Agarwal S.D., Landon B.E. Please switch auto forms mode to off. Griffin C.E., Kaye A.M., Bueno F.R., Kaye A.D. Benzodiazepine Pharmacology and Central Nervous System–Mediated Effects. One study showed that a 7 day IV infusion of flumazenil during withdrawal in patients stabilized with clonazepam or antidepressants led to abstinence in over half of their subjects [67]. Br. It has been shown that the efficacy of withdrawal treatment might be more associated with levels of flumazenil in cerebral spinal fluid rather than plasma levels of the drug [64]. Rapid resolution of catatonia secondary to post traumatic stress disorder with secondary psychotic features through scheduled zolpidem tartrate. Lader M. Benzodiazepines revisited-will we ever learn? In a prospective longitudinal study on the effects of psychotropic drugs in the cognition of the elderly, Allard et al. Decreased alertness. described an increased risk of falls in elderly hospitalized patients prescribed short-acting BZD [23]. a very low breathing rate. 2013 May;8(3):1004-116. doi: 10.1002/ebch.1916. Given this picture, withdrawal symptoms should be carefully treated with BZD long-acting taper, with decreasing doses slowly over time, along with psychotherapeutic interventions such as motivational enhancement and cognitive behavioral therapy (CBT) with psychoeducation [59]. More studies will need to be carried out on the non-pharmacologic treatment of BZD withdrawal, as it is showing some promise for the successful discontinuation of the drugs. Benzodiazepine drugs are widely used in patients with post-traumatic stress disorder (PTSD), but available evidence suggests that they are not effective — and may even be harmful, concludes a. -Inform about signs and symptoms of benzodiazepine abuse, misuse, and addiction and to seek emergency medical help if they occur; and on proper disposal of unused drug. ), 2School of Medicine, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; ude.shusl@100sec (C.E.S. Additionally, given the continual rise of anxiety and sleep-disordered problems over the decades, BZDs remain a regular fixture in the United States today [7]. Additionally, according to several studies, BZD use increases with age, with long-term usage most prevalent in the 65 and older population [16]. Benzodiazepines have been in widespread use since the 1960s. Nightmares of trauma: Benzodiazepines: Various: Try to avoid chronic, daily use; cyproheptadine (Periactin), 4 mg at bedtime, is an alternative treatment. Rosinvil T., Lafortune M., Sekerovic Z., Bouchard M., Dubé J., Latulipe-Loiselle A., Martin N., Lina J.M., Carrier J. Age-related changes in sleep spindles characteristics during daytime recovery following a 25-hour sleep deprivation. Women are more susceptible to BZD overuse because they are more likely to be prescribed than men [29]. Symptoms associated with withdrawal occur due to the chronic effect on the GABA-A receptors in the CNS to BZDs. Additionally, BZD have been shown not to increase or decrease Mini Mental Status Exam (MMSE) scores, caregiver burden (CB), or the Neuropsychiatric Inventory (NPI) in Alzheimer’s patients over 12 months of treatment in one cohort study [75]. All registration fields are required. HHS Vulnerability Disclosure, Help BZDs gained popularity in the 1960s and 1970s through household names such as The Rolling Stones and numerous Hollywood movies sensationalizing Valium (diazepam). Certain factors play a role in the severity of withdrawal symptoms, such as dosage, duration of action of the BZD duration of treatment with the drug, and severity of psychiatric symptoms pre-treatment. Cognitive effects of long-term benzodiazepine use in older adults. Over time, the inhibitory function of GABA may be desensitized with a corresponding sensitization of excitatory glutamine receptors. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (, benzodiazepines, GABA, withdrawal, cognitive decline. A doctor may give you benzodiazepines—or "benzos"—for sleep or anxiety symptoms. Catatonic syndrome in a general psychiatric inpatient population: Frequency, clinical presentation, and response to lorazepam. The dependence on BZDs generally leads to withdrawal symptoms, which necessitates careful tapering of the medication when prescribed [26]. investigated the relationship between hypnotic drug overdose versus non-overdose deaths in patients on opioid maintenance therapy. At higher dosages or with prolonged use, benzodiazepines can also lead to the following side effects: 3. ); ude.shusl@100aat (T.A. Pharmacotherapy for post-traumatic stress disorder - a systematic review and meta-analysis. Bethesda, MD 20894, Web Policies Tips for Benzodiazepine Withdrawal... 