The effects of long-term benzodiazepine use include drug dependence as well as possible adverse effects on cognitive function, physical health, and mental health. Benzodiazepines are generally effective when used on a therapeutic basis in the short term. Most of the problems associated with benzodiazepines result from their long-term use. There are significant physical, mental and social risks associated with long-term use of benzodiazepines. Although anxiety may increase temporarily as a withdrawal symptom, there is evidence that a reduction or withdrawal from benzodiazepines may lead in the long term to reduce anxiety symptoms. Because this improves the physical and mental symptoms of long-term use of benzodiazepines, slowly withdrawing from benzodiazepines is recommended for many long-term users. However, not everyone is having trouble with long-term use.
Some of the symptoms that may occur due to withdrawal from benzodiazepines after long-term use include emotional turbidity, flu-like symptoms, suicide, nausea, headache, dizziness, irritability, lethargy, sleep problems, memory impairment, personality changes, aggression, depression, social deterioration as well as work difficulties, while others have never had the side effects of long-term benzodiazepine use. One should never stop using this drug and should wean himself to a lower dose under the supervision of a doctor. While benzodiazepines are very effective in the short term, side effects in some people associated with long-term use include impaired cognitive abilities, memory problems, mood swings, and overdose when combined with other drugs may render the benefit-risk ratio unprofitable, while others did not experience any adverse effects. In addition, benzodiazepines have reinforcing properties in some individuals and are therefore considered as addictive drugs, especially in individuals who have "drug-seeking" behaviors; Furthermore, physical dependence may develop after several weeks or months of use. Many of the adverse effects of long-term benzodiazepine use begin to show improvement three to six months after withdrawal.
Other concerns about the effects of long-term benzodiazepine use, in some, include dose escalation, benzodiazepine abuse, tolerance and benzodiazepine dependence and benzodiazepine withdrawal problems. Physiological tolerance and dependence can both cause worsening effects of benzodiazepines. Increased mortality risk has been associated with long-term use of benzodiazepines in several studies; However, other studies have not found an increase in mortality. Due to conflicting findings in studies on benzodiazepines and an increased risk of death from cancer, further research into the long-term use of benzodiazepines and the risk of death has been recommended. Most studies have been performed on the prescribed benzodiazepine users; but with regard to mortality, this has been proven by research to increase the user prescribed in the last decade and a half and the 75% of deaths associated with it occur in the last four years. The long-term use of benzodiazepines is controversial and has resulted in significant controversy in the medical profession. The view of the nature and severity of the problem with the long-term use of benzodiazepines differs from expert to expert and even from one country to another; some experts even question whether there is a problem with the long-term use of benzodiazepines.
Video Effects of long-term benzodiazepine use
Symptoms
The effects of long-term benzodiazepine use may include disinhibition, concentration and memory disorders, depression, and sexual dysfunction. Long-term effects of benzodiazepines may be different from the adverse effects seen after administration of acute benzodiazepines. Analysis of cancer patients found that those taking sedatives or sleep tablets had significantly lower quality of life in all measurements performed, as well as a worse clinical picture of symptomatology. The worsening of symptoms such as fatigue, insomnia, pain, dyspnea and constipation are found when compared with those who do not take sedatives or sleep tablets. Most individuals who successfully discontinued hypnotic therapy after a gradual taper and did not use benzodiazepines for 6 months had less severe sleeping and anxiety problems, less stress and had a general feeling of health improvement at 6 months of follow-up. The use of benzodiazepines for the treatment of anxiety has been found to lead to a significant increase in health care costs due to accidents and other adverse effects associated with long-term use of benzodiazepines.
Cognitive status
The long-term use of benzodiazepines can cause general cognitive impairment, including ongoing attention, verbal and memory and psychomotor learning, visual and visual-conceptual abilities. This effect on cognition exists, although its impact on the patient's day-to-day functioning is, most (but not all cases), insignificant. Temporary changes in the brain have been found using neuroimaging studies, but no brain abnormalities are found in long-term patients treated with benzodiazepines. When benzodiazepine users discontinue long-term benzodiazepine therapy, their cognitive function increases in the first six months, although the deficit may be permanent or takes longer than six months to return to the baseline. In the elderly, long-term benzodiazepine therapy is a risk factor for strengthening cognitive decline, although gradual withdrawal is associated with increased cognitive status. An alprazolam study found that 8 weeks of alprazolam administration resulted in a detectable deficit after a few weeks but not after 3-5 years.
