1. Are BZDs a Good or a Bad Idea?
Rakesh Jain, MD, MPH
Lightening strike -
Idea -
Benzos are ALWAYS a good idea and we are way under prescribing it –
Benzos are ALWAYS a bad idea and we are way over prescribing it –

2. Can Long-Term BZD Treatment “Harm” the Brain
Can Long-Term BZD Treatment “Harm” the Brain? Results from an NIMH Study
There was no significant association between VBR and age (r = - .06, P = NS), panic attacks within the past month (r = .04, P = NS), or state anxiety (r = .19, P = NS)
There was a significant association between VBR and duration of BZD use (r = .51, P < .02) and percent of time ill treated with BZDs (r = .67, P < .001)
VBR = ventricle to brain ratio.
Uhde T et al. J Affect Disord. 1987;12(12):

3. Does Cognition Improve after Withdrawal from Long-Term BZD Use?
Improvement in cognitive function does occur following withdrawal from long-term BZD use
Patients withdrawn from long-term BZD use continued to perform more poorly than controls across all cognitive categories, except sensory processing
As age increased post-withdrawal cognitive recovery decreased on tasks of attention/concentration
Articles:
Barker MJ et al. Arch Clin Neuropsychol. 2004;19(3):

4. Higher risk for long-acting formulations
BZD Use & Association with Alzheimer’s Disease – Emerging Data is Concerning
Dose-effect relationship between BZD use and increased risk of Alzheimer’s disease in older people treated previously for >3 months
Higher risk for long-acting formulations
Nature of the link cannot be definitively established
BZD use may be an early marker of a condition associated with an increased risk of dementia
Recommend shortest duration + short half-life formulations
Billioti de Gage S et al. BMJ. 2014;349:g5205.

5. Top 3 Practical Take-Aways
Before using benzodiazepines in any patient, a careful short- and long-term assessment of the risk-benefit is a necessity
Data is accumulating that risk of addiction and physical dependence of this class of medications is higher than originally anticipated
If a decision to slowly reduce or stop these medications is made in conjunction with the patient, there are now several well studied pathways available to achieve this goal