Can medications you take to get a good night’s sleep or ease anxiety increase your risk for Alzheimer’s disease or dementia? That was the scary question raised in a study published on September 27th, 2012 in the BMJ (formerly the British Medical Journal).
Benzodiazepines (benzos for short) are among the most widely prescribed drugs in the world. They are used to calm jittery nerves, ease anxiety, relieve stress and help people fall asleep.
According to the BMJ article, in France nearly one third of the people over 65 take a benzo. One fifth of those in Canada and Spain rely on such drugs. Here in the U.S. the numbers are also amazing. Millions of people take a daily dose of alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax), temezepam (Restoril) or Triazolam (Halcion).
Then there are the so-called Z-drugs which are prescribed for sleep. An example is zolpidem (Ambien). Other Z drugs include zaleplon (Sonata) and eszopiclone (Lunesta). Tens of millions of prescriptions are filled annually for these sleeping pills. Like benzodiazepines, the Z-drugs also affect activity of a neurochemical called GABA and its brain receptors.
The French researchers investigated a possible link between benzos, Z-drugs and dementia. Between 1987 and 1989 they randomly selected 1063 older men and women from the southwest region of France who had no signs of dementia at the start of the study. These people (65 years of age and older) were interviewed face-to-face every two or three years for up to 20 years.
Trained neuropsychologists tested them for cognitive function and asked about psychological well being, health habits and medication usage. None of the participants took a benzo until at least three years into the study. Here is what they found: Roughly one third of the benzodiazepine users (32%) were diagnosed with dementia (memory loss, difficulty thinking clearly, etc) sometime during the trial. Only 23% of nonusers got such a diagnosis. The investigators wrote:
“In this large, prospective, population based study of elderly people who were free of dementia and did not use benzodiazepines until at least the third year of follow-up, new use of benzodiazepines was associated with a significant, approximately 50% increase in the risk of dementia.”
The researchers controlled for things like depression, living alone, diabetes, hypertension and age, but the association with benzos persisted.
Now, we would be the first to point out that association does not prove causation. This was an epidemiological study, meaning that it was not the most foolproof research. But it is not the only study suggesting such a link.
The authors of this report point out that: “Our findings are consistent with three previous case-control studies that also showed an increased risk of dementia in benzodiazepine users.”
The latest Update on Benzodiazepines and Dementia:
Over the last few years other researchers have also looked for a relationship between such medications and dementia. A study published in May, 2015 (Expert Opinion on Drug Safety) asked the question:
Is there really a link between benzodiazepine use and the risk of dementia?
The researchers analyzed 10 observational studies and concluded that:
“Out of the ten studies retrieved, nine reported an increased risk of dementia in benzodiazepine users. The risk increased with cumulative dose and treatment duration and when long-acting molecules were used…the body of evidence seems sufficient for avoiding prescriptions or renewals that are not fully justified and indiscriminate long-term use.”
Another meta-analysis of available research published in PLoS One (online, May 27, 2015) also concluded that long-term benzo use is associated with an increased risk of dementia. The authors note that:
“If confirmed, long-term benzodiazepine use should be considered as a critical public health issue in the context of the widespread use of benzodiazepines and the huge burden of dementia across many countries.”
What This Means:
The alarm bells are starting to ring that commonly prescribed sedatives just might be contributing to forgetfulness, cognitive dysfunction and dementia. In other words a giant experiment has been conducted on hundreds of millions of people worldwide for decades. We do not know for sure that these drugs cause Alzheimer’s disease, but we do not know for certain that they don’t. That scares us.
In the meantime, here are some things we do know.
Benzo Side Effects:
- • Drowsiness, dizziness, fatigue, lethargy
• Clumsiness, impaired coordination (not good for older people)
• Memory problems
• Cognitive impairment, difficulty concentrating
• Dry mouth
• Sexual difficulties
• Low blood pressure
• Depression
• Difficulty stopping the drug
Getting Off Benzos Can Be Challenging!
One reason so many continue to take benzos for so long is that such drugs can be incredibly challenging to stop. When discontinued suddenly, symptoms can be almost unbearable.
Doctors used to say that it was just the underlying anxiety returning. We now know that these medications can rearrange neurochemicals in the brain. For some, it can take many weeks or months to return to “normal.”
Symptoms of Benzodiazepine Withdrawal:
- Anxiety, restlessness, jitteriness, agitation
- Irritability, sensitivity to sound, light and touch
- Impaired concentration
- Panic
- Insomnia
- Faulty memory
- Depression
- Headache
- Fatigue
- Muscle cramps
- Muscle twitching
- Seizures
- Sweating
- Diarrhea
- Blurred vision
- Decreased appetite
Unanswered Questions:
Is this association between benzos and dementia causative or just an association?
- Which brain centers are affected and what could the underlying mechanism for cognitive dysfunction be?
- Could there be some other underlying factors (such as anxiety) that are the real culprits?
- Will younger people who rely on these drugs for years be at greater risk for dementia as they age?
- Are there alternatives to benzos that could be effective for dealing with anxiety or insomnia?
If you would like to learn more about benzodiazepines and strategies for weaning off such drugs we offer our FREE Guide to Psychological Side Effects. We hope it will facilitate a conversation with your physician.
You may also find our Guide to Getting A Good Night’s Sleep of interest.
And we would like to hear your story. Please comment below if you have pros or cons to share about benzodiazepine-type drugs. If you have had trouble getting off benzos, share that story too.
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