Sleep effect
Sleep architecture can be affected by benzodiazepine dependence. Possible adverse effects on sleep include induced or worsening respiratory distress during sleep. Like alcohol, benzodiazepines are commonly used to treat insomnia in the short term (both prescribed and self-medication), but worsen sleep in the long run. (Need quotes.) Although benzodiazepines can make people fall asleep, while sleeping, medications interfere with sleep architecture: reducing sleep time, delaying time and reducing REM sleep, increasing alpha and beta activity, decreasing K complex and delta activity, and decreasing in sleeping waves slow (ie, NREM stages 3 and 4, the most restoring part of sleep for energy and mood).
Mental and physical health
Long-term use of benzodiazepines may have similar effects on the brain as alcohol, and is also involved in depression, anxiety, post-traumatic stress disorder (PTSD), mania, psychosis, sleep disturbances, sexual dysfunction, delirium, and neurocognitive. interference. But a study of 2016 found no association between long-term use and dementia. Like alcohol, the effects of benzodiazepines on neurochemistry, such as decreased levels of serotonin and norepinephrine, are believed to be responsible for their effects on mood and anxiety. In addition, benzodiazepines indirectly can cause or worsen other psychiatric symptoms (eg, mood, anxiety, psychosis, irritability) by worsening sleep (ie, sleep disorders caused by benzodiazepines).
The long-term use of benzodiazepines may lead to the creation or exacerbation of physical and mental health conditions, which improve after 6 months or more abstinence. After a period of about 3 to 6 months of abstinence after completing a gradual reduction regimen, a noticeable improvement in mental and physical health becomes apparent. For example, one study of hypnotic users gradually withdrawn from their hypnotic medicines was reported after 6 months of abstinence that they had sleep deprivation and anxiety problems, less stress, and had a general feeling of improved health. Those who continue to use hypnotic drugs have not improved in their insomnia, anxiety, or general health rating. One study found that individuals who withdrew from benzodiazepines showed a clear reduction in the use of medical and mental health services.
About half of patients attending mental health services for conditions including anxiety disorders such as panic disorder or social phobia may be the result of alcohol or benzodiazepine dependence. Sometimes anxiety disorders precede the dependence of alcohol or benzodiazepines but alcohol dependence or benzodiazepines often act to keep anxiety disorders away and often progressively make them worse. Many people who are addicted to alcohol or prescription benzodiazepines decide to stop when it is explained to them that they have a choice between ongoing mental illness and stop and recover from their symptoms. It has been noted that since every individual has an individual's sensitivity to alcohol or sedative hypnotics, what a person can tolerate without ill health will cause others to be very ill, and that moderate drinking in sensitive people can cause anxiety syndrome an increased and sleep disorder. A person suffering from the toxic effects of alcohol or benzodiazepines will not benefit from therapy or other drugs because they do not address the root causes of the symptoms. Recovery from benzodiazepine dependence tends to take longer than recovery from alcohol but people can regain their previous good health. A review of the literature on benzodiazepine hypnotic drugs concludes that these drugs cause unwarranted risks to individuals and public health. Risks include dependence, accidents and other adverse effects. Gradual cessation of hypnotism leads to improved health without worsening sleep.
Daily users of benzodiazepines are also at higher risk of experiencing psychotic symptoms such as delusions and hallucinations. One study found that of the 42 patients treated with alprazolam, up to one-third of long-term users of the benzodiazepine (Xanax) drug alprazolam were depressed. Studies have shown that long-term use of benzodiazepines and the non-benzodiazepine agonist nonbenzodiazepine Z receptor drug is associated with causing depression as well as an apparent increase in risk of suicide and an increased risk of overall mortality.
