The People's Perspective on Medicine

Will Benzodiazepine Use Increase Your Risk for Alzheimer Disease?

Benzodiazepines like alprazolam and diazepam have been popular for decades. Can such drugs increase the risk of Alzheimer disease if taken for long periods of time?

Americans love benzodiazepines (aka benzos). These anti-anxiety agents are used as all-purpose psych drugs. Millions of people take benzos to calm jittery nerves, ease anxiety and overcome insomnia. They include alprazolam, chlordiazepoxide, clonazepam, diazepam, lorazepam. The generic names are not as familiar as the brands: Xanax, Librium, Klonopin, Valium and Ativan. But despite their widespread popularity, these medications have side effects. And they’re hard to stop. Could taking a benzo, especially over the long run, raise your risk for Alzheimer Disease?

Mother’s Little Helper:

During the 1960s and 1970s, benzodiazepines were incredibly popular. Drugs like Librium and Valium topped the hit parade of most prescribed drugs. The Rolling Stones alerted the public to the dangers of sedatives in its iconic song “Mothers Little Helper” in the 1966 album Aftermath.

Many people were convinced the pills in the song were yellow 5 mg Valiums. Another possibility was Miltown (meprobamate), which preceded benzos. One other possibility was Nembutal. This barbiturate (pentobarbital) was very popular in its day. By now, you get the picture. Americans have had a love affair with sedatives, anti-anxiety agents and tranquilizers for many decades. The Stones captured the culture with these lyrics:

  • “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…”

Benzos and a Connection with Alzheimer Disease:

While many folks may welcome something to help them cope with their stressful situations, a new study from Finland raises questions about the safety of this strategy (Acta Psychiatrica Scandinavica, Aug, 2018) .

The scientists reviewed the prescription drug use of people diagnosed with this condition between 2005 and 2011, a total of 70,719 men and women. They compared this to the medications used by healthy neighbors of a similar age and sex. There were 282,862 of these matched controls.

What they found was that people who used benzodiazepines for anxiety or sleep and even those who used Z-drugs such as zolpidem or zaleplon for sleep were 6 percent more likely to be diagnosed with Alzheimer disease. Although this increase was statistically significant, it is very modest. So many older people take these medicines, however, that the increase in risk is a concern.

Benzos and a Link to Alzheimer Disease | Old News!

This is not the first time researchers have found a connection between benzodiazepine use and dementia. A study published in the BMJ back in 2014 found that benzos could increase the risk of Alzheimer disease by nearly 50 percent, especially among long-term users.

The authors concluded:

“Benzodiazepine use is associated with an increased risk of Alzheimer’s disease…Unwarranted long term use of these drugs should be considered as a public health concern.”

They go on to say:

“Our findings are of major importance for public health, especially considering the prevalence and chronicity of benzodiazepine use in older people and the high and increasing incidence of dementia in developed countries.”

Other researchers have performed data analysis and concluded that benzodiazepine use is not linked to Alzheimer disease (BMJ, Feb. 2, 2016). But a recent review of previous research concluded that there is an association between benzodiazepine use and the development of dementia (Pharmacotherapy, Aug. 11, 2018).

The People’s Pharmacy Perspective:

Benzodiazepines and Z-drugs have their place. After a crisis or the loss of a loved one, some people need an anti-anxiety agent to help them cope or get some sleep. Such drugs can be helpful for short-term use. When weeks stretch into months and months stretch into years, such drugs pose problems. For one thing, they are very hard to stop.

People taking drugs like alprazolam or lorazepam often complain of withdrawal symptoms of they stop too suddenly. Older people may be especially susceptible to dizziness and falls while taking benzos. If there is an increased risk for Alzheimer disease, that is a double whammy. Learn more about this problem in our Guide to Drugs and Older People.

Researchers are learning that many things contribute to dementia. Our genes are one factor. If mom and dad had Alzheimer disease, our chances of experiencing cognitive decline are increased. Head injuries are another important factor. So is exposure to anticholinergic drugs.

Other chemicals and medications may also play a role in mental decline. There is growing evidence that benzos may be part of that process.

Share your own experience with benzodiazepines below in the comment section. Was stopping challenging? If so, how did you deal with the “discontinuation syndrome”?

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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I took xanax for twenty yrs. I never took more than prescribed which was 0.5 at night and another half of that at noon. Well I usually only took half a day and sometimes they other half if needed. Then I weaned down to only half. Then I decided I wanted to get off it entirely so I only took a forth of a 0.5 for a long time. I started having severe dizzy spells. Fall-to-the- floor dizzy spells. I thought it was from my heart. I had no idea it was from the xanax. Then I stopped all together. I lasted 7 weeks and then started having more symptoms like severe shaking.

