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

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  1. Nyla

    My mom was recently diagnosed with Alzheimer’s. She has been on both of these medications for years and now is being taken off of them. It is so scary to hear what medications can do to you. It is probably to late for my mom but I’m sure happy that other people might be saved from this horrible disease.

  2. DrMikey

    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.

  3. mike

    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.

  4. SC

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

  5. Torrence

    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.

  6. KHS

    BLK said:
    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.

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