Why I Recommend Against the Use of Benzodiazepines: A Provider’s Perspective
Benzodiazepines, often referred to simply as “benzos,” are among the most commonly prescribed psychiatric medications worldwide. Drugs such as alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium) are well-known for their ability to reduce anxiety and promote sleep. In the short term, they can provide profound relief: a racing mind quiets, muscles loosen, panic subsides, and sleep comes more easily. For someone in crisis, this effect can feel nothing short of miraculous.
But for many, these medications worsen and complicate their wellbeing. Use of benzodiazepines carries risks that extend far beyond initial symptom control. These drugs alter brain chemistry in ways that worsen anxiety, foster dependence, impair natural coping mechanisms, and interfere with processes as fundamental as memory, sleep, and emotional healing. Over time, many individuals find themselves in a cycle of escalating use, withdrawal symptoms, and worsening the very issues the drugs were prescribed to treat.
For some, these adverse effects will continue long after they have stopped the benzodiazepine. The Benzodiazepine Information Coalition reports that 40–80% of patients prescribed a benzodiazepine will experience withdrawal syndrome, and 10–15% will develop severe, protracted withdrawal syndromes that can last for months, or even years.
As a specialist who treats benzodiazepine dependence, I’ve observed that what begins as welcome relief can later give rise to new problems, leaving many patients wishing they had never started the medication. This article explains the risks of benzodiazepines use, how they affect the brain, and why I recommend against their use.
What is GABA and How Does it Impact Anxiety?
Gamma-aminobutyric acid (GABA) is our agent of calm. It is the primary inhibitory neurotransmitter in the central nervous system. Its role is to quiet down excited neurons in the brain and does so by binding to its receptors, GABA-A and GABA-B, on neurons in the brain. This process opens chloride ion channels and makes neurons less likely to fire, reducing neuron activity and promoting a calming effect. By dampening excessive neural activity, GABA helps to reduce overactive brain signals that are often associated with anxiety. When GABA levels are sufficient and its receptors function correctly, it contributes to feelings of relaxation and tranquility, helping to manage stress responses and prevent the brain from becoming overly stimulated. Conversely, a deficiency in GABA or impaired receptors will result in increased anxiety.
What Reduces GABA?
GABA is very important in helping us manage anxiety but its availability is susceptible to a number of health problems, lifestyle choices, and chemical influences. Sleep deprivation will decrease the availability of GABA in key brain regions while also increasing cortisol, a stress hormone. Elevated cortisol from infections, stress, poor sleep, blood sugar abnormalities - secondary to eating habits and metabolic issues-, and toxin exposure (like air pollution, heavy metals, and forever chemicals), will interfere with GABA activity. Substances like alcohol and medications like benzodiazepines will decrease GABA activity and reduce GABA receptor responsiveness and availability.
To produce GABA, your body needs the amino acids glutamate and glutamine, along with vitamin B6 to act as a cofactor. Low levels of the neurotransmitter GABA, from an unhealthy gut microbiome or nutrient deficiencies, or problems with how GABA acts on the receptors, which happens even after a short period on a benzodiazepine, can disrupt this delicate balance. This leads to more neuron activity in the brain and the manifestation of anxiety symptoms such as restlessness, nervousness, and difficulty relaxing.
How Do Benzodiazepines Work?
Initially, benzodiazepines work by quickly increasing GABA activity through the GABA-A receptors resulting in a marked reduction of anxiety. This increase of GABAergic neurotransmission results in the anxiolytic (reducing anxiety), sedative, muscle relaxant, and anticonvulsant (seizure prevention) properties of benzodiazepines.
The Inter-Dose Withdrawal Phenomenon
Inter-dose withdrawal happens when the effect of a benzodiazepine wears off between scheduled doses, causing withdrawal symptoms to appear even though the person is still taking the medication as prescribed. This is most common with short-acting benzodiazepines such as alprazolam (Xanax) or lorazepam (Ativan), where blood levels fall more quickly. As the drug level drops, the brain—already adjusted to the extra calming effect of benzodiazepines—temporarily experiences a relative shortage of GABA activity, leading to symptoms such as anxiety, restlessness, irritability, trouble sleeping, or physical tension. These symptoms often subside once the next dose is taken, which reinforces the cycle of re-dosing. Over time, this can lead individuals to take the medication more frequently or escalate to higher doses.
So Popular, So Misunderstood
As with opioids, the promotion of benzodiazepines was so effective and the initial benefits so celebrated, that discussion of their risks was pushed aside, forcing many harmed patients to gather in quiet support groups for fear of being called an “addict” by their healthcare provider or community.
