Not All Benzodiazepines Are Created Equal: Benzo Roast

Not All Benzodiazepines Are Created Equal: An In-Depth Roast of the Four Most Popular Benzos

Have you ever heard that “a benzo is a benzo?” I really cringe when I hear a healthcare professional flippantly come off with this remark when dealing with switching a patient’s benzodiazepine for tapering (or otherwise) purposes. Well, it’s true, all benzodiazepines are benzodiazepines. Just like all antibiotics are antibiotics. However, not all benzodiazepines are equivalent with regard to how they affect each GABA-a receptor subunit; just like not all antibiotics work the same way to kill bacteria, either. Contrary to popular belief, most doctors do have brains. I wish they’d use them more often. If all benzos did the exact same thing in the brain, then drug Use-it-Dr.-House-quote-250x156manufacturers of popular benzos wouldn’t have created so many different ones with different binding affinities. And, each different benzodiazepine has its own molecular structure which separates it from its other benzo family members. Sure, they all share the basic foundation of a Benzene ring fused with a Diazepine ring, but each has its own set of other compound structures which differentiates. So if you are switching benzodiazepines for whatever reason– tapering purposes, perhaps you’re not tolerating your previous benzo very well– the purpose of the benzodiazepine you’re switching to is to “cover” the acute withdrawal symptoms of your previous benzo,  but this is no guarantee that you won’t have some discomfort during the switch or crossover process– because not all benzodiazepines are created equal. It’s common sense.


As redundant as it may sound to repeat this– benzodiazepines have a very important role in today’s healthcare and in Western Medicine. Used in isolation of indicated situations, these medications are usually effective with very tolerable side effects. Paradoxical effects are rare, and usually occur during IV administration or with chronic use. The problem with these drugs is that their effectiveness not only goes away with tolerance dependence; these drugs can actually make you really sick when that does happen.

Just like each benzo has its unique therapeutic effect, they all tend to have their own equally disturbing adverse effects, too. If you were to ask most anyone tapering off any one of these benzos which was the “worst one,” they would probably tell you it was their original benzodiazepine and its adverse side effects–whether they crossed over to another benzo or not. It brings a whole new turn to the phrase “Pick Your Poison.” 

Today, we’re going to highlight the lowlights of the four most popularly prescribed benzodiazepines (in alphabetical order):

  • Alprazolam (Xanax)
  • Clonazepam (Klonopin)
  • Diazepam (Valium)
  • Lorazepam (Ativan)

Of the four, I’ve been dependent on Xanax, Klonopin, and Valium, respectively. I have no experience with Ativan other than a one-off IV administration in a hospital as a teen, however, I’ve been checking its records and, it’s getting roasted just like the other three most popular benzos.

Alprazolam (Xanax)

AKA: “Xanthrax” – “Bars” – “Zandy Bar”

molec-xanax

Molecular structure of AlprazoLAM (Xanax). Notice the extra molecular ring, known as the triazoloring, which is not in the composition found in ordinary benzodiazepines.

Possibly the worst of the most popular benzos, this benzo’s post roast here will be a bit more long winded than the others. There are just so many things this “little blue pill” is infamous for, and you might call me biased, because it was my original poison. I had the worst experience with this one, personally, so I’ve been calling it “Xanthrax.” And I had to cross over to any other benzo with a longer half-life.  This one I found impossible to make cuts to, due to its high potency combined with its short half-life and its stimulatory paradoxical properties.

Originally to be Marketed as both an anti-anxiety and anti-depressant

Alprazolam (Xanax) is almost like a “super-benzo.” It’s no ordinary benzodiazepine. It has “extra” properties, and this is obvious when you compare its four ringed molecular structure to other common, traditional benzodiazepines, which typically have only three (read on for more on why this is). Xanax was originally to be marketed as both an anti-anxiety and an antidepressant by UpJohn, as pictured here in this vintage pharmaceutical ad.

