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Benzodiazepines are prescribed to depressed patients quite often, but these medications also carry significant risks, especially when it comes to their addictive potential. What should you know?

We're sure you won't be surprised that antidepressants are the most commonly prescribed kind of medication for major depressive disorder and other diagnoses that fall under the general umbrella of depression. Antidepressants can, however, be combined with other medications, depending on individual patients' needs. These can include antipsychotic medications and mood stabilizers, but also benzodiazepines

Which depressed people may benefit from treatment with benzos — and why should both doctors and patients be cautious when considering whether benzodiazepines are the right choice?

What are benzodiazepines?

Benzodiazepines are depressants — also called tranquilizers or sedatives. This means they slow the activity of your central nervous system down by enhancing the effect of a brain chemical called GABA (gamma amino butyric acid), leading to effects such as sleepiness and a reduction in anxiety. Benzodiazepines may also be prescribed to prevent seizures and reduce muscle spasms. 

Examples, some of which you'll definitely have heard of already, are:

  • Xanax (alprazolam)
  • Valium (diazepam)
  • Klonopin (clonazepam)
  • Ativan (lorazepam)
  • Librium (chlordiazepoxide)
  • Tranxene (clorazepate) 
  • Paxipam (halazepam)
  • Serax (oxazepam)
  • Centrax (prazepam)
  • Doral (quazepam)

What role can benzos play in the treatment of depression?

Make no mistake — these medications, which are Schedule IV drugs in the United States (which the exception of alprazolam), have legitimate medical uses, for which purpose they are exclusively available by prescription. Benzodiazepines are pretty effective at reducing severe anxiety quickly, as well as helping people with insomnia sleep. Since a significant subset of subset of depressed patients suffers from anxiety too (anxious depression) and many people with depression find themselves battling insomnia, this matters. 

But benzodiazepines are also pretty addictive, and their habit-forming nature means you'll need increasingly higher doses to achieve the same effect if you take them regularly. For this reason, you'll hear that fairly extreme caution should be applied when prescribing benzos to depressed people, and you should — of course — never self-medicate with them by procuring them illegally on the street, where there's definitely a big market for them. If your doctor prescribes you a benzodiazepine, you ideally shouldn't take it for a period of more than four weeks

On the other hand, many doctors still do prescribe benzodiazepines to depressed patients, with one study finding that a quarter of participants used benzos long-term. Eighty percent of these patients were also taking other medications, notably antidepressants. The most commonly prescribed benzodiazepines are, the study found, clonazepam (Klonopin) and lorazepam (Ativan). Those depressed patients who were using benzodiazepines regularly were found to be more likely to be unable to experience pleasure (anhedonia), as well as to be female and unemployed. They were also likely to have panic disorder, obsessive compulsive disorder, and a history of childhood abuse (and thus possible PTSD) than those depressed people not taking benzos. 

Are benzos effective in the treatment of depression?

They can be. A large review of studies into the topic of treating depression with benzodiazepines alone found, among other things, that:

  • A majority of (older) studies concluded that benzodiazepines were as effective in the treatment of (anxious) depression as tricyclic antidepressants, both of which were found to be more effective than placebos. A smaller number of studies pointed to tricyclic antidepressants being more effective than benzodiazepines, while only one reached the conclusion that benzos were superior. 
  • Only one study compared a newer antidepressant from the SSRI class, fluvoxamine (Luvox) to benzodiazepines, specifically lorazepam​, in patients with anxious depression. Lorazepam was found to be better tolerated, but the study's design was poor and many participants dropped out before it was finished. 

Another study, meanwhile, found that benzodiazepines can play a successful role in the treatment of depression combined with anxiety, but aren't better than antidepressants for people being treated for depression without anxious features. 

On the whole, you and your doctor may consider a benzodiazepine if you suffer from severe anxiety and/or insomnia, but otherwise, stick to antidepressants.

Benzodiazepines: Side effects and warnings

  • While you are using a benzodiazepine, you may experience drowsiness, dizziness, confusion, suffer headaches, feel groggy, and even have tremors. Some patients will have visual changes, while others notice increased clumsiness. 
  • Using benzodiazepines over a longer period of time, as little as a month, can lead to dependence. You may feel depressed, have trouble sleeping, and sweat profusely when you come off one, and should never suddenly stop taking a benzo after being on it for a while.
  • The long-term use of benzodiazepines has been associated with a higher risk of developing dementia later in life.
  • People who suffer from lung disease, conditions that cause muscle weakness, or who have had substance abuse struggles should not be taking benzodiazepines. Benzodiazepines have been linked with a higher risk of certain birth defects when used by pregnant women, and aren't suitable for breastfeeding mothers either. People with kidney and liver disease who are prescribed benzos should take lower doses. 

In conclusion

Benzodiazepines may make you feel better in the short-term if you suffer from depression, but this class of medications carries significant drawbacks. Their use in the treatment of depression should, ideally, be reserved for people who also suffer from severe anxiety, insomnia, or both. Even then, the lowest dose possible should be taken for the shortest period of time possible — think of a benzodiazepine as a crisis-management strategy rather than a long-term solution. If you do use a benzodiazepine, only do so under the watchful eye of the doctor who prescribed it to you. Should a doctor suggest a benzodiazepine to you, ask about alternatives before agreeing to take it.

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