A study of 50 patients attending the benzodiazepine withdrawal clinic found that long-term use of benzodiazepines led to a variety of psychological and physiological disorders. It was found that, after several years of chronic benzodiazepine use, the majority of patients experience various mental and physical health problems including agoraphobia, irritable bowel syndrome, paresthesias, anxiety enhancement, and panic attacks, which have not existed before. Mental health and physical health symptoms caused by long-term benzodiazepine use gradually increased significantly over a year after the completion of slow withdrawal. Three of the 50 patients have incorrectly given the initial diagnosis of multiple sclerosis when the actual symptoms are due to the use of chronic benzodiazepines. Ten of these patients had been taking a temporary drug overdose on benzodiazepines, despite the fact that only two patients had a history of depressive symptoms of previous depression. After withdrawal, no patients had any further overdose after 1 year post-withdrawal. The cause of deteriorating mental and physical health in a significant proportion of patients is hypothesized to be due to increased tolerance where type withdrawal symptoms occur, even though the prescribed dose is stable. Another theory is that the use of chronic benzodiazepines leads to a substantial increase in toxicity, which in turn leads to increased psychopathology in long-term benzodiazepine users.
The long-term use of benzodiazepines can lead to perceptual and depersonalization disorders in some people, even in those who take a stable daily dose, and that can also be a protracted withdrawal feature of benzodiazepine withdrawal syndrome.
In addition, the use of chronic benzodiazepines is a risk factor for blepharospasm. Drug-induced symptoms that mimic similar effects of withdrawal may occur at doses prescribed as a result of prolonged use, also documented with barbiturate-like substances, as well as alcohol and benzodiazepines. This suggests that the effects of the use of chronic benzodiazepine drugs are not unique but occur in other GABAergic sedative hypnotic drugs, alcohol and barbiturates.
Immune system
The use of chronic benzodiazepines appears to cause significant immunologic impairment in selected outpatient studies attending the psychopharmacology department. Diazepam and clonazepam have been found to have long-term, but not permanent immunotoxic effects on pregnant mice fetuses. However, a single dose of diazepam has been found to cause lifelong immunosuppression in neonatal mice. No studies have been conducted to assess the immunotoxic effects of diazepam in humans; However, high doses of diazepam, in humans, have been found to be a major risk of pneumonia, based on studies of people with tetanus. It has been proposed that diazepam may cause long-lasting changes in the GABA receptor A by generating long-term disruption of behavior, endocrine function and immune function.
The use of prescribed benzodiazepines is associated with increased levels of trial and suicide solving. The prosuicidal effect of benzodiazepine is suspected due to psychiatric disorders caused by side effects or withdrawal symptoms. Because benzodiazepines can generally be associated with an increased risk of suicide, care should be taken when prescribing, especially for patients at risk. Depressed teenagers who are taking benzodiazepines are found to be at greatest risk for self-harm or suicide, although the sample size is small. The effects of benzodiazepines on individuals under the age of 18 require further research. Extra attention is required in the use of benzodiazepines in depressed adolescents. Benzodiazepine dependence often results in a worsening clinical picture, which includes social damage leading to comorbid alcoholism and drug abuse. Benzodiazepine misuse or misuse of other CNS depressants increases the risk of suicide in drug abusers. Benzodiazepines have several risks based on the biochemical functions and symptoms associated with these drugs such as exacerbations of sleep apnea, sedation, self-care function emphasis, amnesia and disinhibition are suggested as possible explanations for increased mortality. Studies have also shown that the increased mortality associated with the use of benzodiazepines has been clearly documented among 'drug abuse'.
Carcinogenicity
There is some controversy surrounding the possible link between benzodiazepine use and cancer progression; cohort studies in the early 1980s showed a possible association, but advanced case-control studies found no association between benzodiazepines and cancer. In a second US national cancer study in 1982, the American Cancer Society conducted a survey of more than 1.1 million participants. Increased cancer risk is found in sleeping pill users, especially benzodiazepines. There are 15 epidemiological studies which show that the use of benzodiazepine or nonbenzodiazepine hypnotic drugs is associated with increased mortality, primarily due to increased mortality from cancer in humans. Cancer includes brain, lung, bowel, breast and bladder cancers, and other neoplasms. It has been hypothesized that suppressed immune function or viral infection itself is the cause of increased cancer rates. Although initially US Food and Drug Administration observers expressed concerns about approving nonbenzodiazepine Z drugs due to cancer concerns, they finally changed their minds and approved the drugs. A recent case-control study, however, found no association between the use of benzodiazepines and breast, lung, colon, lung, uterine, ovarian, testicular, thyroid, liver, or Hodgkin's disease, melanoma, or non-Hodgkin lymphoma. More specific case-control studies since 2000 show no association between benzodiazepine and breast cancer use. One study found an association between the use of self-reported benzodiazepines and the development of ovarian cancer, while other studies found no association. A 2016 meta-analysis of several observational studies found that the use of benzodiazepines was associated with an increased risk of cancer.
