Benzodiazepine use may raise risk of Alzheimer’s disease

Beverly Merz
Beverly Merz, Executive Editor, Harvard Women's Health Watch

If you have ever taken Valium, Xanax, or some other benzodiazepine to calm your nerves or sleep better, you may have felt woozy or hungover the next day. Experts have long assumed that people’s heads would clear once they stopped taking the drug. That may not be the case. A study published by the journal BMJ suggests that benzodiazepine use may promote the development of dementia.

A team of researchers from France and Canada linked benzodiazepine use to an increased risk of being diagnosed with Alzheimer’s disease. In the study, the greater a person’s cumulative dose of benzodiazepines, the higher his or her risk of Alzheimer’s.

The association isn’t surprising given past research on the subject, but it still should be viewed with caution. “Benzodiazepines are risky to use in older people because they can cause confusion and slow down mental processes, ” says Dr. Anne Fabiny, chief of geriatrics at Harvard-affiliated Cambridge Health Alliance. “However, although there is an association, we still can’t say that benzodiazepines actually cause Alzheimer’s,” she cautions.

Dose, duration, and type of drug matter

The researchers relied on a database maintained by the Quebec health insurance program. From it, they identified nearly 2,000 men and women over age 66 who had been diagnosed with Alzheimer’s disease. They randomly selected more than 7,000 others without Alzheimer’s who were matched for age and sex to those with the disease. Once the groups were set, the researchers looked at the drug prescriptions during the five to six years preceding the Alzheimer’s diagnosis.

Benzodiazepines approved for use in the United States:

  • alprazolam (Xanax)
  • chlordiazepoxide (Librium)
  • clonazepam (Klonopin)
  • clorazepate (Tranxene)
  • diazepam (Valium)
  • estazolam (ProSom)
  • flurazepam (Dalmane)
  • lorazepam (Ativan)
  • oxazepam (Serax)
  • temazepam (Restoril)
  • triazolam (Halcion)
  • quazepam (Doral)

People who had taken a benzodiazepine for three months or less had about the same dementia risk as those who had never taken one. Taking the drug for three to six months raised the risk of developing Alzheimer’s by 32%, and taking it for more than six months boosted the risk by 84%.

The type of drug taken also mattered. People who were on a long-acting benzodiazepine like diazepam (Valium) and flurazepam (Dalmane) were at greater risk than those on a short-acting one like triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), and temazepam (Restoril).

The researchers acknowledge that the use of benzodiazepines could be just a signal that people are trying to cope with anxiety and sleep disruption—two common symptoms of early Alzheimer’s disease. If that’s true, their use of a benzodiazepine may not be a factor in causing dementia but an indication it is already in progress.

Other reasons to avoid benzodiazepines

Even if that’s so, there are other reasons for older people to avoid benzodiazepines. In 2012, the American Geriatrics Society added benzodiazepines to their list of inappropriate medications for treating insomnia, agitation, or delirium. That decision was made primarily because common side-effects of benzodiazepines—confusion and clouded thinking—often have disastrous consequences, including falls, fractures, and auto accidents.

Even short-acting benzodiazepines pack a bigger punch in older people. As the body’s metabolism slows with age, drugs take longer to clear. And because benzodiazepines are stored in body fat, they can continue to produce effects days after people stop taking them.

Although these medications are taken to help people get a good night’s rest, they can have the opposite effect. “When they’re taken over time, they can actually interfere with normal sleep,” says Dr. Fabiny. The quest to sleep through the night can lead to prescriptions for higher doses or longer-lasting benzodiazepines—and even greater side effects.

If you are a caregiver for an older person, you may want to check the medicine cabinet, If you find benzodiazepine, you might want to discuss it with him or her, or with a doctor.

If you take a benzodiazepine, keep in mind that these drugs are designed for short-term use. If you’ve been using them regularly for more than a few weeks, know that withdrawal symptoms can be powerful. Consider talking to your doctor about alternatives.

