Benzodiazepines Implicated in Increased Risk of Dementia

A class of drugs called benzodiazepines sometimes used in Migraine, anxiety, neuromuscular disorders and diseases such as dystonia and seizures, nausea and insomnia and even as an anesthetic prior to surgery, has been linked to dementia in a French study out this past September.

The 20 year observational study monitored older patients who had never used benzodiazepines, and found that those who used this class of drugs one or more times had a 50% increased risk for the development for dementia during the course of the study. This research is important because there is little information currently available about the long-term side effects of the usage of these drugs — neither chronic nor *once-ever* usage. We’re not even sure exactly how benzos work in the human body, although we do know there is some action on a specific neurotransmitter known as GABA.

Benzodiazepines include:

  • Alprazolam (Xanax)
  • Chlordiazepoxide (Librium)
  • Clonazepam (Klonopin)
  • Chlorazepate (Tranxene)
  • Diazepam (Valium)
  • Estazolam (Prosom)
  • Flurazepam (Dalmane)
  • Lorazepam (Ativan)
  • Midazolam
  • Oxazepam (Serax)
  • Tamazopam (Restoril)
  • Triazolam (Halcion)
  • Quazepam (Doral)

In the study, 1063 men and women who were declared dementia-free and had never used a drug in the class known as benzodiazepines were monitored for 20 years. Their average age was approximately 78 years.

Initially they were watched for 3 years, during which time no benzodiazepines were used and no dementia was diagnosed. In years 3-5, 8.9% of patients reported using a benzo at least once and were discluded, assuring a *clean* start to the study. Year five was considered the baseline for the study and patients were monitored for 15 more years (total of 20 years) during which patients visited clinics every 2-3 years.

Earlier a study came out that showed a correlation between the use of benzodiazepines and risk of bone fracture from osteoporosis. In combination with this study, the placement of benzodiazepines on a list of medications to be avoided in the elderly, and our lack of further knowledge about this class of medicines, serves to emphasize use of benzodiazepines for as short a period of time as possible, and only when no other alternative exists, especially in those over the age of 65.

There is some concern that patients who have used benzodiazepines in the past will assume from this study that they might as well continue usage of these highly addictive drugs, assuming that there is no benefit to stopping them in favor of other treatments, which would likely be a mistake.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The Migraine.com team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.
View References
Billioti de Gage, Sophie, PhD student; Bégaud, Bernard, professor; Bazin, Fabienne, researcher; Verdoux, Helene, professor; Dartigues, Jean-François, professor; Pérès, Karine, researcher; Kurth, Tobias, director of research; Pariente, Antoine, associate professor. “Benzodiazepine use and risk of dementia: prospective population based study”. BMJ 2012;345:e6231 — Ogbru, Annette, PharmD, MBA. “Benzodiazepine Drug Information”. Rx List. Updated: 12/3/2008

Comments

View Comments (12)
  • Neshobe
    6 years ago

    Whenever I read an article like this, I start asking questions. I was trained as a scientist, though in a different field. The basic factors behind good research are the same, however. Part of my job included both reviewing research literature for background and research summeries, and collaborating with other researchers on developing research studies addressing specific issues needing answers. Part of what troubles me here is that not all materials classed as benzodiazapams have the same properties. For instance, the only reason clonazapam is included is because it has a chemical similarity in part of its structure to Valium and Librium, which have been shown to be highly addictive. In use, clonazapam neither has the same action of those two chemicals, nor does it demonstrate addictive qualities. It is used as an anti-convulsant, particularly for focal point seizures. Like all anti-convulsants, it can have a rebound effect when abruptly withdrawn, but this is not the same thing as addiction. I have been taking clonazapam for years, and my use of it varies depending on how I am doing. Addiction implies increased physical need and craving, which I have never experienced. My doctors report that they have never observed a patient become addicted to clonazapam, and the same has been reported in literature. The problem is in order to change its classification, somebody would have to do studies demonstrating this. Butthat since clonazapam is an old, generic drug, this is highly unlikely to happen: drug studies are expensive and so done only on new drugs with earning potential.

    Another thing that catches my eye someone else has also noted: the design of the study and the population sample. Without reading the original reports, it is not possible to know what controls there were, and how the researchers made the determination that there might be a link between benzodiazapam use and dementia.

    My experience and observation is that of all the sciences, medical research is the least rigorous and the most poorly monitored. The fact that it is published does not mean it has validity. In fact, repeated analysis of published studies in all fields reveals a decided bias for studies that seem to show positive results, regardless of the quality of the study, and a disinclination to publish studies that demonstrate the opposite. This is particularly true in the medical field.

    So my bottom line is to take this with a grain of salt. I’d want to see much more rigorous study and analysis before I’d even begin to consider this something to worry about.

