Benzodiazepines & Alzheimer's: A Letter to the Editors
In January 2015 Dr. Granoff wrote the following letter to the editors of the British Medical Journal and Psychiatric News in response to reports that long-term benzodiazepine use may be linked to Alzheimer's disease. It is reproduced here as written and reflects his clinical opinion. For his full discussion of these medications, see Anxiety & Panic Treatment: Benzodiazepines as First-Line Care.
Important safety information: Research on benzodiazepines and dementia has continued since this letter was written. Do not start, stop or change a benzodiazepine on your own. Stopping suddenly can cause serious withdrawal reactions, including seizures. The FDA's boxed warning (updated in 2020) describes the risks of abuse, misuse, addiction, physical dependence and withdrawal. Talk with your own prescriber about the benefits and risks for you.
Abbot Lee Granoff, MD
1604 Hilltop West Executive Center
Suite 309
Virginia Beach, VA 23451
January 15, 2015
Dear Editors, British Medical Journal and Psychiatric News:
The Psychiatric News article October 17, 2014, "Long-Term Use of Benzodiazepines May Be Linked to Alzheimer's" is an example of pejorative reporting regarding benzodiazepines. The cited study was in the British Medical Journal 2014; 349: g5205 "Benzodiazepine use and risk of Alzheimer's disease: case--control study."
Benzodiazepines have been around since the early 60s and are a safe and effective treatment for anxiety disorders according to the "APA Task Force Report on Benzodiazepines" 1991, DEA and NIH. I am not aware of any studies repudiating these reports. They are not addictive, no tolerance is built requiring higher doses, withdrawal is usually mild.
Benzodiazepines have two main side effects-sedation and memory loss. Both are dose related and go away when dose is lowered. They are abused by 0.5% of the population who are also abusing alcohol and street drugs at the same time. Psychiatric News did not add the statement by the researchers themselves in their article that the "dose-effect relation between benzodiazepine use and increased rise of Alzheimer's disease might not be causal. The nature of the link cannot be definitely established because the nature of the link might also be an early marker of a condition associated with an increased risk of dementia." They missed the mark by not adding that anxiety is often associated with any progressive Organic Brain Syndrome including Alzheimer’s Disease in its early stages.
In my 38 years of private practice psychiatry, I have treated thousands of patients with benzodiazepines. General Anxiety Disorder usually starts in childhood and Panic Disorder usually starts in the mid to late 20s. Patients with anxiety starting in their 50s to 60s without a concomitant physical, psychological or environmental stressor are very often due to a developing Organic Brain Syndrome which includes Alzheimer's. This anxiety is easily treated with benzos. The dose should be lowered as the OBS progresses because confusion and memory loss from a deteriorating brain from the OBS can be exaggerated by the benzo. While research in all areas of psychopharmacology is appropriate, clinical correlation should play a role in coming to speculative conclusions that might be false. When the underlying disease finally shows up claiming the medication may have caused it is overlooking the prodrome of that disease.
Stating this correlation as causative in that article exploits the negatively biased view of the benzos in the medical literature and lay news. This perpetuates the myth of benzodiazepines being dangerous. The media pounces on these headlines further exaggerating them. This frightens the public from taking them and frightens physicians from prescribing them.
Related reading
- Anxiety & Panic Treatment: Benzodiazepines as First-Line Care
- Anxiety and panic attack symptoms, including when anxiety that starts later in life may have another cause
- Services provided
Ready to take the next step? Call 757-461-7571 to schedule a consultation with Dr. Granoff. The office is at 1604 Hilltop West Executive Center, Suite 309, Virginia Beach, VA 23451.