1-2 Benzodiazepine Equivalent Doses and Example Taper ... 3-4 Potential Medication Augmentation Strategies for . One of the most well-studied BZDs in the setting of withdrawal is alprazolam. The risk of falls leading to injuries in elderly BZD users is significantly increased in patients greater than 80 years old, while the increased risk is not significant in patients under 80 [22]. One study found that propranolol attenuated some withdrawal symptoms in patients who stopped taking either diazepam (a long-acting BZD) and those who took lorazepam (a short-acting one) abruptly [69]. Chronic use of BZD leads to a small but significant change in fluid intelligence, while long-term use of BZD correlates with worse cognitive decline when compared to the effects of using a high dosage [21]. The researchers in the study cautioned the prescription of BZD in the elderly due to the potential for cognitive decline [73]. Some commonly used benzodiazepines are: alprazolam (Xanax®), clonazepam (Klonopin®), diazepam (Valium®), lorazepam (Ativan®) and temazepam (Restoril®). A study of patients undergoing total knee arthroplasty reported that patients who have filled a BZD prescription within 6 months before their surgery are at a high risk of revision of the surgery and femur fracture fixation [36]. Mechanism of action of benzodiazepines on GABAA receptors. Passaro et al. However, Flumazenil carries a high risk of seizures, so one must be cautious when administering this drug [68]. Manconi M., Ferri R., Miano S., Maestri M., Bottasini V., Zucconi M., Ferini-Strambi L. Sleep architecture in insomniacs with severe benzodiazepine abuse. BZDs show an increased risk for abuse and dependence. They showed that benzodiazepine increased the incidence of non-overdose death in these patients which may be attributed to its impairment of cognition, sensory, and motor skills and increased risk of fall leading to injuries [49]. Everitt H., McDermott L., Leydon G., Yules H., Baldwin D., Little P. GPs’ management strategies for patients with insomnia: A survey and qualitative interview study. Neuropsychopharmacol. Alprazolam is widely used as monotherapy for panic disorder and anxiety and was found superior to other forms of monotherapy for these conditions including other BZD, non-SSRI antidepressants, and buspirone. Bierman E.J.M., Comijs H.C., Gundy C.M., Sonnenberg C., Jonker C., Beekman A.T.F. However, in the same study, 27–45% of patients experienced withdrawal symptoms even while taking propranolol [69]. Olfson M., King M., Schoenbaum M. Benzodiazepine Use in the United States. Phenobarbital is an antiepileptic drug that offers a viable alternative to benzodiazepines for AWS treatment. Trauma-focused therapy and some antidepressants work best. 1. ); ude.shusl@eyak.nala (A.D.K. Other important indications for the use of BZDs include the treatment of catatonia, seizure disorders, and alcohol and BZD withdrawal. Lethargy. Some researchers are even looking into long-term subcutaneous administration of flumazenil for BZD-dependent patients. Decades of use mean these drugs are well-studied and well-understood. This makes it harder to recover from PTSD. However, as central nervous system depressants . Conclusions: Interestingly, in this same study, SSRIs and atypical antipsychotics showed the same results; however, trazodone actually improved the NPI [75]. The .gov means it’s official. Cone E.I., Fant R.V., Rohay J.M., Caplan Y.H., Ballina M., Reder R.F., Spyker D., David Haddox I. Oxycodone Involvement in Drug Abuse Deaths: A DAWN-Based Classification Scheme Applied to an Oxycodone Postmortem Database Containing Over 1000 Cases*. This call to action proves especially relevant, as those seeking treatment for BZD dependence and withdrawal are on the rise in the United States [3]. Also see: VA Mental Health, Veterans Crisis Line: Benzodiazepines are 'relatively contraindicated' for PTSD The researchers performed a systematic review to identify clinical trials or observational studies concerning the use of benzodiazepines in patients with PTSD, or in patients with recent trauma evaluated for possible PTSD. Al Jowf GI, Ahmed ZT, Reijnders RA, de Nijs L, Eijssen LMT. Birchley G. Opioid and benzodiazepine withdrawal syndromes in the paediatric intensive care unit: A review of recent literature. Benzodiazepines may help in the short term and make you feel better quickly, but we now know that they do not improve the overall The purpose of this work was to compare the epidemiological profiles of out-of-hospital deaths, in-hospital deaths, and survivors over a 10-year period (2010-2019) of patients who had been treated by Navarre´s . Office of Accountability & Whistleblower Protection, Training - Exposure - Experience (TEE) Tournament, War Related Illness & Injury Study Center, Clinical Trainees (Academic Affiliations), Understanding PTSD and PTSD Treatment (PDF), Call TTY if you While terazosin, an adrenergic-inhibiting agent, is helpful in reducing sleep-related disorders in PTSD, the beta-blocker propranolol may be beneficial in preventing or reducing PTSD symptoms if given shortly after the trauma. McHugh R.K., Geyer R.B., Chase A.R., Griffin M.L., Bogunovic O., Weiss R.D. Due to their toxic effect on the central nervous system, appropriate care is necessary with BZD. They are recommended for short-term treatment of severe anxiety, panic, or insomnia. Email: ncptsd@va.gov Cook et al. J. R. Coll. Registered users can save articles, searches, and manage email alerts. Liu JJW, Nazarov A, Easterbrook B, Plouffe RA, Le T, Forchuk C, Brandwood A, St Cyr K, Auger E, Balderson K, Bilodeau M, Burhan AM, Enns MW, Smith P, Hosseiny F, Dupuis G, Roth M, Mota N, Lavoie V, Richardson JD. BZDs were encouraged for anyone wanting to calm their nerves and ease their sleep, causing them to rapidly attain favor in society [6]. . Charlson F., Degenhardt L., McLaren J., Hall W., Lynskey M. A systematic review of research examining benzodiazepine-related mortality. Bogunovic O.J., Greenfield S.F. Benzos are not recommended for PTSD. The risks versus benefits of minimizing benzodiazepines in patients with TBI who are a … Impact of Traumatic Brain Injury on Clinical Institute Withdrawal Assessment Use in Trauma Patients: A Descriptive Study PM R. 2021 Feb;13(2):159-165. doi: 10.1002/pmrj.12385. Tapering slowly helps reduce uncomfortable withdrawal symptoms. Due to its short half-life, and rapid absorption, alprazolam is distinguished as one of the most rapid-acting BZD with fastest relief of symptomology, increasing its abuse liability [54]. Their relative safety compared to fellow depressants or barbiturates have increased the rate at which they are prescribed [25]. The study also showed that 64% of heroin users are also abusing BZD [46]. This superior effect is thought to be due to its unique alpha-2 adrenergic activity, enhancing its potency for relieving panic and anxiety disorders. Dilsaver S.C., Peck J.A., Traumata D., Swan A.C. Researchers investigating the correlation between anxiolytic and hypnotic drugs with mortality hazards examined over 100,000 patients in a retrospective cohort study. Additionally, in this study, approximately 80% of patients experience withdrawal symptoms, which is much greater than the rate in other studies [65]. and T.A. Dodds T.J. The results suggested that benzodiazepines were associated with no improvement in PTSD-related outcomes, and that using benzodiazepines in patients with recent trauma actually increased PTSD risk . Effective treatments for PTSD, like talk therapy, help you stop avoiding distressing situations and memories. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy. government site. They may also require benzodiazepines to prevent or manage anxiety and agitation and to facilitate effective mechanical ventilation (MV). 2023 Feb 16;7:24705470231156571. doi: 10.1177/24705470231156571. Pregnant women and fetuses are at increased risk for adverse effects of withdrawal; they both metabolize BZD slowly, and the drug can cross the placenta to cause concentrations to build up to significant levels in the neonate [18]. -Do not stop drug abruptly because withdrawal symptoms or seizures may occur. Major trauma is a leading cause of death. Manconi et al. Benzodiazepines like alprazolam (Xanax) and temazepam (Restoril) are used to treat . Trauma ICU patients may require high and/or prolonged doses of opioids and/or benzodiazepines as part of their treatment. BZDs act on the CNS to exert anxiolytic and sedative effects and, together with electroconvulsive therapy, are the mainstay therapy for catatonia [13]. As a library, NLM provides access to scientific literature. Benzodiazepines overview . Some additional side effects of concern include aggressive behavior and expressing anger towards others in between 1% and 20% of users [17]. Mercier-Guyon C., Chabannes J.P., Saviuc P. The role of captodiamine in the withdrawal from long-term benzodiazepine treatment. One of the debilitating side effects of BZDs is their addictive potential. Some PTSD symptoms are related to sleep problems or anxiety. O’Brien C.P. Withdrawal, like with alcohol since they exert their effects on similar receptors, can be life threatening. Cantopher T., Olivieri S., Cleave N., Edwards J.G. confusion and difficulty thinking. If you are in crisis or having thoughts of suicide, The authors attribute this to the severity of patients’ dependence on BZD before treatment with propranolol [65]. ), 3Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, LA 71103, USA; ude.shusl@yeldarb.esyle (E.M.C. Trauma ICU patients may require high and/or prolonged doses of opioids and/or benzodiazepines as part of their treatment. The control group and the experimental group had the same dropout rate in this study [69]. Ethical review and approval were waived for this study due to no human subjects being involved. An improvement in abstinence was found, Abrupt discontinuation of benzodiazepines in severely dependent patients and administration of propranolol rather than a slow taper. Hit enter to expand a main menu option (Health, Benefits, etc). This study prospectively evaluates the effect of early administration of benzodiazepines on the course of PTSD and PTSD symptoms. BZDs are ineffective for PTSD treatment and prevention, and risks associated with their use tend to outweigh potential short-term benefits. Dr. Laura Gibson describes how benzodiazepines get in the way of PTSD treatment. loss of muscle control. Vicens C., Fiol F., Llobera J., Campoamor F., Mateu C., Alegret S., Socías I. The study found no significant cognitive impairment in adults with long-term use of BZD [20]. Hernandez N.M., Cunningham D.J., Hinton Z.W., Wu C.J., Seyler T.M. You may notice more alertness, better coordination and improved memory and mood. This is more significant than the study by Weich et al. Federal government websites often end in .gov or .mil. In a literature review exploring the relationship between BZD and suicide risk, it stated that although anxiety and insomnia which are often treated with a BZD, it can increase the risk of suicide; several studies in the literature have suggested that BZD use is also involved in increased suicide risk in its users [51]. Risk factors include high velocity trauma and cervical dissection . Chronic benzodiazepine dependence. (See 'Trauma-focused CBT' below.) The result was statistically significant. Many clinical studies have been conducted to assess the severity and treatment of withdrawal systems, while others assess more long-term effects of chronic BZD use. Xanax, Ativan), a class of drugs with anxiolytic, hypnotic, and muscle-relaxant properties, are highly effective in treating some mental health and medical conditions, including anxiety disorders, insomnia, and alcohol withdrawal ( Olson, King & Schoenbaum, 2015 ). This neuroadaptive process builds tolerance, causing many chronic users to need increasing dosages for similar effects. Interestingly, a lower prevalence of withdrawal symptoms was noted in the experimental group without any change in pharmacologic treatment from control group [73]. Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence. The use and discontinuation of alprazolam within 2 weeks disrupt sleep onset and quality, increasing suicide risks [51]. Lemoine P., Kermadi I., Garcia-Acosta S., Garay R.P., Dib M. Double-blind, comparative study of cyamemazine vs. bromazepam in the benzodiazepine withdrawal syndrome. The main driving factor for dependence is the development of tolerance, causing users to need increasing doses for the same symptom relief [18]. One study found a withdrawal rate of approximately 40% in those using for six or more months with abrupt cessation of long-acting BZDs [10]. Inclusion in an NLM database does not imply endorsement of, or agreement with, BZDs bind to the effect of the inhibitory neurotransmitter GABA to slow the firing of the autonomic nervous system, preventing hyperstimulation and associated sequelae of withdrawal. In a systematic review of research, Charlson et al. Benzodiazepines, commonly used for withdrawal management, pose unique challenges in this population given the high prevalence of head trauma and delirium. The effect of chronic benzodiazepine use on cognitive functioning in older persons: Good, bad or indifferent? Smoking may decrease drug's effectiveness. Gray S.L., Lai K.V., Larson E.B. Neuronal damage may begin as soon as five min of seizure activity, so abortion with BZDs or other CNS sedatives is imperative [14]. One study further showed that the risk of dying is doubled in patients prescribed BZD compared with controls [47]. Results showed that, compared to wild-type mice, mice on diazepam experienced longer uninterrupted sleep [42]. Current studies are aimed to decrease this rebound anxiety effect while also decreasing relapse into BZD use using different medications, counseling, BZD dosing strategies, or different tapering techniques. have hearing loss. The ultimate concern is that such fetuses will later be susceptible to autism, learning difficulties, attention deficit disorder, and general hyperactivity [24]. Authier N., Balayssac D., Sautereau M., Zangarelli