If you’re older than 50, chances are good you’ll get a prescription someday for a medication to relieve anxiety or insomnia. Called benzodiazepines, these drugs are effective, but there are also problems associated with their use.
Approximately 5.2 percent of adults (ages 18 to 80) in the United States take benzodiazepines, according to a study published in February 2015 in the journal JAMA Psychiatry. People on the older end of the spectrum are even more likely to use them — about 7.4 percent of people 51 to 64 and 8.7 percent of people 65 to 80. The unique medical needs of older people probably play a role in the higher rates of use, says Mark Olfson, MD, MPH, a professor of clinical psychiatry at Columbia University in New York City and one of the lead researchers on the study.
“The quality of sleep naturally declines as people age, and as a result, complaints of insomnia increase with age,” Dr. Olfson says. “Benzodiazepines offer prompt relief that requires little effort on the part of the prescribing physician.”
Older people are also more likely to experience emotionally stressful events like the loss of a spouse or another family member. They may seek benzodiazepines to deal with their depression and anxiety, says Michael Weaver, MD, professor in the department of psychiatry and behavioral sciences, and medical director of the Center for Neurobehavioral Research on Addiction at the University of Texas Health Science Center at Houston.
The Risks of Anti-Anxiety Meds
Benzodiazepines including Xanax (alprazolam), Valium (diazepam), and Restoril (temazepam) have been around for decades, and they work to provide relief from panic attacks or bouts of insomnia, Dr. Weaver says. However, the risks often outweigh the benefits.
People can build up a tolerance to them, and with regular use, their effects can lessen. “They’ll need more of the drug to get the same effect, or they won’t be able to get to sleep without it,” Weaver says. “That may mean people are using more and more over time.”
RELATED: 6 Depression Symptoms You Shouldn’t Ignore
Heavy benzodiazepine use in older adults is particularly problematic, Olfson says, because the grogginess induced by the medications is more likely to result in falls, car crashes, and other accidents.
Also, other medications, as well as alcohol, can interact with benzodiazepines and multiply their effects, Weaver says. “People may not realize that the medication they take for anxiety is similar to the medication they take for going to sleep, which is similar to the cocktail they have as a nightcap,” Weaver says. “It can add up rather quickly.”
If You’re Taking Benzodiazepines
Despite their drawbacks, anti-anxiety medications can be helpful when used properly. They’re intended for short-term use and can be helpful in isolated stress-inducing situations. Someone who is afraid of flying, for example, may take one before they board a plane.
If your doctor prescribes a benzodiazepine, you should talk extensively about appropriate ways to take it, says Grant Brenner, MD, a private-practice psychiatrist in New York City. “When will you take it?” Dr. Brenner asks. “Under what conditions of anxiety, and how severe would it have to be? That’s a better conversation to have than ‘Here’s a bottle of 60 pills. Take no more than three a day.’ ”
If you feel sedated or off after starting the medication, Brenner adds, be sure to let your doctor know — a lower dosage may be appropriate. You should also tell your doctor about any other medications you are taking, both prescription and nonprescription.
Both men and women taking these prescription drugs should watch carefully for signs that they’re becoming addicted or building up a tolerance. Taking more of the medication than is recommended or taking it more often than recommended is a major cause for worry, Weaver says. Feeling shaky or unusual if you don’t take the medication is another sign. If others point out that you’re exhibiting odd behavior, it could also be a clue that the drug is affecting your ability to function. “People may say you seemed pretty sleepy or confused the other day or didn’t seem quite like yourself,” Weaver says.
Tips for Stopping Anti-Anxiety Medications
If you take benzodiazepines regularly and would like to stop, talk with your doctor before making any changes. Abruptly stopping Xanax or Valium can lead to withdrawal, which can make you sick or even be fatal, Weaver says. Over time, your doctor will help you slowly taper off your dosage.
After stopping, you may still need to address the problem that caused you to start taking the drug in the first place. “Whether it’s depression, insomnia, or anxiety, you need to get to the root cause of these problems and find workable alternatives,” Weaver says. “It may be another type of antidepressant medication or working with a therapist for various types of counseling.”
If you find you’re unable to stop taking benzodiazepines, Weaver adds, you may need to find an addiction treatment program that can work with you intensively to break the cycle. Ask your doctor for a referral to one of these programs.