When the shaking happened I took half a pill, and the shaking stopped. I did have a heart workup so my symptoms were not from my heart. So because I was dizzy my doctor switched me from xanax to valium. 5mg twice a day. In the beginning this worked well but now two yrs later I have reached a point where they don’t work as well, and I’m having anxiety symptoms now. I’ve been told it’s because I have reached tolerance. I’m 65, and now I’m starting Zoloft because of my anxiety. One day they will wean me off valium which I do not welcome at all. But if the tolerance to valium is causing my anxiety I need to be off the valium.

The general public, as well as most physicians, have no idea just how damaging long-term use of benzodiazepines truly is. Their expected pharmacological effect is amnesia/memory loss. That’s what they were DESIGNED for. The drug’s effect is independent of the user’s mental condition, or diagnosis, or even species; vets use them for conscious sedation of animals. They’re used in dental and other surgical procedures specifically to make the patient forget or be unaware of what’s happening.

People taking benzos every day are confused and uncertain about events; including what the drug is doing to them. Recent studies aside, all one has to do is google benzodiazepines to read tens of thousands of medical articles on their effects and warnings against long-term daily use written since the 1960s when they first came out. There are currently upwards of 50,000 patients on various online support sites trying to help each other through the often horrific withdrawal from them after receiving little to no help from medical professionals who have been grossly misled about the prevalence and severity of adverse effects. Many are unaware that physical, mental, or emotional issues they’re having are directly caused by these drugs, and doctors frequently add other meds to ‘cure’ the consequences of the benzos without attributing these new symptoms to benzo use and dependence.

All of this is coming to light after decades of controversy. Patients have to do their own extensive research, as well as have serious discussions with their doctors and pharmacists about the dangers of chronic benzo use.

I have been taking Clonazepam (1 tab. at night to rest) for 30 years, I am 75 and in excellent health. Clonazepam is the only prescription I take. I believe the rest I get at night from taking this medication has helped to alleviate all other medical problems, such as high blood pressure, etc. that I don’t have. Also I live alone and handle all my financial affairs and take care of my house and property.

I’ve been taking Diazapam for about 30 years – 5 mg. I take that and half of a 500 mg. Tylenol and I sleep. If I didn’t that that I would NOT sleep. So, it’s risk vs. reward and I don’t think we should be scaared over one research team in Finland. Everyday it’s something else and then the something else turns out not to be right.

This is a very complicated issue. You are correct in pointing out that benzodiazepines may not be the drugs of choice for older patients. However, they help many people live a more normal life. With psychotropics, like all drugs, there are trade-offs. Some non-elderly people take these drugs long-term and do not seem to experience any significant cognitive problems. It remains to be seen what will happen if they continue taking them into their senior years.

I have been on Lorazpam for at least 10 years for anxiety and insomnia. It has been a God send. I tried every natural remedy ,exercise , massage , meditation , and music therapy. It was the only thing that allowed me to sleep and continue with my life.
I also use Zolpidem 6.25 mg infrequently. Usually when I need to travel.. These medications turned me from a sleep deprived zombie into a functioning human being.

So far I have not noticed any cognitive problems. Don’t scare people away from medication that may relieve there suffering. I am 68 years old and doing fine.

Personally have taken alprazolam (xanax) .5 mg initially for very severe panic attacks and generally, very high stress. Work and family demands cause these problems. Found that these medications were fast acting and were a useful “tool” to deal with my “A personality” type. Have been taking them on and off for at least thirty years, or more. Cognitive therapy and meditation is also useful. Compared to the described Miltown & Nembutal, the results are far more effective.

Those referenced rock lyrics are counterproductive (BTW, it was about Valium). It is plainly stupid and lends the idea that one can get high from “benzos”. If sleep is your “high” then you have a problem. This writer has an bit of an insight as my family owned a pharmacy. Forward to the premise: Unlikely that benzodiazepine class drugs will exacerbate any Alzheimer’s concerns. It should relieve them! BTW, this writer is old and crisp as new Benjamin.

I stopped excessive drinking in 1970, I was put on Elavil .25 mg’s. I stopped taking it abruptly without knowing the consequences. I ended up going paranoid, hallucinating and fearful. I finally got over the withdrawal symptoms, but then in 1976, a woman introduced me to valium. I tried getting off of valium once, I was very nervous and I was passing gas a lot. I have had trouble sleeping since I was a kid due to a traumatic childhood experience. I take 5 mg’s nightly along with a benadryl tab to sleep. I am very close to 76. So far my memory and my motor skills are fine.

Researchers are also investigating the strong indication that the HSV-1 virus is the main culprit in both Alzheimer’s and Brain Cancer. Who to believe?

