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TREATMENTS FOR ANXIETYDrugs known as ANXIOLYTICS(often wrongly called the "minor tranquillisers")DRUG GROUP: THE BENZODIAZEPINES
(* means that these products are not available on the UK NHS for anxiety) 1. Diazepam is available
as Atensine, Tensium and Rimaprim, as well as the better
known Valium. It is also available as suppositories and
rectal tubules.
The benzodiazepines are
'calmers'. They help to calm you down and can make you
sleepy. They are therefore used to help to treat, but not
cure, the symptoms of anxiety, such as tension, feeling
shaky, sweating and difficulty in thinking straight. They
also have muscle relaxing properties and some can be used
to help epilepsy, particularly "status epilepticus"
e.g. diazepam, clonazepam
When you are anxious, your
brain becomes more active. Your brain may then make a
chemical messenger (or "neurotransmitter")
called GABA which makes you feel calmer. GABA is the
brains naturally occurring "calmer". The
benzodiazepines make the action of GABA more powerful and
this helps calm the brain down.
Tablets and capsules: Liquids: Shake the bottle well before use as the drug can settle to the bottom and cause you to receive a lower dose at the start and too high a dose at the end of the bottle.
Take your medication as directed on the medicine label. Try to take them at regular times each day. Taking them at meal times may make it easier to remember as there is no problem about taking any of these drugs with or after food. If the instructions say to take them once a day this is usually best at bedtime as they should make you drowsy and help you to sleep.
They should start to work fairly soon after you start to take them. After that your doctor may need to change the dose to suit you.
This should be discussed with your doctor as different people respond differently. Benzodiazepines are very safe drugs if used sensibly. They are best taken in as low a dose as possible for a short time e.g. as a "first aid" measure. Usually this should be no longer than about one month to help you get over your problems and for other treatments to start working. If you need to take them for longer you should discuss this regularly with your doctor. Some people with long-term problems may need to take them for longer.
Due to the effects that benzodiazepines have on the brain they can sometimes produce "dependence" or "addiction" in people if taken regularly every day for more than about 4 to 6 weeks. Dependence or addiction means that you cannot manage without them because if you stop them you get withdrawal symptoms. In the worst cases withdrawal symptoms from the benzodiazepines could include anxiety, tension, panic attacks, poor concentration, difficulty in sleeping, nausea, trembling, palpitations, sweating and pains and stiffness in your face, head and neck. These withdrawal symptoms could occur several days after stopping your benzodiazepine. They may last from one to three weeks but can go on for months. If you have taken them for a long period of time your doctor will need to take you off your benzodiazepine gradually. This will be by reducing your dose slowly over a period of time to reduce the chance of withdrawal effects. It is also true to say that many people suffer no withdrawal symptoms when they stop benzodiazepines, even if they have been taking them for many years. You should thus make sure that you discuss your particular treatment with your doctor. For further information, click here.
It is best not to stop taking them suddenly if you have been taking them regularly every day for more than about 4 to 6 weeks. If you do, you may get some of the withdrawal effects mentioned above. If you take them only when really necessary (e.g. for 1 or 2 weeks during a severe attack of anxiety and then have several weeks without them) this is better than taking them all the time and can prevent you becoming addicted. You should talk about this with your doctor.
Start again as soon as you remember unless it is almost time for your next dose. Do not try to catch up by taking two or more doses at once as you may get more side-effects e.g. sleepiness. If you miss several doses start again when you remember. Tell your doctor about this next time you meet.
Table adapted from UK Psychiatric Pharmacy Group leaflets, with kind permission (www.ukppg.org.uk) Do not be worried by this list of side effects. You may get none at all. There are other rare side-effects. If you develop any unusual symptoms ask your doctor about them next time you meet.
Depending on the dose these drugs should help to calm you down but they can calm you down too much and send you to sleep! At a usual dose they may make you feel a bit drowsy anyway. If you are taking them at night you may feel drowsy the next morning so you should not drive (see below) or operate machinery until you know how they affect you. You should be careful as they may affect your reaction times.
