from alcohols and benzodiazepines. It is likely that NMDA receptors are involved in tolerance to some of the effects of benzodiazepines.
Animal studies have found that glutamergic changes as a result of benzodiazepine use are responsible for delayed withdrawal syndrome, which in mice peaked 3 days after the cessation of benzodiazepines. This is demonstrated by the ability to avoid the withdrawal syndrome by the AMPA antagonist administration. It is believed that differences in glutamate receptors, for example, NMDA and AMPA, are responsible for various stages/time points of withdrawal syndrome. NMDA receptors are regulated in the brain as a result of benzodiazepine tolerance. AMPA receptors are also involved in the tolerance and withdrawal of benzodiazepines. The decrease in the benzodiazepine binding site in the brain may also occur as part of the benzodiazepine tolerance.
Cross-tolerance
Benzodiazepines have an action mechanism similar to those of various sedative compounds that work by increasing GABA receptors A . Cross tolerance means that one drug will alleviate the effects of withdrawal from others. This also means that tolerance to one drug will result in tolerance to other drugs that act similarly. Benzodiazepines are often used for this reason to detoxify alcohol-dependent patients and can have life-saving properties in preventing or treating severe life-threatening withdrawal syndromes from alcohol, such as delirium tremens. However, although benzodiazepines can be very useful in the detoxification of acute alcoholics, benzodiazepines in themselves act as positive reinforcement in alcohol, by increasing the desire for alcohol. Low doses of benzodiazepines were found to significantly increase the level of alcohol consumed in alcoholics. Alcoholic dependent on benzodiazepines should not be withdrawn suddenly but very slowly withdrawn from benzodiazepines, because withdrawal too quickly tends to cause severe anxiety or panic, known as a risk factor relapse in restoring an alcoholic.
There is cross-tolerance between alcohol, benzodiazepines, barbiturates, nonbenzodiazepine drugs, and corticosteroids, all of which act by increasing the function of GABA receptors A by modulation of chloride ion channel function from GABA Receptor .
Neuroactive steroids, for example, progesterone and its active metabolite allopregnanolone, are positive modulators of GABA A and cross-tolerant receptors with benzodiazepines. Active progesterone metabolites have been found to increase benzodiazepine binding to benzodiazepine binding sites at GABA receptors A . Cross tolerance between the positive modulator receptor GABA A occurs because of the same mechanism of action and subunit changes that occur from chronic use of one or more of these compounds in the expressed isoform of the receptor. The sudden withdrawal of one of these compounds, for example, barbiturates, benzodiazepines, alcohols, corticosteroids, neuroactive steroids, and nonbenzodiazepines, precipitates a similar withdrawal effect characterized by central nervous system hypertension, resulting in symptoms such as increased susceptibility to seizures and anxiety. While many neuroactive steroids do not produce full tolerance for their therapeutic effect, cross-tolerance of benzodiazepines still occurs as has been demonstrated between neuroactive steroids ganasxolon and diazepam. Changes in the level of neuroactive steroids in the body during the menstrual cycle, menopause, pregnancy, and stress conditions can lead to decreased effectiveness of benzodiazepines and reduced therapeutic effects. During withdrawal of neuroactive steroids, benzodiazepines become less effective.
Physiology of withdrawal
Withdrawal symptoms are a normal response in individuals who have the use of chronic benzodiazepines, and the adverse effects and drug tolerance outcomes. Symptoms usually appear when the dose of the drug is reduced. GABA is the second most common neurotransmitter in the central nervous system (the most common being glutamate) and by far the most abundant neurotransmitter inhibition; approximately one quarter to one-third of synapses using GABA. The use of benzodiazepines has a profound effect on almost every aspect of brain and body function, either directly or indirectly.
Benzodiazepines cause decreased norepinephrine (noradrenaline), serotonin, acetylcholine, and dopamine. These neurotransmitters are necessary for normal memory, mood, muscle tone and coordination, emotional response, endocrine secretion, heart rate, and blood pressure control. With the use of chronic benzodiazepines, tolerance develops rapidly to most of its effects, so when benzodiazepine is withdrawn, various neurotransmitter systems overdrive due to lack of inhibitory GABA activity. The withdrawal symptoms then appear as a result, and persist until the nervous system physically reverses the adaptation (physical dependence) that has occurred on the CNS.