Evidence of brain damage
In a study in 1980 in a group of 55 patients who consecutively acknowledged that they had abused exclusive sedatives or hypnotics, neuropsychological performance was significantly lower and signs of intellectual impairment were significantly more frequently diagnosed than controls matches taken from the general population. These results indicate an association between tranquilizers or hypnotic abuse and cerebral disorders.
A publication had requested in 1981 if lorazepam was more toxic than diazepam.
In a study in 1984, 20 patients who had undergone long-term benzodiazepines were sent to a CT brain scan. Some scans seem abnormal. The mean ventricular-brain ratio measured by planimetry increased over the mean value in the matched and matched age control subjects group but was less than that in the alcohol group. There was no significant association between CT scan appearance and duration of benzodiazepine therapy. The clinical significance of these findings is unclear.
In 1986, it was assumed that permanent brain damage could result from chronic use of benzodiazepines similar to alcohol-related brain damage.
In 1987, 17 high-dose inpatients from benzodiazepines anecdotally demonstrated an enlarged cerebrospinal fluid space with associated brain shrinkage. Brain shrinkage reportedly appears to be dose-dependent with low-dose users who have less brain shrinkage than high-dose users.
However, a CT study in 1987 found no evidence of brain shrinkage in benzodiazepine users prescribed.
In 1989, in a 4-6 year follow-up study of 30 benzodiazepine inpatients, neuropsychological function was found to be permanently affected in some high-dose benzodiazepine chronic users. Brain damage is similar to alcoholic brain damage observed. CT scan abnormalities show dilatation of ventricular system. However, unlike alcoholics, hypnotic sedatives do not show evidence of widened cortical sulci. The study concluded that, when brain disorders are diagnosed in hypnotic HAART benzodiazepines, it is often permanent.
A CT study in 1993 investigated brain damage in benzodiazepine users and found no overall difference in healthy control groups.
A study in 2000 found that long-term benzodiazepine therapy did not cause brain abnormalities.
Withdrawal from high-dose misuse nitrazepam anecdotally suspected in 2001 has caused severe shock throughout the brain with diffuse slow activity in the EEG in one patient after 25 years of persecution. After withdrawal, abnormalities in the hypofrontal brain wave pattern persist beyond the withdrawal syndrome, which gives the authors an impression that organic brain damage results from chronic high-dose nitrazepam abuse.
Professor Heather Ashton, a leading expert on benzodiazepines of Newcastle University Institute of Neuroscience, has stated that there is no structural damage from the benzodiazepines, and support further research on the symptoms of long-term or permanent possibility of long-term use of benzodiazepines in 1996. He has stated that he believed that the most likely explanation for the symptoms that lasts is survived but gradually settle functional changes in the levels of GABA A benzodiazepine. Technology newer brain scans and more detailed as PET scans and MRI scans in 2002 to his knowledge never used to investigate the question of whether benzodiazepines cause functional or structural brain damage.
By 2014 studies have found an association between the use of benzodiazepines and an increased risk of dementia but the exact nature of the relationship remains a matter of debate. The next study found no such effect.
Maps Effects of long-term benzodiazepine use
History
Benzodiazepines when introduced in 1961 are widely believed to be safe drugs but as the decade progresses, increased awareness of the adverse effects associated with their long-term use becomes known. Initially there was widespread public approval but this was followed by widespread public disapproval, and recommendations for more stringent medical guidelines followed. Concerns about the long-term effects of benzodiazepines have been raised since 1980. These concerns have not been fully addressed. A 2006 review of the literature on the use of benzodiazepine and nonbenzodiazepine hypnotics concluded that further research is needed to evaluate the long-term effects of hypnotic drugs. Most of the problems with benzodiazepines are linked to long-term use rather than short-term use. There is increasing evidence of the long-term use hazards of benzodiazepines, especially at higher doses. In 2007, the Department of Health recommended that people with long-term benzodiazepines be monitored at least every 3 months and also recommended for long-term substitution therapy in benzodiazepine drug users due to lack of evidence base for effectiveness and because of long-term use risks. Long-term effects of benzodiazepines are very similar to the long-term effects of alcohol (regardless of organ toxicity) and other hypnotic sedations. The effects of withdrawal and dependence are almost identical. A 1987 report by the Royal College of Psychiatrists in the United Kingdom reported that any long-term use benefit of benzodiazepines is likely to be much greater than the risk of long-term use. Although benzodiazepines are still widely prescribed. The socioeconomic costs of prescribing the widespread benzodiazepine prescription are high.