Vintage Xanax ad

Vintage Xanax ad

 Triazolobenzodiazepine: A Super Benzo with an Extra Ring in its Molecular Structure

It’s a member of the Triazolobenzodiazepine family of benzodiazepines. This benzodiazepine class is the reason for that extra ring in its molecular structure. The chemical structure differs from the traditional benzodiazepines by incorporation of the triazoloring. Due to the triazolo ring, the drug can “have additional modes of action than the normal benzodiazepines.” [1]

molec-xanax-triTriazolobenzodiazepines can be identified by their suffix, which typically ends in “-lam” rather than “-pam”.  For the purpose of this entry, we’ll call the Triazolobenzodiazepines “the lams.” If you go ahead and have a look at the molecular structure of Xanax (Alprazolam) to the left of this paragraph, you’ll see this extra ring, covered by letters, numbers, and other elemental glyphs which represent its properties. But– that’s indeed the triazoloring, and its effects may act on various neurotransmitters.

Confusing the Endocrine System

From my research, some possible neurotransmitters affected by the lams include Norepinephrine, Serotonin, Dopamine, and the central corticotropin-releasing factor (CRF),[2][6][11][20] which is part of the Endocrine system. The Endocrine system regulates hormones in your body. When you think of hormones, you usually think of reproductive hormones, however, there are also other types of hormones, such as stress hormones, like Cortisol, and Cortisol levels are affected by the CRF. This study found that chronic administration of alprazolam actually causes dramatic spikes of Cortisol levels between doses, whereas lorazepam, a classic benzodiazepine, did not have this effect.[20]

Can Induce Panic Disorder and Exert Stimulatory Effects

Xanax can actually cause Panic Disorder in people who did not previously have Panic Disorder, especially when there is an increase in the dosage due to tolerance of the anxiolytic effects of Xanax.[5] This drug lies to you in this regard, because usually people just take more of it to quell the exaggerated panic attack that it may cause. They often feel like it’s the only thing keeping their panic attacks at bay; when it could actually be causing the panic attacks; and taking more of the drug can actually have that paradoxical effect. Read on.

Animal studies in rats indicated that even low doses of Alprazolam (Xanax) actually induced  increased locomotive stimulatory behavior  after administration of low doses of Alprazolam, but this phenomenon did not occur on the administration of low dose Lorazepam (Ativan), which is a classic ordinary benzo, and not a Triazolobenzodiazepine. The study concludes:  “In the rat, behavioral stimulatory effects of low-dose benzodiazepines is evidenced with alprazolam but not lorazepam.” [6] The study implies that these effects may be associated with Dopaminergic and Serotonergic activity associated with administration of Alprazolam.

Oxymoron: A Sedative Stimulant

Additionally, some of the lams in addition to working on traditional GABA-a receptors,  are also found to affect serotonin receptors by sensitizing hippocampal neurons to serotonin with chronic use.[11] Hmm, I wonder what other excitatory neurotransmitters become hypersensitive with chronic use of a Triazolobenzo?
Adinazolam can also affect norepinephrine receptors and have serotonergic activity in a similar way that Imipramine, a TCA, does.[2] This, while also exerting GABA-ergic sedative effects…. It just sounds like speed and a downer combined in one little pill, to me.

Imagine, if you will, being dependent on a drug that has dramatic spikes and troughs in blood levels from day-to-day, and it’s also a downer and an upper.

A Personal Experience with Xanax Dependency:

“I thought my parents were going to have me exorcized by a Priest when I woke up in withdrawal from Xanax every morning … and what made it even more disturbing was when I took my morning dose that my body so craved, I would develop such severe motor restlessness that I was almost literally climbing the walls with my eyes half closed in a chemical, intoxicated exhaustion.”

Difficult to Taper: Ultra Short Half-life and High Potency

Alprazolam is a high potency benzodiazepine, which means that very little of it is needed to have a strong effect. This also means that any dry cut to it would have a significant impact on blood and tissue concentrations, and this, together with its short half-life could be setting the patient up for a potentially acute withdrawal reaction during attempts to make a reduction from these often asymmetrical oval shapes (generic brands, anyway– brand Xanax come in the shape of uniform rectangular shapes). This is why people usually cross over to a different benzo to taper this one.

Serotonin Syndrome when mixed with Serotonergic Drugs?

Honestly? Chronic use of this kind of drug sounds like a recipe for a catastrophically confused endocrine and central nervous system[2][6][11][20], maniacally unstable blood concentrations, and if mixed with other serotonergic drugs, can spell disaster. Perhaps it can even induce Serotonin Syndrome?
Serotonin Syndrome can happen when two serotonergic drugs are mixed. Monotherapy with only one serotonergic drug can also produce Serotonin Syndrome, and if alprazolam truly has serotonergic activity, it is concerning.