There’s currently no cure or treatment for Alzheimer’s disease. That makes prevention all the more important. Limiting the use of a benzodiazepine for anxiety or sleep troubles may be one small step toward prevention.

Related Information: A Guide to Alzheimer’s Disease

Comments:

  1. res194

    I know that the data is there. I do not know if they have considered the fact that just about every elderly person was prescribed these drugs and did not realize it and therefore did not report. Let me explain. My great aunt whom I lived with for over i3 years, was not only on benzo’s she was on phenobarbital for over 40 years and possibly more. When she came to live with me I learned that she took each of these meds every night for insomnia. When I was concerned I asked her how long she had been taking these meds she tried to remember and all she could say was she knew she had been taking they some time before her husband had died and he died in the early sixties. I asked her if she was aware of the dangers of these meds she indicated that she only followed her doctors advice and she trusted him to do the right thing. I then asked her if she knew the name of these two meds (she took no other meds so she was not overwhelmed with the number of meds she took) and she was not able to even named the two meds that she took. I wasn’t surprised because as a RN, I found that many of my patients could not name their meds in spite of being mentally capable of doing so . In most of these cases I encouraged my patients to learn the name and use of the meds that they took. I can tell you that most of these cases I got an answer like ” I trust my doctor and I know that he wouldn’t do anything to harm me.” I also know that doctors as a general rule do not encourage their patients to learn the name of their meds or their uses because that would encourage more questions and the amount of time that doctors spend with their patients. We all know that is not what doctors want. So I was not at all surprised with her answers. Now let me explain my aunt and her mental acuity. My aunt died at the age of 91 a year after she fractured her hip. My aunt only became confused when she woke up after having general anesthesia for her hip surgery. Until that point she was sharp as a tack and had a memory that I think most of us would envy. So, considering the lack of knowledge that most patients have with naming all the meds they have had throughout their lives and the history taking I am not really convinced by this study.

  2. Sue

    I took care of my parents in their home until their deaths in 2012. Both parents took most all of the above-listed drugs listed in the study for years, and I am talking from the 1970s to 2012. As they aged, they were prescribed more and more of increasing doses of said drugs. Both were diagnosed with Alzheimer dementia. Both of my parents died from the effects of Alzheimer dementia. It was a long, agonizing time of years we took care of them. Their care went from daily small things to continual round-the-clock care and finally hospice. I have extensively studied my family history for over 30 years and cannot find one biological relative who had any evidence of Alzheimer dementia on either my father or mother’s side of the family. At one point, my parents’ addiction to this drug was so bad, they required hospitalization in a psychiatric ward, trying withdrawal schedules, etc., and the family members both fighting this all the way, seeing the handwriting on the wall of what was to come, and yet this drug was prescribed like water. I wish there were somewhere I could go to report this. In the end, both of their deaths were directly linked to Alzheimer dementia with the textbook symptoms.

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  4. Kali

    Interesting. I take this with a grain of salt due to the small and limited nature of the study, but note that in reading the comments, I didn’t see anyone who was taking Klonopin for Burning Mouth Syndrome. I assure you that hundreds, if not thousands of us are, since Clonazepam/Klonopin and Gabapentin/Neurontin are the most frequently prescribed meds for this horrible condition that can last for decades.
    If, in fact, there is a true link between Klonopin and Alzheimer’s (not convinced yet, BTW – need more studies!) then all of us will be without the one thing that provides some of us much needed relief in managing this chronic pain.

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  6. Kino

    As anxiety, sleep disorders, restless leg syndrome, HBP, heart rate, diabetes and so on are all related to allergic responses I feel patients would be much better served by a blood allergy test for IgE’s to dairy.
    When you are in a normal state, and you consume something you are allergic to the brain activates the immune system, instead of the digestive system.
    The brain thinks (rightly so) that you are being attacked by pathogens and activates the fight or flight response in the limbic brain.

