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Sleeping Pills, Anti-Anxiety Drugs & Dementia

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Can medications you take to get a good night's sleep or ease anxiety increase your risk for Alzheimer's disease or dementia? That is the question being raised as a result of a new study published in the BMJ (formery 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. According to our calculations, over 100 million benzo prescriptions were dispensed from U.S. drugstores in 2010.

Popular Benzo Brands:

Alprazolam (Xanax)
Chlordiazepoxide (Librium)
Clonezepam (Klonopin)
Diazepam (Valium)
Lorazepam (Ativan)
Oxazepam (Serax)
Temezepam (Restoril)
Triazolam (Halcion)

This does not include the Z-drugs which are prescribed for sleep. An example is zolpidem (Ambien).

The French researchers investigated a possible link between benzos 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. That would have required a randomized, double-blind, placebo-controlled protocol where half the older people were put on a benzo and the other half put on placebo. The trouble is that such a study would have cost hundreds of millions of dollars and would have taken at least two decades to complete. Such a study is unlikely to be conducted given the cost and the time.

So we are stuck with epidemiology for now. There are other studies that have come up with a similar conclusion. 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."

In fairness, though, there have been some studies that have not uncovered such a relationship with benzos. This BMJ study is, however, one of the largest and longest. The authors conclude:

"Benzodiazepines remain useful for the treatment of acute anxiety states and transient insomnia. However, increasing evidence shows that their use may induce adverse outcomes, mainly in elderly people, such as serious falls and fall related fractures. Our data add to the accumulating evidence that use of benzodiazepines is associated with increased risk of dementia, which, given the high and often chronic consumption of these drugs in many countries, would constitute a substantial public health concern. Therefore, physicians should carefully assess the expected benefits of the use of benzodiazepines in the light of these adverse effects and, whenever possible, limit prescription to a few weeks as recommended by the good practice guidelines."

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

Based on the number of prescriptions that are filled for drugs like alprazolam, chlordiazepoxide, clonezepam, diazepam, lorazepam, oxazepam, temezepam and triazolam annually, it is clear that millions of people are taking "mother's little helpers" every day for months, if not years.

One reason so many continue to take benzos for so long is that it can be incredibly challenging to stop these drugs. 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. Trouble getting off, share that story too. And please vote on this People's Pharmacy Health Alert.

Thanks for taking time to consider what we think is an important health news story.

If you find this kind of People's Pharmacy Health Alert worthwhile, you may want to share it with a friend. At the top of this page you will see a box next to the title with icons to email this to a friend or acquaintance or post to Facebook or Twitter. While you are at it, you may want to let those you care about know that they can sign up for The People's Pharmacy electronic newsletters and health alerts by visiting our site and putting their email address in the upper right hand box that says "Free email newsletter." Staying informed on breaking health news stories is the best way to protect yourself and those you care about.


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35 Comments

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In reference to the use of stimulants for ADD:

You had a speaker state people don't think a pill is an answer to everything. I am a pharmacist and people actually do think that way! Why diet or exercise? There are pills to fix cholesterol and BP.

I see families where all 3 children are on medication. Children are by nature undisciplined and need to be taught focus and structure as part of the maturation process. Stimulants are definitely over used

Are there epidemiological studies that found similar results for antidepressants like Wellbutrin?

I have a problem with this report. I have been on Clonezepam for years. I am 75 going on 76 and do not have the problems stated. I write articles frequently for a local newspaper without any problems. Yes, I have some memory loss. BUT, also remember many things from my distant past.

If this study is correct why is there not more serious problems in all the countries listed? The numbers listed should create an epidemic in all the countries, even here. This would certainly be a serious problem and DEMAND action in the mediacl field, and even the government.

In 1989 I had foot surgery, was given the "Valium cocktail" to relax before the anesthesia. For the following six months I felt "foggy headed" just not quite with it. Had no clue why.

Several years later, needed another foot surgery. Mentioned to anesthetist and was given one-half the Valium cocktail. For three months felt "foggy headed".