Few providers are aware of the excruciating discomfort and novel health issues that some clients experience after taking benzodiazepines. Consequently, patients, looking for help with anxiety, sleep, irritability, teeth-grinding, seizures, and other problems, are never warned about the risks, and start down a complicated path, blind to what lies ahead.
Continued research and advocacy have started to increase awareness through groups like the Benzodiazepine Information Coalition, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the American Society of Addiction Medicine (ASAM). Finally, in 2020, the U.S. Food and Drug Administration (FDA) made the following statement, “The current prescribing information for benzodiazepines does not provide adequate warnings about these serious risks and harms associated with these medicines so they may be prescribed and used inappropriately.”
Adverse Effects and Risks of Benzos
Let’s take a closer look at the risks and complications of these medications. It’s important to understand that these issues often affect people who take benzodiazepines exactly as prescribed—not “addicts,” not college students chasing a high after hearing a song about “bars” or “Xannies,” but everyday individuals. A mother under stress. A student struggling with anxiety brought on by medication meant to help them focus. People taking a medication they thought would help with the challenges of life.
Benzodiazepine Withdrawal
When someone has been taking a benzodiazepine for a number of days and reduces their prescription or delays their next dose, withdrawal is possible. Withdrawal from benzodiazepines can manifest with a wide spectrum of physical, cognitive, and emotional symptoms, reflecting the brain’s decreased GABA receptor activity. As discussed early, the effects of benzodiazepines on the brain and its efforts to compensate, result in downregulation of GABA activity and a compensatory increase in excitatory neurological functions. This leaves the individual’s neurochemistry prone to anxiety and chemically dependent on the medication.
Early or mild withdrawal symptoms often include anxiety, irritability, restlessness, insomnia, and heightened sensitivity to light, sound, or touch. Physical symptoms may include tremor, muscle tension, sweating, palpitations, nausea, and headaches. In more severe cases, patients can experience perceptual disturbances such as heightened awareness, depersonalization, or visual or tactile hypersensitivity, as well as autonomic hyperactivity (increased blood pressure, heart rate, gastrointestinal issues), seizures, or delirium. Cognitive symptoms such as poor concentration, memory impairment, and slowed processing are also common during withdrawal. The timing and intensity of these symptoms depend on the benzodiazepine’s half-life, dose, duration of use, and individual neurobiology, with shorter-acting agents typically producing more abrupt and intense withdrawal.
Benzodiazepine Dependence
Even when taken as prescribed, dependency can occur when a patient takes a benzodiazepine in as little as 2 weeks. Over time, benzodiazepines’ impact on GABA receptor activity results in decreased ability to feel calm on one’s own. This leads to a state of physical dependence - when someone cannot function without the medication.
Are Benzodiazepines Really All That Bad?
When a client asks for me to prescribe them benzodiazepines, I often hear, “I only take them as prescribed.” As if they’re saying, “I’m not an addict. I won’t abuse them.” Therapists often contact me asking if I can start our mutual client on Xanax or Klonipin, “Just something to get them through.” As we will review, my concerns are what happens for so many when they take the medication exactly as prescribed.
Falls, Accidents, and Paradoxical Reactions
Benzodiazepines depress central nervous system activity, which can increase the risk of falls, motor accidents, and respiratory compromise, particularly when combined with alcohol or opioids. Psychiatric risks include paradoxical reactions such as increased agitation, aggression, or disinhibition, and regular use can worsen underlying anxiety or cause depression due to neuroadaptive changes. Finally, abrupt discontinuation or misuse can precipitate seizures, delirium, severe withdrawal syndromes, and death, underscoring the need for careful tapering and clinical monitoring.
How Benzodiazepines Increase Anxiety
Benzodiazepines markedly increase neurotransmitter GABA activity. But our biology has developed to be attuned to our environment. To survive, our biology has evolved to maintain a level of alertness and responsiveness – this keeps us from becoming lunch or falling off a cliff. So when a chemical, like a benzodiazepine, or alcohol, floods our brain with GABAergic tone, our biology works to re-establish homeostasis, or equilibrium, in how calm or alert we are. The brain will decrease its sensitivity to this signal by lowering the number of GABA receptors, changing how the receptors are built, and making them less responsive to the medication. At the same time, the brain increases its stimulating systems, especially those that use glutamate, an excitatory neurotransmitter and GABA’s counterpart, to counteract the peaceful state that benzodiazepines initially created. Through these functions, benzodiazepines worsen anxiety symptoms, often exacerbating the original complaint or creating new symptoms the client did not have when they first started the prescription.