I have had two friends who were in their nineties who both fell. One broke her back and the other broke a hip. Both ladies had sharp minds with no sign of dementia. After being in the hospital for three days they were not the same. Both had dementia and have since gone to nursing homes and will finish out their days there. Speaking to other people they say they have heard of the same thing happening. What’s going on? Do you have a clue? I am 90. still drive and walk without any aid and am working to improve my balance.

I’ve been taking Alprazolam for an “off label” medical issue for well over ten years, starting at nine, .5 mgs., and have reduced it to 2.5 mgs. daily, with no problem at all. Withdrawal should be done slowly, and under the supervision of a Clinician, not suddenly stopping the medication.

My issue is is the necessity to ramp down my Central Nervous System, and Alprazolam has been the best medication to accomplish an overactive CNS. Both parents had Alzheimer’s/Dementia, and so I am willing to take the risk using the medication, as I will likely develop All/Dem at some point in my life. I’m 73, and I take University level classes to maintain neuro-placticity, and I maintain as healthy a lifestyle as possible. I do not have anxiety, or need a bit of help sleeping, and had no problem reducing my dose to a level that worked well for me.

I look forward to further study of Alzheimer’s/Dementia and Benzodiazapines, as I feel if patients do not have addiction issues, and are watched carefully, that this drug is advantageous in maintaining good health. I would have no problem eliminating Alprazolam from use, but would suffer dire consequences with my overactive Central Nervous System. I suspect that government funded studies may used for the purpose of eliminating a valuable controlled substance as they have with Opioids and other similar drugs. Each patient should be viewed as an individual by his/her PCP, and a decision made that is appropriate.

I am not a big believer in Better Living Through Chemistry. Pharmaceuticals have their place in Heroic Medicine such as in an emergency situation. I use Ashwagandha daily (only one capsule) to ease anxiety and to help me sleep. This herb comes from India and has been used by possibly millions of people for centuries. In healing people the saying “above all else do no harm” should always be considered.

I have taken clonazepam for YEARS at bedtime to escape tinnitus so I can sleep. I never use it during the day and I stay at 1mg (sometimes 2 mg.) As I am nearing 70, this info is particularly alarming. Because I have Meniere’s Disease, dizziness is a concern but I have to sleep…and I have to not hear the ringing.
A conundrum! Clonazepam is the only thing I’ve ever tried that doesn’t leave me hungover feeling.

Have been taking this terrible benzo for almost 6 years. Am desperately trying to get some authentic Help to transition to another medication which will actually help the rare, unusual physical condition I am enduring. So far it seems hopeless. No help from doctors. Am afraid, totally distressed and desperate!

Jayne…Thank you for your very important information on health issues. I am an 82 yr.old female…widowed three years ago. Have been taking Fluoxetine 20mg {Prozac} daily for several years and I never hear any pros or cons about Fluoxetine as my PCP ‘s seem to leave taking it up to me. Of course, I have some trouble remembering names and searching for the correct words, but am self-sufficient in cooking, bill paying, shopping, driving a car etc. Thankfully, I am a very healthy and happy person. Thank you.

I am,70, concerned about this. I take benzos and have done for years to help me sleep. But: I) I have tried (read) everything else and nothing works and I would get even less sleep without them; 2) Matthew Walker’s new book, “Why We Sleep”, makes it very clear how damaging to all aspects of ones health lack of sleep can be, and, as I recall, that includes an increased chance of dementia. So there is, so to speak a trade off; 3) In terms of everything else from diet to exercise to a lot of mental acclivity, I do everything right so to what extent is this a major countervailing factor: 4) You cite a 2014 BMJ article that purports to show the above link. In 2018 the BMJ published an article that refuted this one: “Benzo Use and Risk of Incident Dementia or Cognitive Decline: Prospective Population Based Study,” BMJ 2016: 352:i90. (Published February 2, 2016).

How much Xanax is too much..and how ‘long’ is too long? I’ve used .25 mg tabs ‘as needed’ (less than 90 per year) for over 10 years! I’m now afraid to use them even occasionally, but have not had any withdrawal symptoms. I’m 70 years old and in excellent health. Should I stop these all together?

I have used 1.5 Mg of Xanax just for sleep for 7 years. I don’t use it for anxiety or any other reason. Sometimes, I try to reduce to 1 mg or if very stressed, up to 2. So far, I have common memory problems but no signs of dementia. I have tried OTC and natural supplements but they don’t work or leave me groggy. If I forget to take it which happened once about 6 months ago, I just find myself awake at 2 AM…but no withdrawal symptoms. I am grateful my doctor prescribes it.

There is no mention if dosage is a factor. I take .5 mg alprazolam at bedtime. Some people take much more than that.
I am 79 and have taken this for 8 years. Wish I have known how adictive it is and I would have found safer ways to sleep well but doctor says it’s fine.