    In this there are a series of sympathetic & other reactions in the body to face the danger in a concerted way. first of all to the Voluntary Nervous System. This system directs our skeletal muscular system to contract, (often causing back problems if the allergen is consumed often),small blood vessels to dilate, heartbeat to increase, throat muscles and nostrils to open wider, pupils to dilate and eyes to become more alert, sugars to be released from the liver to give us extra energy for the fight (or flight),bowels and bladder to empty making the body as light as possible to run if necessary.
    The brain also triggers the release of various hormones in the body like the adrenaline, noradrenalin,
    glucocorticoids etc.
    This gives us a high. We feel like we can conquer the world, become reckless and over confident, talk louder, become bullies, just to impress a possible assailant.

    The brain shuts down its primary calming mechanism to force you to remain alert & ready to face the threat. This high lasts until the autonomic Nervous System gets activated. This part of our nervous system controls all the involuntary actions of our body. This system has two subdivisions. The Sympathetic Nervous System and the Para-sympathetic Nervous System , which are like the fire alarm and the calming down mechanism of the body respectively.

    The Para-sympathetic Nervous System calms, relaxes & slows down the body. When the sympathetic Nervous System is activated then for obvious reasons the Para-sympathetic Nervous System is inhibited simultaneously.
    When the brain considers the danger past (after 4 to 6 hours) it deactivates the Sympathetic Nervous System, and activates the Para-sympathetic Nervous System, the calming down mechanism of the body.
    This is what gets us the low, which lasts until we consume the allergen again, and of we go on the rollercoaster. Trying to get to sleep in this scenario is literally impossible.

  7. Mike Mann

    I have been taking klonopin for probably 10 years I have been looking for answers why aim losing memory I can’t remember the words I spoke just seconds ago aim also losing my close eye sight two years ago I had 15/20 on my last dot physical now aim having to use my dad’s glasses who passed in May at 75 and could remember what happened 50 or 60 years ago I have talked to my neuroligest several times but she puts it off on meds for my back I took them years before I took klonopin and never had memory trouble

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  10. Neurotruth

    One burning question: does this risk translate to younger patients who use benzos long-term? It seems to only be focused on the elderly.

  11. Peter Eirich

    I have been on lorazepam for several years for a severe anxiety disorder. I just wanted to submit a comment while I still remember how to use the computer.

    • maria harris

      Hello Peter, try to get some non pharmacological treatment. There are numerous articles that link benzodiacepines with Alzheimer Disease… And if alzheimer strikes it won’t go away.
      I am currently taking an online course on Alzheimer and I am amaze by all the information there is , and I never bother to read.
      It is making me more selfconcious.
      Hope you get well.
      M. Harris

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  14. Drole reck

    This is very troubling. I work at a elderly home care agency, which is centered around senior caregivers and elderly patients (many of whom have Alzheimer’s and other forms of dementia). It’s devastating to believe that their illnesses may have been promoted by use of a drug. When we research on topics like Alzheimer’s, we normally try to spread as much helpful info as we can to our clients. Perhaps we can share this? In any case, thanks for a different perspective.

  15. Hannah Frisch

    One thing I can’t find in the original Brit. Medical Journal or the news articles is what kind of doses is the study talking about. In particular, what doses of xanex are high or low in their measure of usage.

  16. Howdy! This post couldn’t be written much better! Going through this post reminds me of my previous roommate! He continually kept talking about this. I’ll send this post to him. Fairly certain he’ll have a good read. Many thanks for sharing!

  17. Benzodiazepunk

    Not surprising at all.

    I’m 30 and was addicted to benzos for a year. During that year and for a year after quitting, I repeatedly told my girlfriend I felt like an early-stage dementia patient. Couldn’t comprehend simple written sentences or remember things that happened minutes ago. We’d get into arguments about things I just SWORE never happened and then I’d freak out because I couldn’t remember. Two suicide attempts and a year of misery later, I’m finally starting to feel like myself again.

    Benzos are fine for occasional use but behave very differently with long-term use. Brain damage from benzos is visible on brain scans in long-term users (see link below). This is nothing new. They’re called “minor tranquilizers” but there’s nothing minor about them.

