Benzodiazepines

<p>From: Reviving the Broken Marionette: Treatments for CFS/ME and Fibromyalgia

Benzodiazepines bind to the so–called benzodiazepine receptor in the brain, which is actually a subunit of the GABAA receptor. This receptor is further divided into subunits and different benzodiazepines have somewhat different effects (sedative, hypnotic, anxiolytic, antiepileptic, muscle relaxant) depending on which subunits they bind to. They are best known as anxiolytics and sleep aids, but some of them have use as analgesics, too. They can also be helpful for dyspnea (breathlessness) which often accompanies CFS/ME and FM.

Benzodiazepines have varying half–lives, which also dictate the clinical use of the drug—a benzodiazepine with a short half–life is good for initiating sleep or for an acute anxiety attack, but those who tend to wake up prematurely need a longer–acting drug. Benzodiazepines are often combined with another drug such as trazodone, or rotated with other drugs to avoid developing tolerance.

The most common side effect is sedation and benzodiazepines also potentiate the effect of other sedative drugs, but in some people they can Sleep aids, tranquilizers and muscle relaxants paradoxically cause irritability, even aggression. Benzodiazepines should not be used in patients with sleep apnea. Because sleep apnea is common in CFS/ME and fibromyalgia, a polysomnography (sleep study) may be warranted.

Benzodiazepines can cause depression, dizziness, muscle weakness and low blood pressure. Some also have the potential of causing retro-grade amnesia. Blood changes and severe allergic reactions are very rare. Benzodiazepines also act as immunomodulators. Interestingly diazepam appears to have a suppressive effect, while alprazolam acts as an immunostimulant.17

Most doctors consider the addiction potential and development of tolerance as the most important concern with the benzodiazepines. Responsible use of small doses usually does not lead to any problems, but long–term treatment should not be abruptly discontinued. Not taking benzodiazepines on a daily basis minimizes the risk of dependency.</p>