Another surgery many years later, I refused the Valium completely, was already prefectly relaxed about the surgery and felt clear headed immediately following the procedure.

Have thought I was just particularly sensitive to Valium, but maybe I'm just more particular about thinking clearly.

I've been using Triazolam occasionally for close to 30 years, but in dosages like 1/2 tab every other month or so. So far, no dementia issues that I remember.

I was given a prescription for Xanax...for anxiety...but did not take any. The more I read, the less I wanted to take it...but I did go off of Priosec (generic form omemprazole) and I do not seem to have as much anxiety?

It was terrible going off omeprazole but thanks for ginger, apple-vingar and TUMS..am down to 2 a nite....(when I have the most problems)....

I've been a nurses aide for 13 yrs and have noticed in the last couple of years that many resisdents on these drugs are seriously addicted to them. It's not just the elderly living in long term care facilities anymore and many are coming in allready addicted.

I'd be interested in knowing if Lexapro has any place in this discussion. Have been taking it for many years and would like to stop.

I take Lorazepam for anxiety caused by sudden hearing loss and tinnitus. It helps me to go sleep.

However, I DON'T DREAM when I take it. When I do not take the pill, I have vivid dreams. It is then affecting my brain function somehow, right?. The problem now is that I cannot go to sleep without it.

I am going through a crisis with my husband. Can't sleep at night,
altho bone tired. I try to take ativan once a week or I take
1/4 of Xanax tablet. I noticed on the next day that I take the Xanax
I have a lot of energy (and believe it, I have never been a person
with a lot of energy).

I am aware of the addiction problem with these drugs and I try not
to over use them.

Some one suggested Unisom to me...so I am going to try that.

I also have anxiety in the middle of the day with all I am going through
and if I take ativan or xanax it just makes me sleepy. I don't know
what the solution is. I am 80 years old, I exercise at a gym several
times a week. I don't have any memory problems except where did I
put my keys this time???? Funny stuff.

Any suggestions for daytime anxiety would be helpful.

Thanks for this update Terry and Joe.

I would like to hear more on this subject.

Is Buspirone HC1 the same thing? I hope not. That is the only thing that helps with severe anxiety for me. For the first time in my life, now I can enjoy a day and sleep at night.

My wife is in late stage alzheimer's. She is 80 and lives in a memory care facility. They often give her lorazapam to calm her agitations. I wonder how this study might relate to her.

The question is: Is it the drug one takes for trouble sleeping and/or anxiety that increases dementia OR

ARE PEOPLE WHO HAVE DIFFICULTY SLEEPING OR DEALING WITH ANXIETY AT HIGHER RISK OF DEVELOPING DEMENTIA REGARDLESS OF WHETHER THEY TAKE MEDICATIONS TO TREAT THEIR SYMPTOMS OR NOT?

I will be 88 years old on 3 Oct. I have taken 45 mg mirtazapine and 2 to 3 .5 mg clonazepam every day as well as .5 mg ambien occasionally since 2008. I am doing better than most people my age. I can't remember everything from the past but I think I do very well. I also lead a pretty dull life. Reading has been the one constant of my life.

A PS. I was once on ativan and got off it by walking the floor. I would not take it again. But prednisonse can make a nervous wreck out of you also.

When I travel, I take 1/2 or 1 Ambien to put myself on the time schedule of my destination. I know that when I get home, be it two days or two weeks later, that I have an awful 2 or 3 days of non sleep, jittery, restless legs - the whole kit and kaboodle of body reactions - until the Ambien is out of my system. My husband takes 1.5 ambien every night as well as Tylenol p.m. I'm afraid he'd really have to check in to a detox center if he ever decided to quit. I'm going to have to rethink the usage of this drug. Thank you for this alert.

Torrence, you alone are a sample of one. It means you are one of the fortunate, but some people will have adverse affects. Terry and Joe are notifying the rest. Thousands of people have to be tested to see which adverse effects even occur. Even placebos have had side effects reported.

I am a 71 year old female diagnosed with anxiety disorder. I take one half of a Xanax 0.25 pill several times a week. I don't like to take it because it always affects my memory while it is in my system. This always happens, and did from the first time I took one.