Because of this drug’s high potency and short half-life, it leaves the body almost as fast and hard as it hits; and therefore it may be a little more challenging to cross over to a weaker benzo such as Diazepam (Valium) from this one.. however, I personally found this benzo to be impossible to taper due to its potent punch and interdose withdrawal. Round-the-clock cravings and such. So even though crossing over to a weaker benzo was uncomfortable at first, it was worth it as it enabled me to taper.

Interdose Withdrawal

One of the primary problems people report with the lams such as Xanax are interdose withdrawal symptoms, or withdrawal symptoms between doses, due to the short half life (6 – 12 hours)[3] and short duration of action of the drug. Most, if not all of the lams have very short half-lives. In addition to that, it has a very fast onset; like a proverbial punch to your brain. Going all night without a Xanax when you’re dependent on it and in tolerance of it, then taking it first thing in the morning can make for some very rough mornings. If you’re tolerant/dependent on Xanax or have previously been dependent on it, you probably know exactly what I’m talking about.

Clonazepam (Klonopin / Rivotril)

AKA: “Klonopoison” – “Napalm” – “K-pin” 

Molecular structure of Clonazepam (Klonopin, Rivotril)

Molecular structure of Clonazepam (Klonopin, Rivotril)

Clonazepam has a nickname of “Napalm” for a reason. It’s actually a Nitrobenzodiazepine; a chlorinated derivative of Nitrazepam (Mogadon),[8] and Clonazepam’s substructures include Nitro compounds.[7] If you think that sounds invasive, it’s probably because it is. This is not just another high potency benzo, (with some equivalency charts arguably finding it to be at least twice as potent as Xanax);  it’s like a benzo trump card in how powerful it is. It does have a slower and more subtle onset of effect, and a slower clearance rate, which in my opinion, still makes it preferable to Alprazolam. (I mean.. if I had to choose).

Primarily an Anticonvulsant

This benzo has been used in clinical practice to stop seizures. While this benzodiazepine has a high potency, it has a modestly long half-life and a very long duration of action, which some people have felt were more suitable for beneficial for tapering purposes.

Clonazepam is often associated with a lot of adverse neurological side effects that really seem to stick around, and this could be because it is a benzodiazepine of the primarily anti-epileptic drug (AED) variety, with strong anticonvulsant properties and a ridiculously tight binding affinity.

Radioactive-Photobombing_c_94769

I wonder if this radioactive photobomber was on Kpin.

In the United Kingdom, and other countries, its license for use is quite limited to Epilepsy and  related convulsive neurological disorders. In Canada, its Pharmacology indicates that it is “Used as an anticonvulsant in the treatment of the Lennox-Gastaut syndrome (petit mal variant), akinetic and myoclonic seizures.” [7] The United States is one of very few countries where it is routinely used in Psychiatry. Perhaps it’s the only country that does. Regardless of its indications for use, it is a traditional three-ringed molecular structured benzodiazepine. Tolerance can develop with any type of benzodiazepine, and this is no exception– sooner or later. With Clonazepam, it is usually later, from my experience. You might think this is a good thing– if you’re on Clonazepam for long term treatment of anything. But this probably is of little benefit to you if you desire to taper off it or have reached tolerance to it– It hangs around that receptor. It’s like that ex that just won’t get over it and clings to you like a dryer sheet.

Intense Binding Affinity

Clonazepam binds more tightly to the GABA receptors than any other benzo, and binds to more subunits of the GABA receptor than most any other benzodiazepine,[9] according to this book (page 176). The book was written by Professor Simon D. Shorvon, Professor in Clinical Neurology & Consultant Neurologist, and author of several publications on Epilepsy.
The book explains that “Clonazepam has higher binding affinity to the benzodiazepine receptor than diazepam or other benzodiazepines, and furthermore clonazepam binds to subgroups of the GABAA receptor that do not bind the other drugs.”[9] (emphasis is mine).
So, expect your GABA receptors to be very highly affected by this benzo.

Because of this tight binding affinity and high potency, patients requiring high doses are a good indicator of tolerance; and it may be a little more challenging to cross over to a weaker benzo such as Diazepam (Valium) from this one.