  18. mukundlal

    this is absolutely right use of benzodiazepin can aggrevate neuronal ds.

  19. A-1 Home Care

    This is very troubling. I work at a elderly home care agency, which is centered around senior caregivers and elderly patients (many of whom have Alzheimer’s and other forms of dementia). It’s devastating to believe that their illnesses may have been promoted by use of a drug. When we research on topics like Alzheimer’s, we normally try to spread as much helpful info as we can to our clients. Perhaps we can share this? In any case, thanks for a different perspective.

  20. Dr.K.O.Mammen

    AS WE AGE WE AND OUR PHYSICIANS RESORT TO DRUG ABUSE FOR A QUICK SOLUTION.
    I am 83 and have had many relations who took diazepams over several years as sleeping medication. No one had Alzhimers . My night cap has been a shot of Scotch . the onetime I took a valium I had to carried to bed sans scotch and sans dinner.

  21. Now time to employ a natural remedy!

  22. H. Franzblau

    My husband just died from Alzheimer’s disease at the age of 62. He took valium every day since his early 20’s. He also took xanex regularly probably beginning in his 40’s. I always wondered if this had anything to do with having this horrible disease, particularly at such a young age.

  23. Helpless von Benzos

    I’m screwed. I have been taking large amounts of Xanax for decades. When I was prescribed this medication, I asked the doctor the risk factors. He said that they were minimal. If he had said otherwise, I wouldn’t have taken them. If the research turns out to be correct, I’m truly screwed.

    The only thing that I can think of that might be a saving grace is that I have an extremely active mind, and have kept learning new things, was involved in a mentally demanding job, and have always looked for ways to expand my knowledge base and try new things. In other words, I’ve worked my brain hard, and in lots of different directions.

    I hope it’s enough. I watched my father die horribly of Lewy Body Dementia last year…horribly. If it comes to that, I think that I’ll just find a nice, really cold winter night, and walk out and lie down in the snow before I put my family and myself through the living hell my dad and his family went through.

    You know, in my whole life, I’ve never been able to catch a break. This is just more bad news in a life that’s been one nightmare after another. I’ll be glad when it’s over. I just wish that it doesn’t end like my father’s life ended…

    • Jill Routon

      I feel the same way Helpless von Benzos. But we have to sleep. And whatever way we go probably won’t be pleasant. Let’s just stay positive! 🙂

    • Hubernia

      Hi, I agree with you. I had a rough, rough childhood, and both my late parents had severe anxiety, but were never medicated, unless you count alcohol. I inherited the tremendous anxiety and FINALLY found relief with Klonopin in 1994. I have been taking it steadily since then, without increasing the dosage. However, I know it would be a terror to quit. One weekend I didn’t have my meds, and I had awful neuralgia and sleepiness. The Klonopin relieved that when I resumed. What the heck. Herbal tea and other remedies never touched the anxiety I felt. I commiserate with you, and all the rest of us with GAD or something like it. We get relief and then get slammed. Alas.

  24. muppaprojects.com

    even i too had tough experience with this Benzo. Am really out of control during that time.

  25. Jay

    I think you’re are missing the main point given in this study, and that’s that there is a “possible” correlation…

    “The researchers acknowledge that the use of benzodiazepines could be just a signal that people are trying to cope with anxiety and sleep disruption—two common symptoms of early Alzheimer’s disease…”

    Woah, wait a second… It could be nothing, there could be no correlation

    “…If that’s true, their use of a benzodiazepine may not be a factor in causing dementia but an indication it is already in progress.”

    So, you’re saying that sleeping problems and anxiety COULD simply be signs of alzheimers. That’s what I was always taught in nursing school

    The study clearly states there is POSSIBLE correlation between the dosage amount given and alzheimers. (AKA an unscrupulous doctor giving out 2mg xannie bars to 16 year olds and shoving them full of more and more).