I used to be a social drinker when I was younger, and even when I was in my forties, alcohol had the same effect. I over react to medications, so I take the least amount of what will benefit me. I wish I knew of a different drug. I really need somthing as the anxiety affects my heart.

Typical sensationalism - The article states an "approximately 50" increase in risk.

In my math, which is apparently different than the author, 32%/23% = 1.391 which is a 39% increase. I am not saying that 39% is not significant but it is quite a bit less than 50%. Please lets not be so flip with the numbers. It makes the whole article lack credibility.

BLK has a darn good question (wouldn't people who have anxiety and sleep problems be more likely to develop dementia anyway?) I think they would be. The "mind-body continuum" is quite real and compelling. This is similar to the recent study which reported that people who use sleeping meds are more likely to "die early." YES, but how about the lifestyle, behavioral and psychological factors which often accompany anxiety and inability to sleep? Many of these factors might lead to an earlier death all by themselves.

Additional questions to be answered:
What dosages and lengths of treatment were looked at in the study? If these were considered, were there low doses or short treatment periods which did not increase the risk of dementia?

Does a later period without the drugs result in a reduced risk of dementia (again)?
Were confounding factors of other drugs considered? For example, did the risk of dementia go up when the person also had been exposed to anesthesia for surgery, especially lengthier surgery?

Magnesium helps, and is good for you anyway.

FTH ask your doctor to give you a small amount of == Clonezepam (Klonopin)===
My Doctor suggested that to me instead of Zanax== it seems to be milder & last longer with no withdrawal systoms.

Paul

Retired now, I was a nurse for over 42 years. The increase in the use of these addictive drugs is staggering. No doubt, in my mind that these drugs change the way people think. These symptoms appear as poor logic, poor memory and impaired reasoning even before dementia appears. Worse yet, these meds tend to come in very tiny pills, somehow making people think they are safer. It was very common to see withdrawal in patients who were hiding their overuse of these drugs, and the withdrawal was a frightening thing to watch. Severe confusion, agitation and even hallucinations can result and last for days.

Please report on Ambien in light of it's dangers. I am not sure how that drug made it to the market, but people who use it seem to have problems similar to what you are reporting here with benzos.

Could it be that chronic anxiety diminishes the hippocampus, which is vital for memory, and that anti-anxiety meds actually prevent memory loss from being worse than it otherwise would be?

When used in combination with another antidepressant (i.e. Effexxor) or gabapentin, the benzos definitely effect short term cognitive function. These adjuncts are commonly co-prescribed for anxiety accompanying depression and/or sleeplessness. In absence of engraved in stone proof, we have to strongly infer that if the short term effects of these combinations or singly prescribed drugs create memory dysfunction and absent minded behavior symptoms, then we should assume that they will have a definite causative effect in older patients when taken for chronic conditions. One of my favorite adages is that the main cause of problems always seem to be the solutions to the previous problems.

Let's not forget that the immediate adverse effects of benzodiazepines can include, but are not limited to, drowsiness, poor concentration, and mental confusion, all of which could impair performance on tests of cognitive functioning and suggest possible dementia. What happens to the symptoms of dementia in these long time users when the medication is withdrawn?

I am so very frustrated to the point of crying anytime I read why sleeping is good for you. I am suffering from insomnia! Does anyone wake up saying "today I'm not going to sleep?" I've been to the psychiatrist, who took me through journaling, cleaning my bedroom of any distractions, etc to no avail. I've taken chamomile, melatonin, all the herb teas supposed to induce sleep. I've taken Ambien with disastrous results. I'm currently doing acupuncture, I exercise about 4 -5 times weekly and I still can't sleep.

I have high cholesterol and a family history of strokes and heart attacks. Am the only one without hypertension. Am scared anytime I read these medical stories and get stressed out. What should I do? I need help. It's been going on for three years. I need help please... somebody out there. Please help me. I have to wake up and go to work every day but gradually I'm losing it. I forget things easily and I work with students. Help.