As someone who tapered Clonazepam for three years, I can vouch for this. Even when I got to very low doses, this drug had an effect on me. And when I finally did get down to such a negligible dose that I became practically benzo free, I feel like it stripped my GABA receptors and left them very raw, so I was facing a possible Protracted Withdrawal Syndrome, despite a very slow taper. Please note, though, that I sped up my taper toward the end and that likely played a role in my botched taper off this drug. I may have been biased, but it seems to me that I’ve seen more people who were protracted from Clonazepam than any other benzodiazepine.

A Personal Experience with Clonazepam Dependency:

“I didn’t think Vampires existed until I was on K. When I tapered down, I found myself unable to leave the house without sunglasses on. Every window had blackout curtains. My skin would crawl and my insides felt like they were writhing. Oh, and I must have aged several decades. I couldn’t stand certain frequencies or loud noises. These symptoms really induce panic and confusion in my whole body. The strange perceptual disturbances reminded me of what is described as HPPD. Who needs acid when you have a ‘nuclear’ drug like this?”

Sensory Disturbance Observations

This  is where I feel like it turned me into a vampire. Not the sparkly kind that likes to give you piggyback rides.. but the kind that tweak out in the sun. It made me feel radioactive. Fortunately, I don’t believe I ever turned into a bat or drank blood or anything. I just couldn’t tolerate the sun, and struggled during the daytime. And to be fair, it seems most everyone in benzo withdrawal tend to struggle during the day.

doctorofmindmd

I wonder if he took a Kpin.

“Doctor of Mind MD” from YouTube (is he a Psychiatrist? A real MD? A medically educated comedian? IDK. He often speaks of his experience in clinical practice.)
..Anyway, he can tell whenever one of his K-pin patients walk through the door; he says they arrive with sunglasses on and calls it “the sunglasses sign.” Not unlike other Psychiatrists, apparently that doesn’t stop him from prescribing it? Who knows. In this video, he says, Now there’s a frequent, common observation I’ve noticed in practice– people on Klonopin might come in with sunglasses. I call it ‘the sunglasses sign.’  I don’t know what the problem is. Does it cause photophobia or what?” – Doctor of Mind MD as he fumbles around with multiple pairs of sunglasses in the video @1:50 min. So, apparently, even doctors with YouTube channels don’t know why this happens.

Diazepam (Valium)

AKA: “Valyuck” – “Mother’s Little Helper” – “Valley Girl” – “V-Cuts”

Molecular structure of Diazepam (Valium)

Molecular structure of Diazepam (Valium)

One of the first benzodiazepines to have ever existed, (came after the first benzo ever engineered – Chlordiazepoxide/Librium)  this one got a bad reputation in the ’60s and ’70s even though it’s a very basic benzo and incredibly weak compared to its high potency, tripped out successors. But, a benzo is a benzo, afterall. Suffice it to say, people had trouble with Diazepam because it’s a benzo. Creating more benzos to remedy problems with benzos–especially stronger ones–  isn’t going to solve problems with benzos. Make sense? I digress.

We’ll kick off this benzo roast with lots of insulting name-calling:

A Wimpy Benzo

Diazepam is initially very sedative in a sleepy-drunk sort of way, and relaxes muscles– but its other GABAergic properties like anxiolysis aren’t reported to be very strong, so you probably should be patient if you’ve decided you’re crossing over to this one from a more potent one. I would avoid crossing to Valium if insomnia is a big issue; since Valium is more sedative than anything, withdrawal of it can have the opposite effect.
It’s not just weak in terms of dosage; it also doesn’t really have a remarkable therapeutic effect. Its weakness has a silver lining, though; being a weak benzo, this can make the drug easier to taper in the longrun– perhaps the withdrawal symptoms won’t be as intense when cutting this one, and this combined with its long half-life is the preferred benzo to taper from[12]. But if your original benzo was very potent, crossing over to this one might be  uncomfortable for a while. Maybe. Some people find a lot of relief with crossing over to Diazepam. But some people don’t tolerate it at all, and it’s been described as feeling “dirtier” than other benzos (see Personal Experience below) and opt to cross to some other benzo with a longer half-life or try to come directly off their original benzo with a microtaper.