Benzodiazepines Worsen Depression
We have reviewed how benzodiazepines worsen anxiety, but they can also cause depression. Long-term use of benzodiazepines can affect the brain’s “reward system,” which is responsible for feeling pleasure and motivation. Over time, the brain adjusts to the constant calming effect of the medication, and certain brain circuits in the limbic system (which regulates emotion) and the prefrontal cortex (which controls planning and decision-making) don’t respond as strongly to positive experiences. This can make activities that used to feel enjoyable seem less rewarding and can reduce motivation to do everyday tasks. These changes can contribute to feelings of sadness, low energy, and other symptoms of depression.
Benzodiazepines Worsen Sleep
Research has demonstrated that benzodiazepines are disruptive to sleep architecture. Benzodiazepines changes the way the brain cycles through different stages of sleep. These drugs increase the amount of non-rapid eye movement (NREM) stage 2 sleep, which can make people feel like they are sleeping better at first. However, benzodiazepines reduce the time spent in deep sleep or NREM stages (3 and 4), which are important for the body and brain to engage in hundreds of functions necessary for our physical and mental wellness. Benzodiazepines also disrupt the fine structure of sleep, such as sleep spindles and slow brain waves, which help the brain process and store new information. These disruptions to our sleep can increase risks for other health conditions, worsen immunity, raise cortisol, and impair cognition, like memory, learning, and overall thinking.
Benzos Interfere With Learning and Cognition
Benzodiazepines are amnestic, meaning they are used to impair short-term memory. By design, they make it harder for the brain to learn new information and retrieve memories. They work by calming the brain’s activity, which can reduce anxiety in the short term, but this also slows down important brain processes needed for learning and memory formation. For example, they disrupt the brain’s ability to form and store new memories—a process called memory consolidation—and can interfere with the deep sleep stages that help the brain organize and retain information. Because learning, schoolwork, and skill-building all rely on acquiring and remembering information, long-term benzodiazepine use can make it more difficult to retain lessons from classes or recall important information.
Cognitive effects, including memory impairment, slowed processing, and reduced attention, are common, and prolonged use of benzodiazepines may increase the risk of persistent cognitive deficits. The British Medical Journal found that individuals who used benzodiazepines for more than 180 days had a 51% higher risk of being diagnosed with Alzheimer's disease compared to those who used them for shorter periods. This risk nearly doubled for those with cumulative use exceeding three months.
Can Benzos Keep You from Healing from PTSD? Yes.
Benzodiazepines are contraindicated – meaning it is against the standard of care to prescribe them - in the treatment of trauma-related disorders, particularly post-traumatic stress disorder (PTSD), because of their interference with the neurobiological processes required for recovery from trauma. While benzodiazepines provide short-term reduction of anxiety through their effect on GABA-A receptor activity, this simultaneously interferes with fear extinction learning and memory reconsolidation, processes that are central to effective trauma-focused psychotherapies such as prolonged exposure and cognitive processing therapy. By blunting the activation of limbic structures, including the amygdala and hippocampus, benzodiazepines impair the emotional engagement necessary for reprocessing traumatic memories, thereby reducing therapeutic efficacy.
Furthermore, chronic benzodiazepine use promotes avoidance behaviors, reinforcing maladaptive coping strategies rather than supporting adaptive integration of traumatic experiences. This can make it very difficult for clients who have been on benzodiazepines over time to reduce their use as they feel unable to cope with stressors. Because of this, I ask my clients to start therapy before we initiate the taper – I want them to begin the work of learning healthy coping skills – as best they can.
As PTSD is common among veterans, the U.S. Department of Veterans Affairs (VA) played a critical role in establishing clinical guidelines on the use of benzodiazepines. It has implemented policies to reduce benzodiazepine prescriptions, especially for conditions like PTSD, where non-pharmacologic therapies are preferred.
Evidence also suggests that benzodiazepine exposure in trauma populations is associated with worse long-term outcomes, including increased risk of substance use disorders and diminished responsiveness to evidence-based therapies. For these reasons, clinical guidelines consistently recommend against benzodiazepine prescribing in individuals with trauma histories, advocating instead for trauma-focused psychotherapies and safer pharmacologic options when medication is indicated.
