What are the risks of remaining on benzodiazepines long term?
Any patient already physically dependent on prescribed benzodiazepines should be the sole authority on whether they will remain on the medication or not. Forcing patients against their will to come off benzodiazepines is dangerous and often has poor outcomes. There are some populations too that may be too fragile or sick, find a great benefit to taking the medications, have a shortened lifespan, or respond so poorly to micro-reductions that they are unable to undertake a withdrawal program. These patients should be allowed the autonomy to remain on the medications and even have them increased as needed should they reach tolerance to the drugs.
Recognizing full patient autonomy, there are still major risks staying on benzodiazepines long term (longer than 2-4 weeks) that all patients should be informed of. These risks should be provided so that each patient may give fully informed consent. Only then will each patient be able to weigh these risks based on their own situation and should be free to make the decision as to whether to continue or to attempt a slow, controlled taper off. Some of the risks of continuing to take benzodiazepines long term are detailed below.
Risks:
- Development of Tolerance and Tolerance Withdrawal
- Increased risk of over-sedation
- Adverse effects in pregnancy, including miscarraige, should the patient be of child-bearing age
- Risk for developing paradoxical effects
- Risks of endocrine effects: increased cortisol, prolactin, growth hormone secretion causing menstrual irregularities, pre-menstrual tension, breast engorgement, gynecomastia, and galactorrhoea
- Benzodiazepines may alter hormonal secretion, including acute increases in cortisol, prolactin, and growth hormone. These changes—especially when sustained or dysregulated—can contribute to menstrual irregularities, premenstrual tension, breast engorgement, gynecomastia, and galactorrhoea. Some evidence also suggests long-term use may blunt or suppress growth hormone release, reflecting complex and time-dependent effects on the endocrine system.
- Increased risk of possible neurotoxic effects
- Increased risk of polypharmacy
- Increased risk of death when benzodiazepines are combined with some medications
- Physical Dependence
- Delaying the inevitable, that benzodiazepine cessation may be found to be either necessary or even forced later
- Increased risk of high medical costs due to benzodiazepines being responsible for frequent emergency and medical visits
- Increased risk of misdiagnosis (from symptoms that are caused by benzodiazepines, but not attributed to them)
- Exacerbation of the original condition (long-term benzodiazepine prescription worsens anxiety/depression/insomnia/PTSD, etc.)
- Increased risk for developing new psychiatric problems (e.g. agoraphobia, panic, terror, fear, obsessions, and compulsions, etc.)
- Increased risk of dose-escalation (due to tolerance to the original doses) or the addition of a second benzodiazepine and/or Z-drug
- Increased risk of respiratory complications in the elderly
- Possible increased risk of cancer
- Increased risk of developing cognitive impairment
- Possible increased risk of dementia and Alzheimer’s
- Increased risk of falls and accidents
- Increased risk of car accidents in the elderly
- Increased risk of hip fracture and femur fracture
- Increased risk of memory loss (which may or may not be permanent)
- Losing relationships/jobs due to personality & emotional changes/ poor function
- Increased risk of suicidality and depression
- Increased risk of homicidal behavior
- Increased risk for dangerous or disinhibited behavior
- Increased risk of muscle wasting/loss of muscle mass
- Increased risk for emotional blunting/apathy/anhedonia
- Increased risk for sleep disturbances (which can cause long-term poor health)
- Increased risk of death
- Increased risk of sickness (e.g. flu) due to lowered immune response from benzodiazepine use
- Increased risk of accidental overdose, especially in elderly, or with opioid users
- Increased risk of stroke and pneumonia in Alzheimer’s patients
- Increased risk of GI disturbances