Unnatural, Abysmal Mental Depression

if-you-ever-feel-dumb-just-remember

I added this funny meme in case reading this paragraph was depressing

Despite its low potency, the number one complaint I hear about Diazepam’s side effects, and withdrawal syndrome, is basically depression. At times, severe depression. Not just gloominess; I’m talking abysmal, irrational hopeless feelings of doom and despair which can possibly lead to suicidal ideation or worse. I would go into detail about why this may possibly be, but even Psychiatry isn’t really sure about the physiology of depression. Shots in the dark with theories about Serotonin and Norepinephrine and their role in depression just doesn’t cut it for me. But Diazepam really seems to agonize it. No pun intended. I wouldn’t do a Diazepam crossover if you already struggle with depression in some severe way. It’s a true depressant downer. I can vouch for this based on my own experience, and I’m not really that prone to depression. It is an official side effect listed in its Prescribing Information and on drugs.com.[13] I just don’t think they really emphasized enough just how much this drug “depresses” the central nervous system… and mind.
Back when I tapered Clonazepam, I used to think that people suffering depression from Diazepam needed to grow a backbone. But uh… After getting on Diazepam, I developed the motivation of a sloth, the memory of a fish, and the backbone of an invertebrate.

Some people just don’t tolerate this benzo.

A Personal Experience With a Diazepam Crossover:

“When I crossed from K to V- first of all- I slept ALL day and night- I was awake (and disoriented) only a few hours a day. That really freaked me out. I also got severe, severe depression – darker than anythnig I’ve ever known. And nausea- intense nausea and diarrhea. It felt much “dirtier” to me than the drugs I was intially on – K and X.”

Because this individual was originally on two other infamously bad and potent drugs, it wouldn’t be known whether she was having some acute withdrawal symptoms underneath the Diazepam that it wasn’t covering, or perhaps a combination of adverse side effects of initial Diazepam therapy and acute withdrawal symptoms from her original benzos – Clonazepam and Alprazolam– either way, it’s not a fun “trip.”

A Personal Experience With Diazepam…

“At first I thought this drug was miraculous….suddenly I could sleep and function without anxiety even though I just had a miscarriage… was horribly depressed. After the V got hold of me, the depression got worse than it ever was before. I also had night terrors, the kind where you wake up screaming in fear, I never dreamed before being on Valium… and now I do, and it’s all nightmares. It’s sad cause it still helps my anxiety, but I’m glad I’m going to taper off.”

A Benzo with Multiple Personalities

anti-joke-triceratops-meme-generator-i-have-multiple-personalities-and-so-do-i-08daa5Yeah, I just diagnosed a drug with a mental illness.
Did you know that when you take Diazepam, you’re actually on Diazepam, and its active metabolite Nordiazepam (Nordaz), and its other active metabolites Oxazepam (Serax) and Temazepam (Restoril)[14], [15]? That’s because Diazepam is such a basic benzodiazepine that it is broken down into these metabolites, which exert subtle active therapeutic properties when plasma bound, during and after metabolization. Diazepam, once metabolized, is highly lipophilic, meaning that it will rapidly absorb, and settle into adipose fatty tissues rather than remain highly plasma bound in the blood where it is made available to the brain after administration. Serax is a very short acting, weaker benzo, and Temazepam isn’t much better, but it is Nordiazepam that helps give Diazepam its reputation of long half-life. I once wondered why some people struggle with Diazepam interdose withdrawal– but if I had to guess, I’d put my money on the combination of its shorter duration of noticeable effects and… well, when you take a Diazepam…
Surprise!
You’re also on Nordaz, Serax and Temazepam, too! (erm, so, expect to get some of their side effects even if you don’t take them directly… you do if you take Valium).

While this is disconcerting news, it is this slow process of metabolization and evolution of metabolites that is commonly believed to help let you down easy when you make a cut to Diazepam[15]– in theory anyway, and support by Dr. Reg Peart, a Ph.D who died whilst researching benzodiazepines to death. Literally. It is said that his establishment had research papers on benzodiazepines and withdrawal piled to the ceiling, and there is some controversy on who has obtained this documentation and what they’re doing with it.