I have recently learned to pay a lot more attention to the role of anti-cholenergic effects of medications. I had often heard that they might cause something that looked like dementia, but they are so helpful that I continued to prescribe them. In the past year I had a patient referred for dementia. Family had taken away the car keys because he got lost driving. He was on Amatriptyline 600 mg nightly for sleep. That medication was tapered and stopped. He complained bitterly of inability to sleep, but he was competent to drive again.

Another patient was brought in by her mother who had taken over her care because she was so mentally confused. Careful history revealed that she was taking 6 tablets of benadryl containing over the counter sleeping aides every night. With much effort, I convinced her stop her night time meds. Within a week she was clear headed and living in her own apartment again. Both of those events focused my attention on the reality of mental issues with anti cholinergic meds.

I had been on Flow Max for urinary urgency for about two and a half years. It seemed a blessing to me. No longer having to stop the car and get out to pee on the side of the road. It got to the point that even Flow Max wasn’t working well enough and I opted for surgery. Surgical recovery was pretty rough, but a month later I noticed that I was no longer making mistakes when I wrote prescriptions. Prior to that time I had made enough mistakes that I was having other staff double check every prescription that I wrote. Once I stopped the FlowMax that wasn’t necessary any more. I now think that what I had assumed was typical age related mental decline completely cleared up once I was off the FlowMax. Up to that point I would not have suspected I had any medication related impairment.

The anti-cholinergic effect is clearly real.

I’m not at all sure that the association between benzos and dementia is causative. I think that eventually it will become clear that early in the course of developing dementia, people have trouble with anxiety because they are having to work harder to keep their lives on track. Those people ask the physicians for relief in the form of medication and subsequently their dementia process becomes more evident. For these patients, I’ve come to the conclusion that quality of life trumps concerns that this antii-anxiety treatment will somehow “cause” dementia.

Has anybody had experience with seroquel XR? One a recovering alcoholic/addict and this is the only thing that has allowed me to sleep and live a morlam life. I am concerned about future side effects but have come to the conclusion that I would not have a future without the current meds.

Benzos have been a lifesaver for me in dealing with anxiety and insomnia. Getting off them is not a problem as long as you go very very slowly. I hate to see benzos thrown under the bus when there are so many factors contributing to denentia.

I was prescribed Lorazapam about 15 years ago to calm occasional tachycardia from a heart condition known as SVT (supra ventricular tachycardia). Gradually I started using it as a sleep aid. I began to rely on it to sleep and used it regularly. At some point a few years ago I realized that perhaps I was emotionally dependent on it, perhaps was addicted to it, and chose to wean myself off of it. I can tell you it took all my will-power and determination to end my dependence on Lorazapam. I did it gradually by cutting pills in half then taking every other day etc. and have been ‘clean’ of Lorazapam for 5 or 6 years now. It turns out this was a very good decision in light of this report on it’s connection to Alzheimer’s. Yes, it was very, very difficult to wean myself off it – but worth it. I hope I don’t pay for it now at 74 and counting…

I think antidepressant drugs are like all others as far as side effects so to single ut a specific drug like this to point out its dangers is not fair to the public because ANY drug you abuse will cause damage to your body and to your health in general.

I think if a person is suffering from pain, repression or any kind of debilitating condition they should be allowed to take the medication they need to get better. Anxiety and panic attacks can kill a lot faster than taking a drug to combat it.

My sister, now 93, has been using Xanax for the past 9 years. She is sharp and her memory is way too good. OK, she’s in the lucky 94%.

As an older adult (72) and seemingly in very good health, I have a recurrent issue with insomnia. My primary care doctor referred me to a local sleep clinic where it was determined that I do not have sleep apnea. Having tried all the herbal and most other remedies know to man, I’m still wide awake at 3:00 p.m. doing relaxation exercises and wondering why the no-caffeine after 11:00 a.m. and my strenuous exercise program isn’t working. One wonders: is it more harmful to go without sleep and be exhausted every morning or more harmful to take part of a sleeping pill and feel well the next day? Both my doctor and the sleep specialist vote for the second. There’s so much written about the importance of sleep and that, of course, translates into more concern about not sleeping. I have no history of taking any substance on a regular basis and wonder if that’s the rationale for my physicians deciding that some help, two or three times a week, is a better idea than feeling like a zombie in the morning, particularly at this age.

what is the best way to wean off of valium. I have been taking it for a couple of years, not every day and always breaking a 5mg in half. I want to stop. what do u suggest . Thanks LK

What dosages are dangerous? If you take only .5 mg per day at bedtime, is that enough to increase your risks?

Having read this column for a while, is there any drug ever made that is not associated with Alzheimer’s disease?

I benefit from Benzos for 40+ years .
I will GLADLY take that risk.

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