    Also take a second to look at the sample population. We are only seeing the geriatric population here, not the ENTIRE population. PLUS we are only seeing a population sample from ONE SINGLE PART OF CANADA! It is very possible that there is a genetic/regional correlation as much as there is anything else. Also, doctors in certain parts of the world are more focused on different diseases and some doctors are very reluctant to diagnose anything, these doctors could be some of them. Let’s do a study of how many times a day a doctor diagnoses an alzheimers patient versus a possible suicide risk.

    This kind of horrible reporting on plain old BAD STUDY TYPES are all about FUD (Fear Uncertainty and Doubt). Who paid for this study? I would guarantee it was paid for by someone in big marijuana or in big anti-psychotics.

    Now here’s a study, do anti-psychotics cause alzheimers?

    Where do I come from: I’m an RN, patients lives have been saved by benzos and my life was SAVED by benzos. So what? I may end up with alzheimers, but I would have committed suicide if it weren’t for benzos. How many other people say that.

    Let’s grow up as a medical community and stop spreading fear and get back to treating PEOPLE holistically .

    I’m embarrassed for you harvard. you know better.

    • Alan A

      Thank you for reminding everyone that this is not a “causation” study only a possible link. My life would have continued to be hell with anxiety, GAD, and social phobia. I used to fear checkout counters at the store because of interaction with another person. I’ve been on oxazepam for more than 20 years and it has helped me greatly. I tried all or the natural remedies which didn’t help at all.

    • Sarah

      Thanks for your post. I wish my own doctor could be as rational about the matter as you. I’ve been on Klonopin for years and it is the only thing that I have ever found that helps with my obsessive compulsive disorder and (used to be frequent before) panic attacks. I’ve never felt drowsy or “foggy” from it. In fact it’s always made me more alert and productive because it got me to stop being consumed by obsessive and frightening thoughts. But, apparently because of this study, my doctor says I should be off of it because of a significant link to Alzheimer’s…Guess she didn’t expect me to read the source material or thought I wouldn’t notice the potential flaws in it if I were to read it. I’m 30 years old, so without any evidence for this possible link besides one found in geriatric patients, the benefits of taking it far outweigh the risks for me.

  26. Barbara Selinger

    I am 65 years old. My mother had Alzheimer’s. I’ve been taking Clonazapen at bedtime for about 2 months to help me sleep and also to prevent leg spasms during the night. Before that I took Xanax at bedtime for about 6 mos. How do I get off the medications safely to avoid withdrawal symptoms? Thanks.

    • Alison Page

      Barbara,
      You can make an account at benzobuddies.org and they can help you devise a tapering plan. Also working with your doctor, but many are not very knowledgable about safe, slow benzo tapering or withdrawal.

  27. ken haddad

    I had my first panic attact at he age 20, i felt out of control; i was told to see a shrink, for 2 yrs i was put on librium, that was 1970. today i still have to klonpin; 35 yrs and the atacts keep on coming. now whenhis any more i try to stop my withdraws are extreme ringing in my ears also it sounds like i am in room with 100 people all talking at the same time. I dont no what to do. any help i realy can”t live like this any more

    • Alison Page

      Hi ken,
      I’m so sorry that happened to you. Tranquiliser drugs are so potent and he body goes into tolerance after a while. As I mentioned to Barbara, you can check out benzobuddies.org to figure out a way to taper slowly and get support. Working closely with your doctor during your taper is important, as well. Good luck, you can recover.

  28. Trudy Scott, Nutritionist

    Thank you for sharing your stories Janette, Alison and DMH! Whether or not this is a causal link I would not recommend these drugs for anyone ever!

    I interviewed Dr. Catherine Pittman on the Anxiety Summit in June and she shared a survey she did with the Benzobuddies.org group – the terrible effects of these drugs were shocking. You can read more here and get access to data from her survey, plus read comments from other folks who have battled with this horrible drug http://www.everywomanover29.com/blog/anxiety-summit-benzodiazepines-risks-vs-benefits/

  29. Janette Miller

    13 years ago I was given Benzo by my doctors for a stomach complaint with no warnings. I am one of the few that react terribly badly to this type of drug so it was stopped abruptly. My withdrawal was horrendous and lengthy. The first three years were the worst. I just had to live through the experience alone as there was nothing anyone could do. The Benzo forums helped get me through.

