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Benzodiazepines (BZDBDZBZs), sometimes called “benzos“, are a class of psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. As depressants—drugs which lower brain activity—they are prescribed to treat conditions such as anxietyinsomnia, and seizures. The first benzodiazepine, chlordiazepoxide (Librium), was discovered accidentally by Leo Sternbach in 1955 and was made available in 1960 by Hoffmann–La Roche, which soon followed with diazepam (Valium) in 1963.[1] By 1977, benzodiazepines were the most prescribed medications globally; the introduction of selective serotonin reuptake inhibitors (SSRIs), among other factors, decreased rates of prescription, but they remain frequently used worldwide.[2][3]

Benzodiazepines are depressants that enhance the effect of the neurotransmitter gamma-aminobutyric acid (GABA) at the GABAA receptor, resulting in sedativehypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant properties. High doses of many shorter-acting benzodiazepines may also cause anterograde amnesia and dissociation.[4] These properties make benzodiazepines useful in treating anxietypanic disorderinsomniaagitationseizuresmuscle spasmsalcohol withdrawal and as a premedication for medical or dental procedures.[5] Benzodiazepines are categorized as short, intermediate, or long-acting. Short- and intermediate-acting benzodiazepines are preferred for the treatment of insomnia; longer-acting benzodiazepines are recommended for the treatment of anxiety.[6]

Benzodiazepines are generally viewed as safe and effective for short-term use—about two to four weeks[7]—although cognitive impairment and paradoxical effects such as aggression or behavioral disinhibition can occur. A minority of people have reactions such as worsened agitation or panic when they stop taking benzodiazepines.[8] Benzodiazepines are associated with an increased risk of suicide due to aggression, impulsivity, and negative withdrawal effects.[9] Long-term use is controversial because of concerns about decreasing effectivenessphysical dependencebenzodiazepine withdrawal syndrome, and an increased risk of dementia and cancer.[10][11][12][13] In the long term, stopping benzodiazepines often leads to improved physical and mental health.[14][15] The elderly are at an increased risk of both short- and long-term adverse effects,[14][16] and as a result, all benzodiazepines are listed in the Beers List of inappropriate medications for older adults.[17] There is controversy concerning the safety of benzodiazepines in pregnancy. While they are not major teratogens, uncertainty remains as to whether they cause cleft palate in a small number of babies and whether neurobehavioural effects occur as a result of prenatal exposure;[18] they are known to cause withdrawal symptoms in the newborn.

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