Short Duration of Action

While the half-life of Diazepam is very, very long, its duration of therapeutic action is moderate to short, depending on where you get your intel. In my experience this means you might be highly sedated by it briefly, but that effect may wear off quickly and what’s left is are subtle CNS sedation effects. One of the older, classic treatments for an inpatient experiencing Delirium Tremens, a serious complication of Alcohol Withdrawal Syndrome is 10mg Diazepam IV very frequently through out the day, and this is probably because of that short duraton of action.
Despite its shorter duration of action, the fact that it has a long biological half-life can help prevent interdose withdrawal symptoms, which are a primarily physiological, biological phenomenon, not necessarily a psychological one… and the drug would leave the body slowly and more steadily.
The main thing to remember if you’re crossing over to Diazepam for tapering purposes is that you’re not crossing over to Diazepam to get a high from it.

Ativan (Lorazepam)

“Crapivan” – “Valium’s Little Brother” – “Lora”

molec-ativanThis one is a sneaky little brat. I have very limited personal experience with it, as I’ve only had it once via IV during a hospital stay unrelated to benzos, (I have a cardiac problem) and this was also before I’d ever been dependent on benzos. So I had to talk to others who’d been dependent on it and found themselves needing to come off of it. From my very limited experience with it, I have to say that it’s a “sneak” because it’s kind of weak in the way of therapeutic effectiveness; I remember asking for more after just one dose– and I wasn’t wanting more to get “high,” it just wasn’t working, and I needed higher and repeated doses, which I actually refused. Yet when people try to discontinue it, even if they’ve been on low doses or on it for a very short amount of time, so often it has already caused dependency. It sneaks up on you.

Sneaky and Rapid

sneaky

Ativan. The troll of the benzodiazepines.

You know how it just sort of melts in your mouth? It does the same thing to your brain. Many patients find themselves popping these little “Lora” buggers like pez candies all day long. There is something so very unnatural about that, and this has been known since at least 1985[24]– The Handbook of Neuropsychology and Aging, edited by Paul David Nussbaum, explains that “Patients taking rapidly  eliminated drugs, such as loraepam, and more specifically alprazolam (Zipursky, Baker, & Zimmer, 1985), should be cautioned against running out of medication or deliberately abstaining from their medication. The resulting symptoms can be severe, adversely affecting medical and psychiatric conditions.”[24] Bearing in mind that Lorazepam is weaker than Alprazolam, one can see how this can easily lead to dose escalation and the need for multiple daily doses.

Why again, are physicians still prescribing this drug long term with this knowledge? And Heaven forbid you drop one of these down the drain or lose it some other way. Many people who are either taking lorazepam or tapering it find that they have to dose it several times per day to ward off these severe withdrawal symptoms which can occur between doses, otherwise known as interdose withdrawal.

Valium’s Little Brother

Lorazepam, after Diazepam and Chlordiazepoxide (Librium) has come to be the usual course of treatment for Alcohol Withdrawal Syndrome[26], and thus people have been calling it “Valium’s Little Brother.” Lorazepam has also been indicated for the treatment of Delirium Tremens (DT) associated with Alcohol Withdrawal Syndrome, a severe and potentially fatal form of Acute Alcohol Withdrawal Syndrome. While acute withdrawal and DT-like phenomena can occur with sedative-hypnotic substances, it is particularly troublesome with Alcohol Withdrawal Syndrome due to the Wernicke-Korsakoff’s syndrome that can happen as a result of Alcohol Withdrawal related DTs. The DTs are also something that can occur after consuming extremely excessive amounts of alcohol, especially on an empty stomach.[25][27] Wernicke-Korsakoff DT is much more invasive in that it involves the fluid that encapsulates the brain and damages liver; it is worth it to note that this sort of DT is not a concern with benzodiazepines, if that’s any consolation at all.
Unfortunately, Lorazepam, while weak, is still much more potent than Diazepam, and its short half-life can precipitate the classic benzodiazepine withdrawal syndrome which is not unlike the generic alcohol withdrawal syndrome (but not the freaky kind of DTs).

A Personal Experience with This Drug…

“I’d heard so many awful things about Xanax that when my doctor told me about Ativan, I was relieved thinking that it wouldn’t have the same problems that Xanax does. My pDoc told me it wasn’t as addictive, but he was wrong. I was hooked within a week or taking it as prescribed and whenever I tried to stop I had withdrawals like I was on it for years. My original dose was 0.5mg at night. In a short time that turned into 4mg a day just because of interdose withdrawals.”