    Over the years the symptoms fade but even today I still get bad days. I now check every drug I take as Benzo/ tricyclics/morphine can be hidden in drugs for other illnesses and doctors are not aware.

    If Benzo were thalidomide it would be banned. One third experiencing withdrawal which is so awful it can kill cannot be considered an acceptable percentage for the greater good. Many of my Benzo forum friends committed suicide.

    I was just as bad when I took a pill and when I didn’t. I was told if I could live through the withdrawal it would eventually end. 13 years down the track it almost has and all for a few pills.

  30. DMH

    Like Alison, I’ve also been hit extremely hard by benzodiazepine usage and withdrawal, both Ativan (taken for 10 months before full-blown addiction set in – use was “as needed,” .5-1.0 mg.) and Klonopin (.5-1.0 taken daily for three weeks before tapering began). I’m 62 years of age. I tapered off Klonopin for 7-1/2 months and, six months off the drug, I can say that cognitive impairment and derealization have been extremely difficult to heal from, to the extent that I go out of my home for short periods of time only. I’m still struggling and am afraid that it may take over a full year, post-benzodiazepines, for me to fully recover. However, getting off the benzodiazepines is something that I’m thankful to have done, and I credit BenzoBuddies for their extremely informative forum.

    It’s truly frightening, the number of elderly patients who are given benzodiazepines. Doctors don’t understand, for the most part, the complexities of this drug and that there is a very sizable subset of people who go through excruciating withdrawals, even after very short-term use. Withdrawal can also be a very drawn-out process, lasting for years and mimicking anxiety disorder as well as other offshoot maladies. This is not a drug to prescribe lightly with no caveats whatsoever. Yet doctors, seemingly with little regard, write up prescriptions frequently for these drugs.

    Teaching Safe and Effective Prescribing in UK Medical Schools by Maxwell & Walley is an excellent article and ought to be used as a protocol in U.S. medical schools as well.

  31. Alison Page

    After reading the responses to the BMJ article, I am under the impression that benzodiazepines tranquilize/slow the bodies ability to metabolize and detoxify. One of the ingredients in (most?) benzos is an aluminum dye (blue lake, something like that). So part of what these reactions may be are aluminum toxicity instead of dementia.

    Benzodiazepines harmed much more than just my cognition, but this may be a piece of the puzzle in terms of cognitive damage.

  32. Alison Page

    My story was featured in the Boston Globe Article “When withdrawal is the hardest part” by Jeremy Fox that you refer to at the bottom of this article. I am only 29 years old, and I developed what I refer to as pseudo-dementia once I developed a tolerance to benzodiazepines and it got worse once the drug was stopped. From what I have seen from others recovering from and in tolerance to benzodiazepines, cognitive functioning and memory can get hit hard and actually mimic dementia. I wonder if this is true dementia, or a side effect/withdrawal effect.

    I was so cognitively impaired earlier in recovery that I felt like a stranger in my own house, couldn’t drive a car, couldn’t think rationally, or assimilate new information. It ends up it was all part of recovery.

    • Janette Miller

      Dear Alison

      Like you I have been damaged by Benzo. I was older than you 59 in fact when I was given a few pills for a stomach complaint with no warning at all. My withdrawal was horrendous and lengthy.

      However 12 years in I was diagnosed as B12 deficient. Lack of B12 can lead to a compromised nervous system which obviously did not help. One injection of B12 was a miracle. All my anxiety disappeared overnight. I needed a lot of injections and still do but gradually B12 has repaired my nervous system so almost normal.

      B12 is a vitamin and completely safe according to FDA. You cannot overdose. If I had known what it could do 13 years ago I might have tried it to help me with my withdrawal. It might have been better than sitting for hours with me hands under the cold water tap to stop the fits.

      I know what hell you are going through. Hopefully it will fade soon. Benzo has to be stopped. Good luck. YOu are so brave.