Long-term use of benzodiazepines (like diazepam, clonazepam, or lorazepam) has always been controversial. And we now know more about the risks, especially for older people. Because benzodiazepines can affect reaction time and coordination, they increase the risk of falls and motor vehicle accidents. Both of those are already concerns for older people. More recent studies show that benzodiazepines increase the risk of developing dementia such as Alzheimer’s Disease. We also now know that combining benzodiazepines and opioid pain medications is especially dangerous. Your doctor knows more now about the risks of diazepam than when she (or another doctor) first prescribed it.
We have always known that benzodiazepines are addictive. When we say that, we are not passing judgment on people who take them; instead, we are talking about a biological effect. Long-term use of benzodiazepines causes brain changes that make the medication less effective over time. And most people experience a rebound or withdrawal reaction if they try to stop or cut down.
We know that benzodiazepines reduce anxiety in the short run; it is less clear if they are really helpful in the long run. Increasing anxiety if you stop or cut down doesn’t necessarily mean that a benzodiazepine is really helping. It may be just a rebound effect, meaning that you should cut down more slowly. I wouldn’t say that no one should ever take benzodiazepines long-term. But I would recommend anyone taking benzodiazepines regularly to try to cut down. Even if you can’t stop completely, reducing the dose will reduce the risks. Going very slowly is the key to successfully cutting down or stopping. For someone taking moderate or high doses of a benzodiazepine for years, tapering off may take six months or more. Dr. Heather Ashton developed a manual for doctors and patients about gradually tapering benzodiazepines. Many of my patients have found it helpful.
