Least sedating benzodiazepine
If taken over long periods, the BZs can produce a loss of muscle coordination and some cognitive impairment, especially in the elderly. They also can use the BZs to help with sleep, to control anxiety produced by other drugs or to reduce withdrawal symptoms from other drugs.
Because of these concerns, it may not be in the best interest of patients who have both panic disorder and a current substance abuse problem to use the BZs for their anxiety. Studies indicate that between 35 and 45 percent of patients are able to withdraw from the BZs without difficulty. These are symptoms of withdrawal, rebound, and relapse, which can sometimes occur simultaneously. Physical dependence means that when a person stops taking a drug or reduces the dose quickly, he or she will experience symptoms of withdrawal.
These symptoms can be bothersome but are usually mild to moderate, almost never dangerous, and resolve over a week or so.
However, nonbenzodiazepines have dissimilar or entirely different chemical structures and are therefore unrelated to benzodiazepines on a molecular level.
The nonbenzodiazepines are positive allosteric modulators of the GABA-A receptor.
Generics are available for many, which helps reduce cost. These may continue during the first few weeks, but tend to clear up, especially if you increase the dose gradually. Some people experience low moods, irritability or agitation.
Rarely, a patient will experience disinhibition: they lose control of some of their impulses and do things they wouldn't ordinarily do, like increased arguing, driving the car recklessly or shoplifting. A patient taking a BZ should drink very little alcohol and should refrain from drinking within hours of driving a car. Although it is rare for a person with an anxiety disorder to abuse a benzodiazepine, patients with a history of substance abuse report a more euphoric effect from the BZs than do control subjects.
Like the benzodiazepines, they exert their effects by binding to and activating the benzodiazepine site of the receptor complex.
Many of these compounds are subtype selective providing novel anxiolytics with little to no hypnotic and amnesiac effects and novel hypnotics with little or no anxiolytic effects.
You can take benzodiazepines as a single dose therapy or several times a day for months (or even years).
Studies suggest that they are effective in reducing symptoms of anxiety in approximately 70-80% of patients. Tolerance does not develop in the anti-panic or other therapeutic effects. Some patients experience the sedative effects of drowsiness or lethargy, decreased mental sharpness, slurring of speech and some decrease in coordination or unsteadiness of gait, less occupational efficiency or productivity and, occasionally, headache.
Benzodiazepines are generally viewed as safe and effective for short-term use, although cognitive impairment and paradoxical effects such as aggression or behavioral disinhibition occasionally occur.