Benzodiazepines like clonazepam have an important role in treating severe anxiety in the short term. Too often, however, people may end up taking these medications for lengthy periods of time. After many months, it can be quite difficult to discontinue such drugs.
The Trouble with Clonzepam:
Q. I’ve been taking clonazepam 0.5 mg for about 3 months, and I do not recommend it.
I was having dizzy feelings (work-related stress), insomnia, and was prescribed this medication by a neurologist. The medication worked initially, allowing me to get several hours of sleep. As time passed, I had to split the pill up as I was getting bad side effects.
I’m 26 years old, and now I’m trying to get myself back to normal as I’m consistently confused and tired. I have experienced feelings of hopelessness, suicidal thoughts and not wanting to do anything.
After talking with my doctor and psychotherapist it was decided to wean off this medication and try amitriptyline. I know this is an antidepressant but I am reading that it too can cause somewhat similar side effects.
The moral of the story: if you have anxiety, go to a therapist first before seeking drug treatment. Also, on a side note it’s nice to have an outlet like this website, so you can interact with people who understand and share how you’re feeling. Most others have no idea what you are going through.
Clonazepam and Other Benzodiazepines:
A. Clonazepam (Klonopin) belongs to a category of medications called benzodiazepines or benzos for short. Other popular benzos include:
- Alprazolam (Xanax)
- Chlorazepate (Tranxene)
- Chlordiazepoxide (Librium)
- Diazepam (Valium)
- Lorazepam (Ativan)
- Flurazepam (Dalmane)
- Oxazepam (Serax)
- Prazepam (Centrax)
- Temazepam (Restoril)
- Triazolam (Halcion)
Mother’s Little Helper:
During the 1960s and 1970s, such drugs were incredibly popular. The Rolling Stones immortalized sedative-type drugs in its amazing song “Mother’s Little Helper” from the 1966 album Aftermath. Some maintain that this song was about 5 mg yellow Valium pills. Others insist it was about the barbiturate Nembutal (pentobarbital). Still others suggest it was about Miltown (meprobamate). Regardless of the actual pill the Rolling Stones had in mind, the words apply to many of the sedatives and tranquilizers still prescribed today:
“Kids are different today, I hear ev’ry mother say
Mother needs something today to calm her down
And though she’s not really ill, there’s a little yellow pill
She goes running for the shelter of a mother’s little helper
And it helps her on her way, gets her through her busy day…
“Men just aren’t the same today, I hear ev’ry mother say
They just don’t appreciate that you get tired
They’re so hard to satisfy,
You can tranquilize your mind
So go running for the shelter of a mother’s little helper
And four help you through the night,
Help to minimize your plight.
Doctor please, some more of these
Outside the door, she took four more
What a drag it is getting old…”
Towards the end of the song, the Stones warn:
“And if you take more of those
you will get an overdose
No more running for the shelter of a mother’s little helper
They just helped you on your way
through your busy dying day.”
Benzodiazepines remain 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 an article in the BMJ, 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 are dispensed from U.S. drugstores each year.
The Story on Clonazepam:
The Food and Drug Administration approved clonazepam for seizure disorders. It has also been given the green light for panic disorders, although the FDA is very cautious to say that the drug’s effectiveness for more than 9 weeks has not been studied in well-controlled clinical trials. The FDA warns that any doctor “who elects to use Klonopin [clonazepam] for extended periods should periodically reevaluate the long-term usefulness of the drug for the individual patient.”
Many physicians do prescribe clonazepam for longer than 9 weeks. And they often prescribe it “off label” for things like anxiety and insomnia. We worry that many doctors fail to warn their patients that clonazepam can interfere with mental alertness and that no one should drive or operate machinery while taking this drug.
There is also an FDA warning that
“Antiepileptic drugs (AEDs), including Klonopin [clonazepam], increase the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Patients treated with any AED for any indication should be monitored for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior.”
Benzo Side Effects:
- Drowsiness, dizziness, fatigue, lethargy
- Clumsiness, impaired coordination (not good for older people)
- Memory problems
- Cognitive impairment, difficulty concentrating, confusion, irritability
- Dry mouth
- Sexual difficulties
- Low blood pressure
- Difficulty stopping the drug
Benzos and Dementia:
There is a darker side to benzos. French researchers have investigated a possible link between benzodiazepines 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.
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.”
Stopping benzos is not always easy. One reason so many continue to take these drugs for so long is that it can be incredibly challenging to stop them. 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
- Faulty memory
- Muscle cramps
- Muscle twitching
- Blurred vision
- Decreased appetite
Is this association between benzos and dementia causative or just an association?
- 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.
If you find this kind of information 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. While you are at it, you may want to let those you care about know that they can sign up for our **FREE** People’s Pharmacy electronic newsletters and health alerts by visiting our site and putting their email address in the box provided. Staying informed on breaking health news stories is the best way to protect yourself and those you care about.