Tranquilisers

What are tranquilisers?

Several different groups of drugs may be used to relieve anxiety or induce sleep (or occasionally for other effects such as muscle relaxation). These include:

• Benzodiazepine drugs
• Diazepam (trade name Valium)
• Temazepam
• Nitrazepam
• Lorazepam
• A group often referred to as the Z drugs - zopiclone, zolpidem and zaleplon

Benzodiazepines have been in use since the late 1950s and their effects are well understood. They act by enhancing the effect of a brain chemical transmitter called gamma-aminobutyric acid (GABA), which depresses or calms the central nervous system, slowing down mental activity to cause relaxation and sedation.

The Z drugs were introduced in the 1980s and are said to have fewer side effects and a lower risk. However, they act on the same receptors in the brain and the general prescribing advice is that they too shouldn't be used long term.

As many as two to three per cent of adults find themselves taking benzodiazepines or Zs for many months or more, in an effort to control symptoms.

Effects of tranquilisers

In the short term, tranquilisers can be very effective in managing the symptoms they are prescribed for, such as:

• Tension
• Anxiety
• Excessive worry
• Stress
• Insomnia
• Sleeping problems

They are often used to help someone get through a particularly stressful life crisis, such as bereavement.

Benzodiazepines may also be used in low doses as a muscle relaxant, for example when there is muscle spasm causing back pain or dental problems, and occasionally in epilepsy or relaxation prior to surgery.

There is also a very significant illicit use of benzodiazepines ('benzos') by those with other substance abuse problems, such as alcoholics and heroin users.

Risks of tranquilisers

As the brain gets used to the tranquiliser or sleeping pill, often as soon as three or four weeks after starting them, the drugs may become less effective. More of the drug is then needed to achieve the same effect - this is known as tolerance.

If the drug is suddenly stopped, there may be unpleasant withdrawal symptoms. This indicates a dependence on or addiction to the drug, and that you need to take the drug just to feel normal. Dependence may occur after just four weeks on benzodiazepines or Z drugs.

Physical withdrawal symptoms include:

• Restlessness
• Insomnia
• Headache
• Sweating
• Tremor
• Nausea
• Palpitations
• Muscle spasms
• Confusion and seizures (occasionally)

Psychological withdrawal symptoms include:

• Increased anxiety
• Depression
• General feeling of being unwell
• Agitation
• Panic attacks
• Out-of-body sensations
• Paranoia and intense psychological distress (occasionally)

Withdrawal symptoms are worst in the first week or two and may last as long as six weeks or more. Generally, the higher the dose, the longer benzodiazepine has been used and the more rapidly it is discontinued, then the more likely severe withdrawal symptoms will occur. Sometimes people continue to have some withdrawal symptoms for months, and it can be difficult to resist going back onto the drugs in order to cope.

Those taking heroin may use benzodiazepines when heroin is unavailable, or to counter some of the symptoms of withdrawal (benzodiazepines used along with prescribed opiates such as methadone can make the effects of the opiates feel stronger). Some heroin users have said that coming off benzodiazepines is harder than coming off heroin. Using these drugs with heroin increases the risk of overdose - one in every four heroin-related deaths involves the combined use of these drugs.

Stopping tranquilisers

The usual strategy a health professional will advise when stopping tranquilisers or sleeping pills is to reduce the dose of the drug gradually over a number of weeks or months before finally stopping it, rather than suddenly giving up.

At the same time other tactics should be put into place to help to manage symptoms and deal with underlying problems. These might include:

• Relaxation skills
• Help with sleep problems
• Anxiety management
• Counselling
• Cognitive behavioural therapy
• Complementary therapies such as massage or aromatherapy
• Careers and relationship advice