The withdrawal symptoms usually consist of a mirror image of the drug effect: Sedative effects and suppression of REM and SWS sleep stages can be replaced by insomnia, nightmares, and hypnogogic hallucinations; its anti-anxiety effects are replaced with anxiety and panic; the effects of muscle relaxation are replaced by muscle spasms or cramps; and the anticonvulsant effect is replaced by seizures, especially in cold turkey or withdrawal that is too fast.
Benzodiazepine withdrawal represents a portion of excitotoxicity to brain neurons. The rebound activity of the hypothalamus-pituitary-adrenocortical axis also plays an important role in the severity of benzodiazepine withdrawal. The tolerance and the resulting withdrawal syndrome may be due to a change in gene expression, which results in long-term changes in the functioning of the GABAergic nervous system.
During withdrawal from full or partial agonists, the changes occur at benzodiazepine receptors by increasing regulation of some receptor subtypes and subregion of other receptor subregions.
Withdrawal
Long-term use of benzodiazepines leads to an increase in physical and mental health problems, and as a result, discontinuation is recommended for many long-term users. The withdrawal syndrome of benzodiazepines can range from mild and short syndromes to severe and severe syndromes. Withdrawal symptoms may lead to the ongoing use of benzodiazepines for many years, long after the original reason for taking benzodiazepines has passed. Many patients know that benzodiazepines no longer work for them but can not stop benzodiazepines because of withdrawal symptoms.
Withdrawal symptoms may appear despite slow reduction but can be reduced with a slower rate of withdrawal. As a result, withdrawal rates have been recommended to be adjusted for each patient. The time required for withdrawal may vary from a few months to a year or more and often depends on long-term use, doses taken, lifestyle, health, and social and environmental stress factors.
Diazepam is often recommended because of its long elimination half-life and also due to its availability in low-potency doses. Nonz benzodiazepine Z drugs such as zolpidem, zaleplon, and zopiclone should not be used as a substitute for benzodiazepines, because they have a similar mechanism of action and can cause the same dependence. The pharmacological mechanism of benzodiazepine tolerance and dependence is the internalization (removal) of receptor sites in the brain and alteration of gene transcription codes in the brain.
With long-term use and during the withdrawal of benzodiazepines, emerging depression with treatment and emotional defection can arise and sometimes also suicidal ideation. There is evidence that the higher the dose used the more likely the use of benzodiazepines will induce these feelings. Reducing doses or stopping benzodiazepines may be indicated in such cases. The withdrawal symptoms may persist for some time after stopping the benzodiazepines. Some of the most frequent dashed symptoms include anxiety, depression, insomnia, and physical symptoms such as gastrointestinal, neurological, and musculoskeletal effects. Prolonged withdrawal may still occur despite slow dose titration. It is believed that the protracted withdrawal effect is due to long-lasting neuro-adaptation.
Diagnosis
For the diagnosis of benzodiazepine dependence to be made, ICD-10 requires that at least 3 of the following criteria are met and that they have been present for at least a month, or, if less than a month, that they appear repeatedly over a 12-month period.
- The behavior, cognitive, and physiological phenomena associated with repeated use and which usually include a strong desire to take medication.
- Use of difficulty control
- Keep using even if there are dangerous consequences
- Preferences provided for drug use rather than other activities and obligations
- Increased tolerance to drug effects and sometimes physical withdrawal.
These diagnostic criteria are good for research purposes, but, in day-to-day clinical practice, they should be interpreted according to clinical judgment. In clinical practice, benzodiazepine dependence should be suspected in those who have been taking benzodiazepines for more than a month, in particular, if they are from high-risk groups. The main factors associated with an increased incidence of benzodiazepine dependence include:
- Dose
- Duration
- Concurrent use of antidepressants
Benzodiazepine dependence should also be suspected in individuals who have substance use disorders including alcohol, and should be suspected in individuals who obtain their own benzodiazepines. The dependence of benzodiazepines is almost certain in individuals who are members of an independent relief group.