It is not thought that the benzodiazepines cause any changes in weight. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice.
Benzodiazepines do not have any known significant effects. Drowsiness may have some effect. In some people, reduced anxiety may be an advantage.
If you drink alcohol while taking these drugs it may make you feel more sleepy. This is particularly important if you need to drive or operate machinery and you must seek advice on this. They may effect your reflexes or reaction times. They can also increase the effects of alcohol and so it is best to avoid alcohol.
You should have no problems with any food or drink other than alcohol (see above).
You should have no problems if you take other medications although a few problems can occur. Make sure your doctor knows about all the medicines you are taking. The benzodiazepines can "interact" with other sleeping drugs and some antidepressants by increasing their sedative effect, although your doctor should know about these. Some other medicines can make you drowsy. Combined with your benzodiazepine this could make you even drowsier. This does not necessarily mean the drugs can not be used together, just that you may need to follow your doctors instructions very carefully. You should tell your doctor before starting or stopping these or any other drugs.
It is not thought that the contraceptive pill is affected by any of these drugs.
It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs. If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine. Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press. It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups: B = Animal and human studies indicate a lack of risk but are not fully conclusive C = Animal studies indicate a risk but there is no safety data in humans D = a definite risk exists but the benefit may outweigh the risk in some people X = the risk outweighs any possible benefit The benzodiazepines are classified as follows: alprazolam "D", chlordiazepoxide "D", clonazepam "C", diazepam "D", lorazepam "D" and oxazepam "D". The others are not classified. Although some studies have shown a slightly increased chance of abnormalities with benzodiazepines, alcohol and other drug use may have been the reason for this. The risk of oral clefts is reported to be about 7 in 1000 births with diazepam. Occasional use of shorter-acting benzodiazepines would appear to have a very low risk. Regular use of longer-acting benzodiazepines (e.g. chlordiazepoxide, diazepam) may also lead to some short-term breathing difficulties in newborn babies, and some withdrawal effects e.g. the floppy baby syndrome. You should seek personal advice from your GP, who may then if necessary seek further specialist advice.
You will not need to have a blood test to check on your benzodiazepine.
The benzodiazepines can reduce your ability to carry out skilled tasks such as driving or operating machinery. You may also feel drowsy the day after you take them. Until these effects wear off or you know how your drug affects you do not drive or operate machinery. You should be careful as they may affect your reaction times. It is against the law to drive, attempt to drive or be in charge of a vehicle when unfit, either through illness or from the side effects of medication. Under UK law, it is the drivers responsibility to let the DVLA and insurance company know if you may be "unfit" to drive. If you do not, and you have an accident, it could effect your insurance cover. Your doctor will be able to advise you, and may wish to access the UK Driver and Vehicle Licensing Agency (DVLA) guidelines website, which has the current DVLA guidelines on anxiety/depression, psychotic disorders, mania and other conditions. If your doctor advises you not to drive, and you continue to do so, the doctor can inform the DVLA directly, as he or she would be lawfully responsible were you to have an accident. Once told, the DVLA may wish to carry out an enquiry, but you are entitled to drive until there a decision is made. |
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Email your comments or feedback. No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support. Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site. |
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your comments or feedback. No site can be entirely bias-free. No matter how hard someone tries, training and background will always influence your outlook. We have, however, tried to eliminate bias, and we hope you take these pages in the spirit in which they are provided i.e. a genuine attempt to inform, educate and support. Information here is based on published data. References include the UK British National Formulary (BNF, published by the British Medical Association and Royal Pharmaceutical Society of Great Britain), Martindale (the extra pharmacopoea, published by RPSGB Pharmaceutical Press), Psychotropic Drug Directory (latest edition), Data Sheet Compendium (UK Manufacturers Data Sheets, published by the Association of British Pharmaceutical Industry), MicroMedex (an independent and extensive CD-ROM based drug information source), UK Psychiatric Pharmacy Group leaflets, Royal College of Psychiatrists advice and guidelines and the current medical literature. Thanks also to all those people who left e-mail comments, suggestions and requests, who have helped shape the site. |
What are they used for ? 