The Benzodiazepines

These medications are used to treat anxiety, insomnia and panic attacks. They also have anticonvulsant properties, relax skeletal muscle, treat alcohol withdrawal, and sometimes treat the side effects of antipsychotics.

Benzodiazepines are more similar than they are different. They differ only in their onset of action and their duration of action.

Whether or not benzodiazepines cause cognitive side effects (verbal learning, speed of thinking, etc.) is quite controversial. A recent meta-analysis concluded that they do cause cognitive dysfunction during treatment, and that while cognitive function improved after the benzodiazepine was discontinued, it did not return to the level of functioning seen in control groups that did not take benzodiazepines.


alprazolam (Xanax)

chlordiazepoxide (Librium)

clonazepam (Klonopin)

chlorazepate (Tranxene)

diazepam (Valium)

estazolam (ProSom)

flurazepam (Dalmane)

lorazepam (Ativan)

oxazepam (Serax)

quazepam (Doral)

temazepam (Restoril)

triazolam (Halcion)


1) Very safe in overdose

2) Generally, they work quickly

3) High rates of compliance


1) All can cause tolerance and dependence

2) Sedating, with dangerous interactions with other anxiolytics

3) Can cause impairment similar to intoxication – ataxia, slurred speech, poor judgment, etc.


Rapid onset: midazolam, diazepam, chlorazepate, flurazepam

Intermediate onset: chlordiazepoxide, alprazolam, lorazepam, triazolam

Slow onset: oxazepam, temazepam, clonazepam, prazepam

Physical dependence onset parameters:

Valium – 15 mg. for 90 days

Xanax – 1.5 mg. for 45 days

Ativan – 6 mg. for 60 days

Withdrawal symptoms: anxiety, poor concentration, muscle pain, perceptual disturbances, seizures

Dependence is linked to a preoccupation with acquiring the drug, craving, compulsive use and frequent relapse despite adverse consequences.

Successful tapering of benzodiazepines must be done very slowly. If done slowly enough users can taper successfully, although they will feel worse each time the drug dose is lowered. Users expect they are going to feel terrible when the taper is complete, but virtually everyone feels better after discontinuation. They feel less sedated and their thought processes are less cloudy.

Joseph Wegmann, R.Ph., LCSW is a licensed clinical pharmacist and a clinical social worker with more than thirty years of experience in the field of psychopharmacology. His diverse professional background in psychopharmacology and counseling affords him a unique perspective on medication management issues. In addition to consulting with numerous psychiatric facilities, he has presented psychopharmacology seminars to thousands of clinicians in 46 states.

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