Research has found that about 40 percent of people with a benzodiazepine dependency diagnosis do not realize that they are dependent on benzodiazepines, while about 11 percent of people who are judged independent of their beliefs. When assessing a person for benzodiazepine dependence, asking specific questions rather than questions based on concepts is recommended by experts as the best approach to getting a more accurate diagnosis. For example, asking people if they "think about drugs at certain times other than when they take medicine" will give a more meaningful answer than asking "do you think you are psychologically dependent?". The Benzodiazepine Dependence Self Report Questionnaire is one of the questionnaires used to assess and diagnose benzodiazepine dependence.
Prevention
Because of the risk of developing tolerance, dependence, and adverse health effects, such as cognitive impairment, benzodiazepines are indicated for short-term use only - weeks, followed by gradual dose reduction.
The Drug Review Committee (UK)
The Drug Review Committee conducted a review of benzodiazepines due to significant concerns about tolerance, drug dependence, the problem of withdrawing benzodiazepines, and other adverse effects and published the results in the British Medical Journal in March 1980. The committee found that benzodiazepines did not have antidepressant or analgesic properties and therefore, treatments that are not appropriate for conditions such as depression, tension headaches, and dysmenorrhea. Benzodiazepines are also not useful in the treatment of psychosis. The committee also recommends against benzodiazepines for use in the treatment of anxiety or insomnia in children.
The committee agrees with the Institute of Medicine (USA) and the conclusions of a study conducted by the Office of White House Drug Policy and the National Institute for Drug Abuse (USA) that there is little evidence that long-term use of benzodiazepine hypnotics is beneficial in the treatment of insomnia because development of tolerance. Benzodiazepines tend to lose the nature of promoting their sleep within 3-14 days of continuous use, and, in the treatment of anxiety, the committee found that there is little convincing evidence that benzodiazepines retain efficacy in the treatment of anxiety after 4 months of continuous use. because of the development of tolerance.
The committee found that regular use of benzodiazepines led to the development of dependence characterized by tolerance to the effects of benzodiazepine therapy and the development of benzodiazepine withdrawal syndrome including symptoms such as anxiety, fear, tremor, insomnia, nausea, and vomiting after treatment interruption. use of benzodiazepine. Withdrawal symptoms tend to develop within 24 hours after discontinuation of short-acting benzodiazepines, and 3-10 days after termination of benzodiazepines that work longer. Withdrawal effects may occur after treatment, lasting only 2 weeks at therapeutic dose levels; However, withdrawal effects tend to occur with outside use habits 2 weeks and more likely to be higher in doses. The withdrawal symptoms may appear similar to the original condition.
The Committee recommends that all benzodiazepine medications be gradually withdrawn and recommend that benzodiazepine treatment be used only in carefully selected patients and that therapy is restricted to short-term use only. It is noted in the review that alcohol may potentiate the central nervous system depressant effects of benzodiazepines and should be avoided. The effects of the central nervous system-depressants from benzodiazepines can make driving or operate dangerous machines, and parents are more susceptible to these adverse effects. High single doses or recurrent low doses have been reported to produce hypotonia, poor sucking, and hypothermia in the neonate, and irregularities in the fetal heart. The committee recommends that benzodiazepines be avoided in lactation.
The committee recommends that withdrawal from benzodiazepines be done gradually, since the sudden withdrawal from high doses of benzodiazepines may lead to confusion, toxic psychosis, convulsions, or conditions resembling delirium tremens. A sudden withdrawal from a lower dose can cause depression, nervousness, rebound insomnia, irritation, sweating, and diarrhea.
The committee also made the mistake of concluding:
on the evidence available today, the true potential addiction of benzodiazepines is low. The amount dependent on benzodiazepines in Britain from 1960 to 1977 has been estimated to be 28 people. This is equivalent to the dependence rate of 5-10 cases per million patient months.
Treatment
Benzodiazepines are considered highly addictive drug classes. Psychological and physical dependence can develop in as little as a few weeks but may take years to develop in other individuals. Patients who wish to withdraw from benzodiazepines usually receive little advice or support, and the withdrawal should be piecemeal for several months.