Read more: http://www.oprah.com/comments/100000002/29417/13#ixzz28k4hqyVI

To D.A., I am sorry. I have similar problem with insomnia and anxiety. For me it has been lifelong... But it kicked in hard about a year ago. I have tried all the things you mentioned.

The greatest sleep aids for me are 1) daily vigorous exercise, 2) worrying less, 3) daily sunshine. I have most control over the first; it is also the most effective.

I suggest you read Say Goodnight to Insomnia by Gregg Jacobs. The author provides insight that may help you worry less and a plan that may help you move toward better sleep. My sleep is not great but it improved greatly soon after reading this book and might be better if i was more compliant with his program.... But here I am on the internet at 11pm...

Regular yoga helps me. Yoga is relaxing and can get you some needed rest (i know it is no substitute for sleep). With practice, yoga can also help you learn to stay present with discomfort... Which somehow makes it possible to believe the future can be better... And it frequently is.

I wish you a good night's sleep ...

BLK said:
The question is: Is it the drug one takes for trouble sleeping and/or anxiety that increases dementia OR ARE PEOPLE WHO HAVE DIFFICULTY SLEEPING OR DEALING WITH ANXIETY AT HIGHER RISK OF DEVELOPING DEMENTIA REGARDLESS OF WHETHER THEY TAKE MEDICATIONS TO TREAT THEIR SYMPTOMS OR NOT?
-----------

This is *exactly* my question. If the people began taking the drug 3 years later, but had not earlier, it is perhaps because they began experiencing symptoms for which the drug provided help. In other words, the symptoms of difficulty sleeping may have appeared, indicating a problem, and the drug was prescribed subsequent to that issue.

I have one comment on this subject already, but reading all of the other comments I thought I might have another one that might be of some help. My wife who takes a pill to help her sleep, has become a couch potato. Nothing I say to her about exercise, of which I do, helps. I believe that when you become a couch potato you WILL have many problems with your health. My wife hurts all the time just about everywhere. I love her dearly but I'm helpless with her situation.

There are many factors to anyone's health. Some people can take a certain pill without any effects, and another taking the same pill may have all kind of problems. But in reality we are our own worst enemy. I have anxiety, but believe the way I have lived my life caused most, if not all of it. We live in a fast paced life style and wonder why need pills to get by. It's because we have chosen a life style that will demand a pill. The bible tells us to "be content with what you have". I have yet to find anyone that fits the bill. Sorry for the long letter.

Love your analysis.
Feeling the same, 41 going on 42. Ha!

Benzos are intended to be used short term! I started on 1 mg of clonapin per day 10 yrs ago. Progressed to 3.5 per day and after a 1 yr taper switching over to Valium, have become benzo free. benzo use contributed to an 80lb weight gain-lost over 70lbs during wd. over time they effect your metabolism. Benzo use cost me over 30k.

My memory has slowly returned but not at previous level. I don't know long term effects. The wd was horrible w regular brain zaps. I worked w a physician exper w tapering and followed The Ashton Manual.

We need more support groups for people wd from benzos. Few rehabilitation programs are adequate in helping benzo wd-its very protracted and does not fit into a 30 day program that most insurance covers. I strongly suggest that no one take any benzo beyond 6 months!

There are options available that don't have the level of toxicity caused by prolonged levels of benzo in the blood plasma and suppression of natural GABA production. GABA is a critical substance that regulates many physiological and cognitive functions. My impulse control was not good and there are other aspects of behavioral change I feel directly attributed to my benzo wd-overeating, saying offensive and inappropriate comments, lack of boundaries. I hope that others can learn and be proactive in harm reduction regarding these very dangerous substances that are insidiously deceptive.

I've been taking Halcion for 30 years with no ill effects that I'm aware of. However, I use it very little -- typically 1/4 tablet to get back to sleep after waking in the mddle of the night, and usually only 2 or 3 times a month. I also take a larger dose -- 1/2 tablet at bedtime -- if I feel like I'm getting the flu, believing that good night's rest is important for fighting it off. Seems to work.

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