Benzodiazepines Are Contraindicated for Those With Alcohol Use Disorders, Opioid Therapy, and Stimulant Prescriptions
Benzodiazepines are contraindicated in clients with alcohol use disorder, ongoing opioid therapy, or prescribed stimulant medications for Attention Deficit Hyperactivity Disorder (ADHD) due to the high risk of adverse pharmacodynamic interactions and compounded substance use risk. When combined with alcohol or opioids, benzodiazepines have compounded central nervous system depressant effects, markedly increasing the likelihood of respiratory depression, overdose, and mortality. In individuals with alcohol use disorder, benzodiazepines also present risks of cross-tolerance and heightened dependence, complicating relapse prevention and recovery. Co-prescription with opioids further elevates the risks, as both drug classes act on overlapping inhibitory neural pathways, amplifying sedation and impairing psychomotor performance.
Additionally, in patients prescribed stimulant medications for ADHD, benzodiazepines can mask stimulant-related side effects such as anxiety, insomnia, or tachycardia, obscuring clinical assessment and fostering maladaptive patterns of polypharmacy. The combined use of these substances undermines therapeutic outcomes, increases the risk of misuse or diversion, and necessitates avoidance of benzodiazepines.
Benzodiazepine-Induced Neurological Dysfunction (BIND)
BIND refers to the protracted withdrawal syndrome that occurs in 20% of those who take a benzodiazepine for 2 weeks or more and continues long after they have stopped taking the medication. It is an array of neurological, psychiatric, and somatic symptoms that develop during a taper, or after the medication has been discontinued. Although the mechanism is not well understood, BIND is thought to be due to neurotoxic effects the medications have on the brain or the adaptive changes that occur in the client’s neurochemistry. These neuroadaptations can manifest clinically as chronic anxiety, depression, cognitive deficits, insomnia, perceptual disturbances, dysautonomia, and heightened sensitivity to stress and sensory input. Unlike classic withdrawal, BIND symptoms may persist for months or years after discontinuation, suggesting impaired neuroplastic recovery and disruption of homeostatic balance in specific regions of the brain, such as the limbic, cortical, and autonomic circuits.
Situations Where Short-Term Use Is Appropriate
Although I strongly recommend against routine or prolonged use of benzodiazepines, I do acknowledge that they remain an important tool in specific, short-term contexts. In emergency medicine—whether for acute agitation, panic, or seizure management—or in procedural settings such as a patient’s fear during an MRI or anxiety before a painful dental intervention, benzodiazepines can be both effective and appropriate. My concern is not with these carefully targeted, time-limited uses, but with the way these medications are often prescribed casually or chronically, leading to the very problems I have outlined above.
How Common Are Problems from Benzodiazepines?
Below are facts cited from the Benzodiazepine Information Coalition site on Estimates of Patients Experiencing Withdrawal.
Dr. Malcolm Lader states, “I estimate about 20-30% of people who are on a benzodiazepine like diazepam have trouble coming off and of those about a third have very distressing symptoms.”
Reconnexion, a nonprofit organization in Australia offering counseling and support for benzodiazepine dependent patients, states: “It is estimated that between 50-80% of people who have taken benzodiazepines continually for six months or longer will experience withdrawal symptoms when reducing the dose.”
In this study, which compared “the effect on withdrawal severity and acute outcome of a 25% per week taper of short half-life vs long half-life benzodiazepines in 63 benzodiazepine-dependent patients,” ninety percent of patients experienced a withdrawal reaction but, according to the study authors, “it was rarely more than mild to moderate.”
According to the American Psychiatric Association’s Benzodiazepine Task Force on Benzodiazepine Dependence, Toxicity, and Abuse 40-80% of patients experience withdrawal.
The Royal College of Psychiatry and the Royal College of General Practitioners states that “around 4 in every 10 people who take them every day for more than 6 weeks will become addicted*.”
Hood et al. (2014) finds that anyone who has taken benzodiazepines for a period of at least six months and then who attempts to quickly stop the medication will experience some withdrawal reactions, and for 40% the reactions will be moderate or severe.
The American Psychiatric Association’s (APA) Clinical Practice Guidelines for Panic Disorder (2009) warns that “all benzodiazepines will produce physiological dependence in most patients.”