Political controversy
In 1980, the Medical Research Council (United Kingdom) recommended that research be undertaken for the long-term use effects of benzodiazepines. A parliamentary UK parliamentary investigation 2009 recommended that research on the long-term effects of benzodiazepines should be done. The view from the Department of Health is that they have made every effort to make the doctor aware of the problems associated with long-term use of benzodiazepines, as well as the dangers of benzodiazepine drug addiction.
In 1980, the Drug Committee of the Agency for Drugs and Health Care on Drug Safety issued guidelines restricting the use of benzodiazepines for short-term use and updating and strengthening this warning in 1988. When asked by Phil Woolas in 1999 whether The Department of Health has every plan to conduct research of long-term effects of benzodiazepines, the Department responded, saying they have no plans to do so, since benzodiazepines have been limited to short-term use and monitored by regulatory authorities. In the House of Commons debate, Phil Woolas has claimed that there has been coverage in respect of problems associated with benzodiazepines as they are too large scale for government, regulatory agencies, and the pharmaceutical industry to deal with. John Hutton stated in response that the Department of Health takes the issue of benzodiazepines very seriously and does not sweep the problem under the carpet. In 2010, the Parliamentary Group of All Parties on the Tranquility of Trisiliat Destruction filed a complaint with the Equality and Human Rights Commission under the 1995 Disability Discrimination Act against the Department of Health and the Department of Employment and Detention which declared discrimination against persons with prescription drugs as dependent benzodiazepines as due to the denial of special care services, the exclusion of medical care, the non-recognition of the protracted benzodiazepine withdrawal syndrome, and rejection rejection and the scheme return to work. In addition, APPGITA complaints allege that there is a "virtual ban" on gathering statistical information on benzodiazepines across government departments, whereas with other controlled drugs there is a large volume of statistical data. The complaint alleges that the discrimination was deliberate, large-scale and that government departments were aware of what they were doing.
Medical Council Board of Unpublished Meeting
The Medical Research Council (UK) held a closed meeting between medical doctors and British representatives among the pharmaceutical industry between 30 October 1980 and 3 April 1981. The meeting was classified under the Public Record Act 1958 to 2014 but became available in 2005 as a result of the Freedom of Information Act. The meeting was called because of concerns that 10-100,000 people could depend; Chairman of the meeting Professor Malcolm Lader later revised this estimate to include about half a million members of British society suspected of depending on the therapeutic dose rate of benzodiazepines, with about half of those taking long-term benzodiazepines. It was reported that benzodiazepines may be the third or fourth largest drug problem in the UK (the largest being alcohol and tobacco). The chairman of the meeting was followed up after a meeting with additional information, which was forwarded to the board of the Medical Research Council's neuroscience, raised concerns about tests showing definite cortical atrophy in 2 of the 14 individuals tested and borderline abnormalities in the other five. He feels that, because of the methodology used in assessing scans, abnormalities are likely to be a technique that is too low, and finer techniques will be more accurate. Also discussed is the finding that tolerance to benzodiazepines can be demonstrated by injecting diazepam into long-term users; in normal subjects, increased growth hormone occurs, whereas in individuals tolerant to benzodiazepine this effect is dull. Also raised were findings in animal studies that demonstrated tolerance development in the form of a 15 percent reduction in binding capacity of benzodiazepines after seven days of high doses of partial parzodiazepine partial flurazepam agonist and a 50 percent reduction in binding capacity after 30 days with low doses of diazepam. The chairman is concerned that an upcoming paper will "move the whole matter" and wants to be able to say that the Medical Research Council "has a problem under consideration if questions are raised in parliament". The chairman felt that it was "very important, politically that the MRC should be 'one step ahead'" and recommended an epidemiological study to be funded and undertaken by Roche Pharmaceuticals and MRC-sponsored research conducted into the biochemical effects of long-term use of benzodiazepines. The meeting aims to identify possible problems, warn the Department of Health for the scale of the problem and identify the pharmacology and dependency properties of benzodiazepines and the volumes of benzodiazepines prescribed. The World Health Organization is also interested in this issue and it is felt that the meeting will show the WHO that MRC takes the matter seriously. Among the psychological effects of long-term use of benzodiazepines discussed is the reduced ability to cope with stress. The Chairman stated that "the withdrawal symptoms from Valium are much worse than many other drugs including, for example, heroin". It was stated that the possibility of withdrawal from benzodiazepines was "greatly reduced" if benzodiazepines were prescribed for more than four months. It was concluded that benzodiazepines are often prescribed improperly, for various conditions and situations. Dr Mason (DHSS) and Dr. Moir (SHHD) feel that, since large numbers of people use benzodiazepine for a long time, it is important to determine the effectiveness and toxicity of benzodiazepines before deciding what regulatory measures should be taken.