Benzodiazepines are usually prescribed only short term, because there is little justification for long-term prescribing. But some doctors, disagreeing and believing long-term use beyond 4 weeks are sometimes justified, although there is little data to support this point of view. Such point of view is a minority in the medical literature.
There is no evidence that "drug holidays" or abstinence periods reduce the risk of dependence; there is evidence from animal studies that such an approach does not prevent dependence from occurring. The use of short-acting benzodiazepines is associated with breakup of interdoses. Kindling has clinical relevance with regard to benzodiazepines; for example, there is an increased shift in the use of benzodiazepines with shorter half-lives and intermittent use, which may lead to interdosal withdrawal and rebound effects.
Cognitive behavioral therapy
Cognitive behavioral therapy was found to be more effective for long-term insomnia management than hypnotic sedative drugs. There is no official withdrawal program for benzodiazepines with local providers in the UK. Meta-analysis of published data on psychological treatments for insomnia showed a success rate of between 70 and 80%. Large-scale trials using cognitive behavioral therapy in chronic tranquilizing hypnotic users including nitrazepam, temazepam, and zopiclone found CBT as a much more effective long-term treatment for chronic insomnia than sedative hypnotics. Continuous improvement in sleep quality, sleep onset latency, total sleep depth, increased sleep efficiency, significant improvements in vitality, physical and mental health at 3-, 6-, and 12 months follow-up were found in those receiving CBT. The marked decrease in total sedative hypnotic drug use was found in those receiving CBT, with 33% reporting zero hypnotic drug use. Age has been found not to be a barrier to successful CBT outcomes. It was concluded that CBT for the management of chronic insomnia was a flexible, practical, and cost-effective treatment, and it was concluded that CBT led to a reduction in the intake of benzodiazepine drugs in a large number of patients. The use of chronic hypnotic medication is not recommended because of its adverse effects on health and the risk of dependence. A gradual taper is an ordinary clinical course in getting people out of benzodiazepines, but, even with a gradual reduction, most people fail to stop taking benzodiazepines. Parents are very sensitive to the harmful effects of hypnotic drugs. A clinical trial of the elderly depending on the hypothesis of benzodiazepines suggests that the addition of CBT to the benzodiazepine reduction program gradually increased the success rate of benzodiazepine hypnotic drug cessation from 38% to 77% and at 12 months of follow-up from 24% to 70%. The paper concludes that CBT is an effective tool for reducing the use of hypnotics in the elderly and reducing adverse health effects associated with hypnotics such as drug dependence, cognitive impairment, and increased road traffic accidents.
A study of patients undergoing withdrawal benzodiazepines who have a common anxiety disorder diagnosis suggests that those receiving CBT have a very high success rate in stopping benzodiazepines compared to those who do not receive CBT. This success rate was maintained at 12 months follow-up. Furthermore, it was found that, in patients who had stopped benzodiazepines, they no longer fulfilled the diagnosis of generalized anxiety disorder, and that the number of patients no longer meeting the diagnosis of generalized anxiety disorder was higher in the group receiving CBT. Thus, CBT can be an effective tool to supplement a gradual benzodiazepine dose reduction program leading to continuous improvement and sustainable mental health benefits (Disputes).
Letter to patient
Sending letters to patients who warn of the adverse effects of long-term use of benzodiazepines and recommending dose reductions have proven successful and cost-effective strategies in reducing benzodiazepine consumption in general practice. Within a year after the letter came out, found a 17% reduction in the number of prescribed benzodiazepines, with 5% of patients having completely stopped benzodiazepines. A study in the Netherlands reported a higher success rate by sending letters to patients who were dependent on benzodiazepines. The results of the study in the Netherlands reported 11.3% of patients stopped benzodiazepines completely within a year.
Flumazenil
Flumazenil delivered via slow subcutaneous infusion is a safe procedure for those withdrawing from high-dose long-term benzodiazepine dependence. It has a low risk of seizures even among those who experience seizures when previously attempted withdrawal of benzodiazepines.
Epidemiology
Research studies have come to different conclusions on the number of therapeutic dose users who developed physical dependence and withdrawal syndrome. Estimates by researchers on the number of people affected by the 20-100% range of patients prescribed benzodiazepines in long-term therapeutic doses are physically dependent and will experience withdrawal symptoms.
