Do benzodiazepines cause dementia?
That's the question I'm answering today.
I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
Today's topic is based on a viewer question who asked,
"Dr. Marks, have you heard of anyone
getting dementia from benzodiazepines?
I have a family member who went off benzos cold turkey
and is there is in severe cognitive decline
that actually started after COVID."
Thanks for this question.
First, let me explain
what benzodiazepines are commonly called benzos.
Benzodiazepines are drugs
that fall into the category of sedatives.
They work at the GABA receptors in your brain
to produce a relaxing effect
by slowing brain activity.
They also slow muscle activity
which is why you may have taken it from muscle spasms
to relax your muscles.
Benzos are prescribed
for anxiety, sleep,
seizures, muscle relaxation,
and before surgery or procedures.
The effect of benzodiazepines is immediate
like 15 minutes up to an hour,
if you take it orally.
It can take effect within a few minutes,
if it goes straight into your vein.
So, it's a great short term solution for anxiety
because it works fast
and you don't have to wake weeks
like you would within antidepressant for anxiety.
Some examples of the brand name of these drugs
are Ativan, Klonopin,
Xanax and Valium.
These are called anxiolytics
because they reduce anxiety.
Restoril, Prosom, Dalmane and Halcion
are called hypnotic benzodiazepines
and are used for sleep.
Even though these drugs work fast,
they do have downsides
and one is tolerance.
Tolerance is where the medication
can stop working as well as it did
when you first started taking it.
So then, you need to increase the dose
to get the same effect.
And this can happen to anyone
especially, if you take the medication every day.
Once you start taking it daily
your body adapts to the medication
and chemical changes are made to the brain cells.
If you suddenly stop taking it,
you can get wicked withdrawal symptoms
like intense anxiety that's worse than it was
before you even started taking the medication,
and this is called Rebound Anxiety.
You can also feel confused,
have trouble thinking
or even have abdominal cramps.
The most serious thing that can happen is having a seizure,
if you just suddenly stop taking it.
The way around this serious withdrawal
is to always wean off the medication slowly
under your doctor's supervision.
And slow can be months to years.
I've had patients who were taking Benzodiazepines
for 10 years or more
and they wanted to get off.
I would reduce the medication maybe by a half of a pill
every several months.
And then depending on the starting dose,
it may take a year or more to completely get off.
But the idea is that, you want to take it away very gradually
like you're trying to sneak out of the room
with a sleeping animal guarding the door.
You don't want to wake the beast and similarly,
you don't want to set off alarms in your brain.
You want your brain to barely notice the difference
and adjust itself as you continue
to reduce the medication slowly.
Why would someone who is not having a tolerance problem
want to get off in the first place?
Because of the other part of the question related
to cognitive changes and dementia risk.
Benzodiazepines have been linked to causing
an increased risk of dementia and older people.
Some studies show an association
between people with dementia also taking benzos.
But, the studies don't separate out the people
who already have dementia
and happen to be taking benzos for other reasons,
like sleep or medical problems.
So, the studies really don't support the conclusion
that benzos cost dementia.
But, here's what's not in dispute.
Benzodiazepines do cause temporary cognitive impairment
that includes foggy thinking and compromised memory.
I use the word compromised memory
because it may not be obvious
that you're having memory problems,
like forgetting where you live
or not recognizing people.
It's typically a more subtle forgetfulness,
like misplacing things
or having trouble keeping several things in your head,
like you used too.
This ability is part of your working memory
and benzos can reduce your working memory capacity.
One way, I've heard people describe this
is not feeling quite as sharp as they once were.
They chalk it up to getting older even if they're 30.
Under normal circumstances,
you should not feel like you're on the mental decline
in your 30s or even 40s.
Unless, you're taking something
that can affect your thinking
or you're developing medical problems
that can affect you mentally.
This idea that regular benzodiazepine
use affects your thinking is not new.
But a recent study from earlier this year
is the first to show us
how and why benzodiazepines change your brain
and impair your thinking.
The researchers studied Valium,
and here's what they found that the Valium does.
I've talked about before in other videos
about how nerve cells are connected to one another.
And that connection is important for brain signals
to pass from one nerve to another.
Well, you don't just have one nerve
butting up against another.
You have these other cells called microglial cells
that wrap around the connection points
and hold the nerves together like glue.
These microglial cells are important in the brain
as they do some of the work
of rewiring your nerve connections
and pruning damaged nerves.
Think of them as the clean-up crew.
Researchers saw that Valium interacted
with the microglial cells in a way
that altered their shape
and disrupted the nerve connections.
The Valium also interfered
with the microglial cells ability
to do their cleanup work in the brain,
which impaired cognitive function.
The good news is that they found
that after the drug was stopped
the decreased cognitive ability persisted
for a little while,
but it was eventually reversible.
I didn't see details about how long it takes
for those changes to reverse,
and is that time proportional
to the amount of time that you took the benzo.
In other words, if you took it daily for years
does it take even longer for your thinking
to clear up then if you only took them for months?
Keep in mind, this dampening of your memory
and other cognitive functions results from regular use,
which is daily or several days a week.
You don't see this from using it once here and there.
If you do notice changes in your thinking
from just one dose,
it's probably the leftover effect
of your slowed brain activity,
rather than changes to the nerves shape and wiring.
It would be more like a hangover effect
of the sedating medication
that wears off as the drug wears off.
So, what's the final answer here?
The research does not support the idea
that long term benzodiazepine use causes dementia.
And I'm defining dementia here
as cognitive decline that is permanent.
But research does show that benzodiazepines
cause temporary changes in your nerve cells
that affect your thinking abilities
and these changes are reversible
once you stop taking the medication on a regular basis.
If you're taking a benzodiazepine and want to get off of it,
you need to consult your doctor
who should give you specific instructions
on how to wean off slowly.
The longer you've been taking it
the slower the taper should be.
And there's no specific timeframe that works for everyone,
your symptoms will dictate
how slow or fast that you can go.
It could take weeks, months or a year
depending on how often you change the dose.
What would you do instead
to manage your anxiety once that benzo is gone?
I've got a resource for you that is packed with solutions.
It's my new book called,
"Why Am I So Anxious?".
It comes as hard cover, digital or audio.
You can get it wherever books are sold.
And it's even available in the library system,
if you want to check it out for free.
But after reading it,
I think you'll want your own copy for reference.
But hey, there's nothing wrong with checking it out first.
Watch this video, for a chapter by chapter breakdown on it.
Thanks for watching.
See you next time.