The controversy resulted in 2010 when secret files previously revealed the fact that the Medical Research Council has warned that the benzodiazepine prescribed for millions of patients seems to cause brain shrinking similar to alcohol abuse in some patients and fails to do larger and more stringent. studies. The Independent on Sunday reported the allegation that the "scores" of 1.5 million members of British society using long-term benzodiazepines have symptoms consistent with brain damage. It has been described as a "big scandal" by Jim Dobbin, and lawyers and lawmakers have predicted a class action lawsuit. A lawyer said he was aware of litigation failed in the past against drug companies and the relevance of those documents with court cases and said it was strange that the documents were kept 'hidden' by the MRC.
Professor Lader, who chaired the MRC meeting, refused to speculate on why the MRC refused to support his request to establish a unit for further research of benzodiazepines and why they did not set up a special safety committee to investigate the issue. Professor Lader stated that he regrets not being more proactive in pursuing the matter, stating that he does not want to be labeled as the one who only encourages trouble with benzos. Professor Ashton also submitted a proposal for grant funded research using MRI, EEG, and cognitive tests in a randomized controlled trial to assess whether benzodiazepines cause permanent damage to the brain, but the same with Professor Lader is rejected by MRC.
An MRC spokesperson said they accepted the conclusions from Professor Lader's research and said they only pay for research that meets the required quality standards of scientific research, and states that they continue to receive applications for research in this field. No explanation was reported as to why the documents were sealed by the Public Record Law.
Jim Dobbin, who heads the All-Party Parliamentary Group for Tranquillizer's Forced Dependence, states that:
Many victims have sustained physical, cognitive, and psychological problems even after they have resigned. We seek legal advice because we believe these documents are the bombs they are waiting for. MRC must justify why there is no proper follow-up to Professor Lader's research, no safety committee, no research, nothing to further explore the results. We are talking about a big scandal here.
The legal director of Action Against Medical Accidents says urgent research should be done and say that, if greater research results confirm Professor Lader's research, the government and MRC may be faced with one of the largest group actions for damage the court ever had. seen, given the large number of people potentially affected. People who report persistent post-retreat symptoms such as neurologic pain, headache, cognitive impairment and memory loss have been left in the dark, whether these symptoms are drug-induced or not due to MRC inertia, reported. Professor Lader reported that his research results did not surprise his research group given that it is known that alcohol can cause permanent brain changes.
Class action suit
Benzodiazepines have a unique history because they are responsible for the largest class action lawsuit against drugmakers in Britain, in the 1980s and early 1990s, involving 14,000 patients and 1,800 law firms who accused manufacturers of knowing the potential for dependence but deliberately concealing this information from the doctor. At the same time, 117 general practitioners and 50 health authorities were sued by patients to recover damages from harmful effects of dependence and withdrawal. This led some doctors to require a signed consent form from their patients and to recommend that all patients be adequately warned about the risk of dependence and withdrawal before starting treatment with benzodiazepines. Court cases against drug manufacturers have never reached a verdict; legal aid has been withdrawn, leading to the collapse of the trial, and there are allegations that the psychiatrist's consultant, expert witness, has a conflict of interest. This litigation led to a change in British law, making class action more difficult.
Custom population
Neonatal effects
Benzodiazepines have been found to cause teratogenic malformations. The literature on the safety of benzodiazepines in pregnancy is unclear and controversial. Early concerns about benzodiazepines in pregnancy begin with alarming findings in animals but these do not always cross over to humans. Conflicting findings have been found in infants exposed to benzodiazepines. A recent analysis of the Swedish Medical Birth Register found associations with preterm delivery, low birth weight and a moderate risk increase for congenital malformations. Increased pylorostenosis or gastrointestinal atresia is seen. Increased orofacial loopholes were not shown, however, and it was concluded that benzodiazepines were not the major teratogens.