Benzodiazepines may cause dependence and even dependence on low doses, with 23% becoming addicted in 3 months of use. Benzodiazepine addiction is considered a public health problem. Approximately 68.5% of benzodiazepine recipes come from local health centers, with psychiatry and general hospitals accounted for 10% each. A survey of GPs reported that the reason for starting benzodiazepines was due to empathy for patients suffering and lack of other therapeutic options than patients who sued them. However, long-term use is more common in patient insistence, this is suspected, because physical or addictive dependence has grown.
About twice as many women than men prescribed benzodiazepines. It is believed that this is mostly because men typically turn to alcohol to deal with stress and women against prescription drugs. Female perception bias by male doctors may also play a role in improving tariff prescriptions for women; However, an increase in female anxiety features does not account for the wide gap between men and women.
A study published in the British Journal of General Practice in July 2017 found that in samples taken from surveys conducted in 2014-2015 in Bradford, an average of 0.69% of registered patients have been prescribed benzodiazepines for more than one year. This shows that there are about 300,000 long-term users of diazepine in the UK.
History
Previously, physical dependence on benzodiazepines was widely considered to occur only in people who had a high therapeutic dose range. Low or normal dose dependence was not suspected until the 1970s, and it was not until the early 1980s that was confirmed. Low dose dependence has now been clearly demonstrated in animal studies and human studies, and is a recognized clinical loss of benzodiazepines. Severe withdrawal syndrome can occur from low-dose benzodiazepines even after gradual dose reduction. It is estimated that 30-45% of users of low-dose chronic benzodiazepines are dependent and it has been recommended that benzodiazepines even at low doses are prescribed for a maximum of 7-14 days to avoid dependence. As a result, the global trend leads to stricter regulations for prescription benzodiazepines because of the risk of low dose dependence.
Some controversy remains, however, in the medical literature for the precise nature of low-dose dependence and difficulty in getting patients to stop their benzodiazepines, with some papers linking problems with drug-seeking behavior and drug craving, while other papers After finding the opposite, with the problem of physical dependence with drug search and the uncharacteristic desire of benzodiazepine low-dose users.
Society and culture
Abuse and addiction
Benzodiazepines are one of the largest abused drug classes; they were classified as drug controlled IV schedules because of their recognized medical use. Worldwide the most abused and abused benzodiazepines include temazepam, diazepam, nimetazepam, nitrazepam, triazolam, flunitrazepam, midazolam, and in the United States alprazolam, clonazepam, and lorazepam.
Benzodiazepines can cause serious addiction problems. A survey of doctors in Senegal found that many doctors felt that their training and knowledge about benzodiazepines were, in general, bad; a study in Dakar found that nearly a fifth of physicians ignored prescription guidelines on short-term use of benzodiazepines, and nearly three-quarters of physicians considered their training and knowledge about benzodiazepines insufficient. More training on benzodiazepines has been recommended for doctors. Due to serious concerns of addiction, national governments are encouraged to immediately seek to improve their knowledge through training on the addictive nature of benzodiazepines and appropriate benzodiazepine prescriptions.
A six-year study of 51 Vietnamese veterans who are good drug abusers especially stimulants (11 people), especially opiates (26 people), or especially benzodiazepines (14 people) were conducted to assess psychiatric symptoms associated with drug abuse.. After six years, opiate abusers had slight changes in psychiatric symptomatology; five stimulant users have developed psychosis, and eight benzodiazepine users are depressed. Therefore, long-term benzodiazepine misuse and dependence seems to have a negative effect on mental health, with significant risk of depression. Benzodiazepines are also sometimes abused intra-nasally.
In the elderly, alcohol and benzodiazepines are the substances most frequently abused, and the elderly population is more susceptible to benzodiazepine and delirium withdrawal syndromes than younger patients.
See also
- Long-term effects of benzodiazepines
- Alcohol withdrawal syndrome
- Long-term alcohol effect
- SSRI termination syndrome
- Drug-related crime
References
External links
- Benzodiazepines: How it works and how to withdraw by Professor Heather Ashton
- Benzodiazepine dependence on Curlie (based on DMOZ)
Source of the article : Wikipedia
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