A., Courty P., Somogyi A.A., Vennat B., Llorca P.M., Eschalier A. Allard J., Artero S., Ritchie K. Consumption of psychotropic medication in the elderly: A re-evaluation of its effect on cognitive performance. Another study that tested a different standardized education protocol showed more promising results [73]. The experimental group in this study was counseled on the first visit for 15–20 min on the effects, dangers, and alternatives to chronic BZD use and dependence [73]. The site is secure. Benzodiazepines provide short-term relief from distressing feelings but can become a problem in the long run. The dependence on BZDs generally leads to withdrawal symptoms, requiring careful tapering of the medication when prescribed. Zhang Y, Zhou X, Yang L, Hetrick SE, Weisz JR, Cuijpers P, Barth J, Del Giovane C, Yuan S, Cohen D, Gillies D, Jiang X, Teng T, Xie P. BMJ Open. Effective treatments for PTSD, like talk therapy, help you stop avoiding distressing situations and memories. One case series showed that not only did oxcarbazepine provide more tolerability than the current mainstay of treatment, but it also shortened the withdrawal time frame for patients to just 11 to 19 days, even for patients previously taking high doses of BZD [71]. Many studies have examined the effects of benzodiazepines on cognition with varied results. Hear from Veterans who have turned their lives around with PTSD treatment. Abrahamsson T., Berge J., Öjehagen A., Håkansson A. Benzodiazepine, z-drug and pregabalin prescriptions and mortality among patients in opioid maintenance treatment—A nation-wide register-based open cohort study. First, the elderly (over 65 years old) are of extremely high risk due to their predisposition for falls, confusion, insomnia, memory loss, and other psychiatric problems regardless of BZD use. Prescription monitoring programs and emergency department visits involving benzodiazepine misuse: Early evidence from 11 United States metropolitan areas. A study investigating the prescription of opioids and BZD in veterans showed an increased risk of overdose death in veterans who have prescriptions for both BZD and opioids at the same time [50]. To enter and activate the submenu links, hit the down arrow. Compare options and make the best choice for PTSD treatment. The subjects in this study had mild to moderate Alzheimer’s dementia and showed no change in AD-Cog scores after treatment with BZD [74]. 2023 Mar 9;24(6):5238. doi: 10.3390/ijms24065238. Stewart S.A. Efforts to obtain the medication to stop the withdrawal symptoms can get in the way of other things like work and family. Studies have shown that treatment for longer periods with high-dosage, short-acting BZD contribute to more severe withdrawal effects [61]. Specifically, those with cluster B personality disorders have the worst prognosis in regard to discontinuing BZD. slurred speech. There are pharmacological options for treatment in those suffering from withdrawal or wishing to discontinue their chronic BZD use. Objective: Use of benzodiazepines in elderly patients. Future research is warranted for further exploration into alternative methods of treating BZD withdrawal. Approximately two weeks after birth, the infant experiences withdrawal consisting of continued difficulty feeding, high pitched cries, hyperexcitability, and consequently possible failure to thrive. doi: 10.2196/33151. Patients struggling with the trauma of hallucinated sexual assault, even if there is evidence that it did not occur in reality, should be referred to counseling and supported just like someone who was physically harmed during a medical or dental procedure. After exerting their effect, BZDs are metabolized primarily by the liver and excreted by conjugation, so they should be used in caution in the elderly, smokers, and those with liver disease or damage [3]. Bookshelf This study was limited by the small sample size, a lack of double-blinding, multiple parallel treatments, and had the potential for subjects to fail to report relapse in drug use [67]. Clipboard, Search History, and several other advanced features are temporarily unavailable. These treatments will be discussed briefly below. Due to the difficulties to keep a registry of these cases, few studies include all subjects, because they exclude out-of-hospital deaths. There has been a steady increase in the number of prescribed BZDs in the US [27]. Each of these studies received mixed results, with no statistically significant advantage to BZD therapy. [19] found no significant long-term effect of BZD use on cognition. Mclean et al. BZDs are also used in urgent seizure emergencies, including status epilepticus, acute seizures, cluster seizures, and seizures due to alcohol