    By the way, I’m 70 years old and have been taking clonazapam for over 10 years to manage sensory overload. It actually improves my ability to think and talk clearly and sort out sensory input (the “noise” that gets in the way). From being unable to read or to carry on a coherent conversation for more than a few minutes at a time due to the impact of Neuroborreolosis (Lyme disease affecting the brain) and migraine, with clonazapam I am able to write regularly, and to read several books and journals a week.

  • Ellen Schnakenberg author
    6 years ago

    You’re absolutely right: this was meant to inform patients of the results of this study only. Since there are no other studies like it, it is impossible to compare them to each other. And the study utilized a class of meds, not a single medication. All meds even within a single class are not created equally, that’s why we have them 🙂 Hopefully it will remind patients that everything we take that has the potential to help us, also has the potential to hurt us. We need to make smart decisions. Remember however, that the warning about this class of drugs used in senior patients existed even before this research came out. It’s great that it works for you, but for others, they now have this information to include in their conversations with their doctors and in their decision making process. That is vitally important for me personally. This class is NOT for everyone, and should not be a first in line drug for this age bracket, or probably any others.

    Clonazepam and other meds in this class are useful for many different diseases and disorders. One of them is a condition I have myself: dystonia – a movement disorder. I have not stopped using my meds, because nothing else is available for this condition except Botox (not in my insurance’s formulary) and deep brain stimulation. I am not severe enough to consider DBS. I do think twice before taking my meds now. Do I really need it, or is it just going to make me a little better? It has altered how I take my meds a skosh. I was used to taking them if my spasms got to the point they bothered me or kept me from walking. Now I take it only when they keep me awake or to keep me from the hospital. Whether or not this is the right decision for me remains to be seen. Having that knowledge is important.

    As you know, there is a distinct difference between addiction and dependence. The fact remains that this class as a whole is considered to be highly addictive, and difficult to discontinue in the face of addiction or dependence. Again, it’s all about making smart decisions.

    Congratulations on success with a therapy that is helpful to you. Many folks struggle for years before they finally find something that increases their quality of life as this has seemed to do for you. It doesn’t sound like you are likely to be in a danger zone, but it might still be worth a discussion with your doctor when you are at your next visit. So far as I understand it, the only way to know for sure that you’ll have a problem, is when you do.

    What works for one, won’t necessarily work for another 🙂

  • Julie
    6 years ago

    Wow, I was on Xanax for a while for my panic attacks-for about 2 years. Then I went off because it didn’t seem to help. But that was in 2010. It was short acting. I know with migraines and the more frequently you get them it affects your thougth process and it’s hard to think clearly to begin with and I was having a really hard time with my thought process then. Now this year they put me on Diazepam 5 mg, 1/2 pill in the am and a full pill in the pm. It helps with the panic attacks, PTSD and the chronic insomnia-I mean I was not getting more than 1 1/2 hrs sleep at night for about 5 months in a row and they tried everything and the Diazepam helped w/the panic attacks, the nightmares and the insomnia. I should say I woke up w/night terrors, not nightmares. But they tried me on so many things this past year I cannot remember them all. I do remember Klonopin and Atavin and they didn’t seem to be long acting. I think they tried Restoril. Now I’m scared of the Diazepam but I’m afraid of the panic attacks, Night terrors and insomnia coming back because my therapy is just now getting through the layers of my PTSD and I don’t want to go to the hospital again. A Depression unit is NO fun. It was on lock down and no shower in privacy. NO NO NO. What is a safer alternative to Diazepam?????

  • Julie
    6 years ago

    I’ve never heard of it before. I will bring it up at my next apointment in January if I feel I need to. Like you said though it’s just 1 study and no need to painic. And like you said some people, myself included, hit the panic button. I’ve had time to think since this was posted and my dose is so low and I’ve not been on it that long I will wait til Jan and see what my Dr thinks and go from there. I’m not on the Titanic and the boat isn’t sinking yet so no need to worry about jumping on the lifeboats yet and I see no icebergs approaching in my near future, so right now I will just sail along until I see one approaching, then I will worry about it.

  • Ellen Schnakenberg author
    6 years ago

    It’s important to remember that this is one study. It’s important to keep in mind, but as it is mentioned, there are concerns that people will panic and quit their meds without speaking to their doctors about it. This would be a mistake I believe. As with all studies, use the information they provide to help you make good decisions. Use it to create good conversation with your doctors to make those good decisions.

    Have you tried Atenolol for feelings of panic?

