Cognitive effects benzodiazepines

Barker MJ, Greenwood KM, Jackson M, et al Cognitive effects of long-term benzodiazepine use a meta-analysis. CNS Drugs 18 37M8, 2004... 

Side effects associated with benzodiazepines in PD patients are similar to those observed in other disorders. Sedation, fatigue, and cognitive impairment are the most commonly reported side effects.49 Benzodiazepines should be avoided in patients with current substance abuse, a history of such, dependence, or sleep apnea. Additionally, caution should be used in older adults because they have more pronounced psychomotor and cognitive effects. 

Girdler NM, Lyne JP, Fairbrother K, Neave N, Scholey A, Hargaden N, Wesnes KA, Engler J and Rotherham NA (2002). A Study of post-operative cognitive and psychomotor recovery from benzodiazepine sedation Effects of reversal with flumazenil over a prolonged recovery period. British Dental Journal, 192, 335-339. 

Dowd, S.M. et al., The behavioral and cognitive effects of two benzodiazepines associated with drug-facilitated sexual assault, J. Forensic Sci., 47, 1101, 2002. 

Several studies have shown that impairment of a person s cognitive or mental function can occur in people taking benzodiazepines. These effects can include problems such as lapses of memory, and confusion. For example, college students who take benzodiazepines before exams to help them relax or sleep may not remember some of what they have been studying. 

Barker, M., Greenwood, K., Jackson, M., Crowe, S. (2004). Cognitive effects of longterm benzodiazepine use A meta-analysis. CNS Drugs, 18, 37-48. 

Hommer, D. (1991). Benzodiazepines Cognitive and psychomotor effects. In P. Roy-Byrne D. Cowley (Eds.), Benzodiazepines in clinical practice Risks and benefits. Washington, DC American Psychiatric Press. 

In a double-blind, placebo-controlled study of sex differences in the effects of lorazepam in trained social drinkers, lorazepam substituted for alcohol equally in both sexes and increased associated scores for light-headedness (14). The women had much greater performance impairment in a digital symbol substitution test after lorazepam than the men. These results suggest that the stimulus and cognitive effects of benzodiazepine receptor agonists are modulated by different brain mechanisms. 

Alpidem, like zolpidem, is an imidazopyridine, chemically distinct from the benzodiazepines. It binds selectively to a subset of benzodiazepine receptors (1), which may account for its apparently milder withdrawal effects and a relative dominance of anxiolytic over sedative and cognitive effects (2). Its effects are reversed by flumazenil (3). Alpidem was withdrawn in 1953 in France, the only country in which it was marketed, because of hepatotoxicity (4). 

Some SSRIs (notably fluvoxamine and to a lesser extent fluoxetine) and their metabohtes inhibit hepatic oxidative enzymes, particularly CYP2C19 and CYP3A, that metabolize most benzodiazepines, as well as zaleplon, zolpidem, zopiclone, and buspirone (SEDA-22, 39) (SEDA-22, 41) (168,169). Apart from fluvoxamine, SSRIs do not generally have a chnically prominent effect on hypnosedative effects studies vary from those that have found that fluoxetine has a moderate but functionally unimportant impact on diazepam concentrations (170) to results that suggest significant aggravation of the cognitive effects of alprazolam when co-prescribed with the SSRI (171). 

Benzodiazepines. Several BZs have anticonvulsant activity and ate used for the treatment of epilepsy producing their anticonvulsant actions via interactions with the GABA /BZ receptor complex to enhance inhibitory GABAergic transmission (1). The anticonvulsant actions of the BZs tend to tolerate upon chronic usage in six months, and BZs also lead to withdrawal symptomatology. Other side effects include sedation, ataxia, and cognitive impairment. 

Benzodiazepines are used commonly in SAD however, there are limited data supporting their use. Clonazepam has been effective for social anxiety, fear, and phobic avoidance, and it reduced social and work disability during acute treatment.58 Long-term treatment is not desirable for many SAD patients owing to the risk of withdrawal and difficulty with discontinuation, cognitive side effects, and lack of effect on depressive symptoms. Benzodiazepines may be useful for acute relief of physiologic symptoms of anxiety when used concomitantly with antidepressants or psychotherapy. Benzodiazepines are contraindicated in SAD patients with alcohol or substance abuse or history of such. 

Reducing benzodiazepine use in elderly patients is important for several reasons. Long-term use of benzodiazepines can accelerate cognitive decline in elderly patients (Paterniti et al. 2002). The elderly experience excessive sedation from benzodiazepines compared with younger individuals (Lechin et al. 1996). Benzodiazepine use by elderly patients are not only associated with cognitive side effects... 

The most commonly used therapies for anxiety and depression are selective serotonin reuptake inhibitors (SSRIs) and the more recently developed serotonin noradrenaline reuptake inhibitors (SNRIs). SSRIs, which constitute 60% of the worldwide antidepressant and antianxiety market, are frequently associated with sexual dysfunction, appetite disturbances and sleep disorders. Because SSRIs and SNRIs increase 5-HT levels in the brain, they can indirectly stimulate all 14 serotonergic receptor subtypes [2,3], some of which are believed to lead to adverse side effects associated with these drugs. Common drugs for short-term relief of GAD are benzodiazepines. These sedating agents are controlled substances with addictive properties and can be lethal when used in combination with alcohol. The use of benzodiazepines is associated with addiction, dependency and cognitive impairment. 

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