and BZD withdrawal. National Library of Medicine Specifically, temazepam is commonly used for insomnia, clonazepam is commonly used for anxiety and seizures, lorazepam is commonly used for catatonia and seizure abortion when used intramuscularly or intravascularly, and diazepam is commonly used for anxiety, muscle spasms and rectally for seizures. Veteran Leah Parady describes the side effects she felt when she was dependent on the benzodiazepine Klonopin®. It also reduces the expression of mRNA transcripts such as CaMKIIa, BDNF, GIF, c-fos, NGFIa which are necessary for regulating synapses and plasticity [42]. Licensee MDPI, Basel, Switzerland. The current treatment of choice is to switch the current short-acting BZD for a long-acting alternative then gradually taper the dose to wean the individual off BZD completely [8]. Psychiatry. Predictors of benzodiazepine discontinuation in subjects manifesting complicated dependence. Prim. Eating disorder patients say punitive, threatening methods at Denver treatment center left them with new trauma. They are also used to treat or prevent seizures. Many drugs have been tested as a treatment for withdrawal, with few proving efficacious in randomized control trials. Use of benzodiazepines and benzodiazepine receptor agonists during pregnancy: Neonatal outcome and congenital malformations. is older and . Oxcarbazepine has a better side effect profile and is a more tolerable anticonvulsant than older antiepileptic drugs [71]. Given concerns for use dependence and withdrawal, SSRIs and antidepressants have been made mainstay therapy for these conditions. Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature. Bethesda, MD 20894, Web Policies Benzodiazepine withdrawal in older people: What is the prevalence, what are the signs, and which patients? Eighteen clinical trials and observational studies were identified, with a total of 5236 participants. Two authors independently conducted a search of all relevant articles using multiple electronic databases and independently abstracted information from studies measuring PTSD outcomes in patients using BZDs. This mechanism results in symptoms and signs of psychomotor agitation such as diaphoresis, anxiety, nausea, vomiting, tremors, and possibly seizures and delirium. BZDs are most commonly used for panic disorder and generalized anxiety disorder (GAD) regarding its indications for anxiety. Wick J.Y. were involved in the writing of the manuscript; A.N.E., C.A.N., J.H., E.M.C., A.D.K. Meinhausen C, Sanchez GJ, Robles TF, Edmondson D, Kronish IM, Hinrichs R, Jovanovic T, Sumner JA. Elderly patients in intensive care can develop delirium if they are on a BZD [1]. Key Features of Anxiety and Trauma Related Disorders... 7 Management of Anxiety and Trauma Related Disorders ... 8-16 Potential Contributors to Insomnia...17 Management of . Ragnhildstveit A, Roscoe J, Bass LC, Averill CL, Abdallah CG, Averill LA. doi: 10.1136/bmjopen-2017-020198. They are used for immediate symptom relief of anxiety, epilepsy and other seizure disorders, spasticity from CNS pathology, catatonia, sleep disorders such as insomnia, and withdrawal from alcohol and other BZDs [3]. This could be a feasible alternative to IV infusion of flumazenil because patients can be mobile when given medications subcutaneously, so they are more likely to return for repeat treatments and recommend treatment to friends [64]. Benzodiazepine abuse is common in those on methadone maintenance treatment (MMT), so special consideration must be taken for those withdrawing from the drugs while on MMT [68]. ), appetite and weight changes, unusual smell, and others have been documented [52]. Lowenstein D.H., Bleck T., Macdonald R.L. The site is secure. Cessation after long-term usage (greater than two weeks) has even shown in some individual’s the inability to return to cognitive baseline. Eating disorder patients say punitive, threatening methods at Denver . Quagliato L.A., Freire R.C., Nardi A.E. 8600 Rockville Pike For mothers with BZD use during pregnancy, there is a risk of premature birth and low birth weight. They're much safer than their predecessors. Vorma H., Naukkarinen H.H., Sarna S.J., Kuoppasalmi K.I. The dose of BZD given also positively correlated with increased risk of an overdose death [50]. Regular use of BZDs has been shown to cause serious, harmful psychological and physical dependence, leading to withdrawal symptoms similar to that of alcohol withdrawal. This should provide pause, as BZD discontinuation after chronic use leads to withdrawal symptoms, with heavy users at risk for seizure activity [8]. Table 1 summarizes the studies discussed in this section.
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