  • AnotherMigraineSufferer
    6 years ago

    In all due respect the comment, “The thing swith benzo’s is that there are so many other options most patients are able to take that are much safer, and for which we have a broader base of knowlege” is completely erroneous in my case and I would assume I’m not unique so I’m not sure the broad generalizing statement “most patients” would be an accurate assumption. I have been put on no less than 40 some separate “safer” medications (including everyone that is currently on ther market), all of which caused suicide ideation and/or horrifying hallucinations or extremely adverse reactions. I have NDPD along with chronic daily migraine so at this point benzo’s are required on a daily basis. The threat of alzheimers later, although having great merit,makes little difference in my current life if I am totally incompacitated and remain in bed without the benzos for weeks or more at a time under direct doctor supervision on a weaning schedule. Since that makes matters worse, the critical need to use benzo’s is the only chance I currently have to live an assemblance of having any quality of life.

  • Ellen Schnakenberg author
    6 years ago

    AnotherMigraineSufferer – A couple quick things:

    Dementia is actually not the same as Alzheimer’s disease, although Alzheimer’s is a type of dementia. I think it’s important to make that distinction, because the number of Alzheimer’s patients is high, but when you add in the number of other types of dementia patients, the results are quite eye opening.

    Also, I think after your arduous experience with trying to find help for your situation, you would likely agree that most (the majority) patients are not like you. It’s also helpful to notice the statement at the end of this piece that states “In combination with this study, the placement of benzodiazepines on a list of medications to be avoided in the elderly, and our lack of further knowledge about this class of medicines, serves to emphasize use of benzodiazepines for as short a period of time as possible, and only when no other alternative exists, especially in those over the age of 65.” The fact remains, at this time there are going to be some patients for whom there are few if any alternatives. Most of them would choose to be educated about the potential pitfalls of their treatment as they arise so they can make educated decisions with their doctors based upon current knowledge and protocols. Hopefully this new research will get doctors and patients talking and making those educated decisions, which I think we all agree is a good thing. 🙂

  • AnotherMigraineSufferer
    6 years ago

    Sorry for the typos and I meant to say would NOT be an accurate assumption. I wish all you migraine sufferers comfort and relief in whatever manner you can find it. Take good care of yourself.

  • Ellen Schnakenberg author
    6 years ago

    hangingbyathread – The thing with benzos is that there are so many other options most patients are able to take that are much safer, and for which we have a much broader knowledge base.

    I think the takeaway here for most patients is, now that we know more about benzodiazepines it might be a good time to re-visit treatment with our doctors. This is one drug that can be very dangerous to try to stop on your own, so never consider changing your current management without your doctor’s help.

    As for myself, I am not sure yet what I want to do re: this new information. I occasionally take diazepam as an adjunct drug during especially bad Migraine attacks, to control my dystonia (body wide muscle spasms) and because I cannot take anti-nausea meds. Because of other medical conditions and risks during general anesthesia, my doctors frequently choose fairly high dosages of diazepam and Ativan to conk me out for surgical procedures and tests which, unfortunately I have done averaging at least once yearly.

    The study was done on older adults, most likely because dementia usually hits at older ages and this would make for a shorter study period – but I am only guessing as I saw nothing in the paper itself to indicate the reason why. We really don’t know the implications of usage in younger individuals yet until additional studies are done.

    I have had fairly serious cognition trouble in the past and lived for a while with the scary realization that something was terribly wrong. It was no fun. Dementia is one thing that I do honestly respect. I want to maximize my chance for a healthy old-age like the side of my family I got to know. However, I have to balance that with my quality of life now. With few alternatives in my own personal circumstances, I don’t see at this point that I have a lot of options.

    With this new research, perhaps there will be investigation into other medicines that might be safer alternatives to benzos. I suppose we can only hope…

  • Ellen Schnakenberg author
    6 years ago

    marlenerossman – good thought! However, Compazine is an anti-nausea drug with very severe side effects for me. It is a neuroleptic and as such not an option. You can read about anti-nausea meds and tardive reactions here:

    How can I keep Migraine meds down so they will work? http://migraine.com/blog/how-can-i-keep-my-migraine-medicines-down-so-they-will-work/

    Migraine triggers and comorbidities http://migraine.com/blog/migraine-triggers-and-comorbidities-dystonia/

  • marlenerossman
    6 years ago

    Ellen, have you tried Compazine suppositories? As gross as it sounds, when you are vomiting up all the meds, the Compazine taken rectally stops the nausea and helps with the migraine.

  • taralane
    6 years ago

    This is a disturbing article. I have been taking Clonazepam for over 15 years – at 2 mg a day it is a small dose, but still, difficult to stop taking because of the highly addicting quality. Does this mean one should get off it ASAP, or wait for further information. With everything else migraineurs are susceptible to, dementia is not one I am prepared to deal with.

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