Neurodevelopmental disorders and clinical symptoms are commonly found in infants exposed to benzodiazepines in utero. Infants exposed to benzodiazepines have low birth weight but chase normal babies at an early age, but the smaller head circumference found in benzo infants survives. Other adverse effects of benzodiazepines taken during pregnancy are distorted neurodevelopmental development and clinical symptoms including craniofacial anomalies, late pincer pinch developments, irregularities in muscle tone and movement patterns. Motor disturbance in infants is delayed up to 1 year after birth. Impaired gross motor development takes 18 months to return to normal but impaired fine motor function remains. In addition to the smaller head circumference found in under-exposed mental babies benzodiazepine, functional deficits, long-term behavioral anomalies, and lower intelligence occur.
Benzodiazepines, like other hypnotic tranquilizers, cause the death of neuronal apoptotic cells. However, benzodiazepines do not cause severe apoptosis in the developing brain as well as alcohol. The prenatal toxicity of benzodiazepines is most likely due to their effect on the neurotransmitter system, cell membrane and protein synthesis. This, however, is complicated in the neuropsychological or neuropsychiatric effects of benzodiazepines, if they occur, may not become apparent until childhood or even adolescence. A literature review found data on long-term follow-up on very limited neurobehavioral outcomes. However, a study was conducted that followed 550 children exposed to benzodiazepines, who found that, overall, most children developed normally. There is a smaller subset of children exposed to benzodiazepines that are slower to develop, but by the age of four most of the subgroups of these children have been normalized. There are a small number of children exposed to benzodiazepines that have sustained developmental abnormalities in 4 years of follow-up, but it is not possible to conclude whether these deficits are the result of benzodiazepines or whether social and environmental factors explain sustainable deficits.
Concerns about whether benzodiazepines during pregnancy cause major malformations, especially the crevice ceiling, have been hotly debated in the literature. The meta-data analysis of the cohort study found no association but the meta-analysis of case-control studies found no significant improvement in major malformations. (However, homogeneous cohort studies and case-control studies are heterogeneous, thereby reducing the strength of case-control outcomes). There have also been reports showing that benzodiazepines have the potential to cause syndromes similar to fetal alcohol syndrome, but this has been debated by numerous studies. As a result of contradictory findings, the use of benzodiazepines during pregnancy is controversial. The best available evidence suggests that benzodiazepines are not the main cause of birth defects, namely large malformations or cleft lip or cleft palate.
Elderly
Significant toxicity of benzodiazepines may occur in the elderly as a result of long-term use. Benzodiazepines, along with antihypertensives and medications that affect the cholinergic system, are the most common cause of drug-induced dementia affecting more than 10 percent of patients attending the memory clinic. Long-term use of benzodiazepines in the elderly can cause pharmacological syndrome with symptoms including drowsiness, ataxia, tiredness, confusion, weakness, dizziness, vertigo, syncope, reversible dementia, depression, intellectual disorders, psychomotor and sexual dysfunction, agitation, auditory and visual hallucinations, paranoid ideation, panic, delirium, depersonalization, sleepwalking, aggressiveness, orthostatic hypotension and insomnia. The depletion of certain neurotransmitter and cortisol levels as well as changes in immune function and biological markers may also occur. Older people who have long been benzodiazepine users were found to have a higher incidence of postoperative confusion. Benzodiazepines have been associated with increased body shock in older people, potentially causing fatal accidents including falls. The cessation of benzodiazepines leads to improved body equilibrium and also leads to improved cognitive function in elderly hypnotic benzodiazepine users without worsening insomnia.
A review of evidence has found that while long-term use of benzodiazepines is damaging to memory, its association with causing dementia is unclear and requires further study. A more recent study found that benzodiazepines are associated with an increased risk of dementia and it is recommended that benzodiazepines be avoided in the elderly. Further studies, however, found no increase in dementia associated with long-term use of benzodiazepines.
See also
- Long-term alcohol effect
- Benzodiazepine withdrawal syndrome
- Benzodiazepine dependency
References
Source of the article : Wikipedia
0 Comments