Intense Amnestic Properties

memory-lossAh, memory loss. It is well documented that benzodiazepines can have amnestic effects, however, lorazepam’s binding affinitiy for the GABA-a’s amnestic subunit appears to be stronger than most: “Lorazepam (Ativan) appears to have more profound adverse effects on memory than other benzodiazepines; Lorazepam (Ativan) impairs both explicit memory and implicit memory.”[21] However, like the rest of its effects, tolerance to this amnestic effect develops very rapidly–and not to sound redundant, but rapid tolerance development to this drug is not necessarily a good thing.

Suffice it to say, Lorazepam’s rap sheet seems to be most dissed on due to its rapid dependency onset, dose escalation, intense interdose withdrawal symptoms, and cognitive deficits[22].

A Misleading Brand Name

As depicted in the personal experience shared by the volunteer above, the name “Ativan” doesn’t sound very foreboding. I know people with high status careers who think being on this medication is perfectly fine, but won’t touch any of the other benzos. They call it their “anti-anxiety medication,”  yet when they talk about Xanax or other popular benzos, they call those “drugs,” as if to somehow differentiate a medication and a drug. Its brand name doesn’t have that sharp  inflection that Valium or Xanax does. Even Klonopin’s (Clonazepam) name is a bit ominous, as it begins with “Clon-”,  a prefix most associated with clonus, seizures and related serious neurological health conditions.

 

________________________________________

I’m personally a little freaked out by all of the benzodiazepines. They’re like a bad acid trip when you become hooked and/or tolerant to them.

So which one do YOU dislike the most? We know they ALL suck, but we’re entitled to our own biases, right?
Take the poll below!
(multiple choice options available, but you may only make one submission).

_______________________

Citations and Reference Material:
[1] http://www.ncbi.nlm.nih.gov/pubmed/1362662
[2] Ayd, Frank J. Jr. Lexicon of Psychiatry, Neurology and the Neurosciences. Page 8.
[
3] http://www.benzo.org.uk/bzequiv.htm

[4] http://www.samhsa.gov/data/DAWN/files/ED2006/DAWN2k6ED.pdf
[5] http://www.medscape.com/viewarticle/431758
[6] http://www.ncbi.nlm.nih.gov/pubmed/11226811
[7] http://www.drugbank.ca/drugs/DB01068
[8] Neurology March 1975 vol. 25 no. 3 255 (abstract: http://www.neurology.org/content/25/3/255)
[9] Shorvon, Simon D. “Handbook of Epilepsy.” Page 176.
[
10] http://www.ncbi.nlm.nih.gov/pubmed/1949970

[11] Review of Psychiatry: 1990. Volume 9. 1997. Page 157.
[1
2] Ashton, Professor Heather C. “Benzodiazepines: How They Work and How to Withdraw.”  Chapter II.

[13] http://www.drugs.com/sfx/diazepam-side-effects.html
[14] http://www.ncbi.nlm.nih.gov/pubmed/18618924
[16] http://www.news-medical.net/news/2008/08/27/40964.aspx
[17] http://www.ncbi.nlm.nih.gov/pubmed/1679244
[18] http://www.nature.com/npp/journal/v34/n2/full/npp200889a.html
[19] http://www.ncbi.nlm.nih.gov/pubmed/16492814
[20] http://www.ncbi.nlm.nih.gov/pubmed/14694352
[21] http://www.junebergalzheimers.com/index.php?option=com_content&view=article&id=1&Itemid=15
[22] http://www.ncbi.nlm.nih.gov/pubmed/19573495
[23] Bhatia, Subhas C. et al. Jefferson Journal of Psychiatry. Page 32
[
24] Nussbaum, Paul David. Handbook of Neuropsychology and Aging. Page 488.

[25] http://emedicine.medscape.com/article/166032-medication
[26] http://www.aafp.org/afp/1998/0701/p139.html (Am Fam Physician. 1998 Jul 1;58(1):139-146.)
[27] http://www.nlm.nih.gov/medlineplus/ency/article/000766.htm
While I strive to ensure that all of my information is based on credible sources, I cannot guarantee its accuracy. Nothing contained within this blog or post should be construed as medical advice or matter of fact.