Hope, Alternatives, and What Successful Treatment Includes
Prevention is Worth Everything
As I hope is clear after reading this article, due to the commonly occurring adverse effects and long-term consequences of their use, I recommend avoiding benzodiazepines in nearly all cases. Fortunately, there are endless options for treating anxiety, sleep, panic, seizures, tremors, and other conditions where benzodiazepines may have been used in the past. I recommend starting with a thorough psychiatric evaluation, including labs and functional testing, to identify the drivers of the individual’s concerns. A few of the options we have for treatment include herbal and botanical remedies such as valerian root, passionflower, kava, lavender, and chamomile, which have demonstrated calming or sedative properties. Nutraceuticals and supplements such as L-theanine, magnesium, omega-3 fatty acids, melatonin, and certain B-vitamins may support neurotransmitter balance and sleep regulation. Pharmacological options may include selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), buspirone, hydroxyzine, and mirtazapine. Psychotherapy approaches are essential and include cognitive-behavioral therapy (CBT), mindfulness-based stress reduction, acceptance and commitment therapy (ACT), Exposure and Response Prevention (ERP) for panic symptoms, and cognitive-behavioral therapy for insomnia (CBT-I).
Evidence-Based Treatment for Benzodiazepine Discontinuation
If you are needing treatment for anxiolytic use disorder or benzodiazepine dependence, you may not require in-patient care or a formal detox program. Most motivated clients who are willing to incorporate supportive therapies, make lifestyle changes, and actively engage in treatment can do very well with outpatient care. In my practice, I specialize in guiding clients through this process—using a comprehensive, integrative approach that combines functional medicine, psychiatric expertise, and personalized tapering strategies to make recovery both safe and sustainable.
Treatment for benzodiazepine withdrawal is most effective when it involves a gradual, personalized taper of the medication. This approach helps reduce withdrawal symptoms, lowers the risk of protracted withdrawal (sometimes referred to as benzodiazepine-induced neurological dysfunction, or BIND), and decreases the chance of seizures. I recommend switching from short-acting benzodiazepines to long-acting ones, since these provide more stable blood levels and make tapering easier to tolerate, and reducing gradually, possibly as slow as 5% per month. Adjunctive treatment options may include certain medications, nutritional changes, supplements, psychological therapies, and structured support programs. These strategies aim to treat co-occurring anxiety or mood disorders, strengthen coping skills, and reduce the risk of relapse.
Integrative Approaches
An integrative approach to benzodiazepine withdrawal and recovery focuses on restoring healthy GABA function by combining tapering protocols with complementary strategies that promote overall brain and body balance. Nutritional support plays a role, with magnesium, omega-3 fatty acids, and B-vitamins thought to help regulate nerve activity and support GABA production. Certain herbal and natural remedies, such as valerian root, passionflower, and L-theanine, may provide mild calming effects through their influence on GABA, though research on their effectiveness is still limited. Mind-body practices like mindfulness meditation, yoga, and slow breathing exercises help calm the nervous system and strengthen parasympathetic activity. Regular exercise and healthy sleep habits also encourage neuroplasticity and the restoration of normal inhibitory signaling. When used alongside a carefully managed taper and psychosocial support, these strategies can lessen withdrawal symptoms, build resilience, and support long-term recovery of GABA activity.
Including Functional Psychiatry
Targeted testing can help identify imbalances that may worsen withdrawal symptoms or slow recovery. This is also indicated in someone who has stopped a benzodiazepine and suffering from BIND or protracted withdrawal. Specifically, I recommend testing gut microbiome health, hormone levels, and organic acid profiles. These tests can reveal nutrient deficiencies, impaired neurotransmitter metabolism, or gut dysbiosis that affect GABA function and overall brain chemistry. Addressing these findings through targeted interventions can enhance neurochemical stability. By personalizing treatment strategies in this way, patients can experience improved resilience, reduced symptom burden, and better restoration of normal inhibitory signaling during and after withdrawal.
In Summary: Why I Recommend Avoiding Benzodiazepine Problems Before They Begin
While medications like Xanax, Valium, and Klonopin can temporarily ease anxiety or help with sleep, they carry a high risk of tolerance, dependence, and withdrawal syndromes—problems that can emerge even after just weeks of use. For many, this leads not only to worsened anxiety, depression, and sleep disruption, but also to lasting neurological dysfunction (BIND), making recovery from these drugs far more difficult than the original condition they were meant to treat. Benzodiazepines interfere with memory, learning, therapy, trauma recovery, and overall brain health, and research has even linked prolonged use to cognitive decline and dementia risk. National organizations such as the FDA, ASAM, and the VA now caution against their routine prescribing, especially for anxiety, insomnia, and trauma-related conditions. My role as a prescriber is to protect the long-term mental and physical health of my clients, and for that reason, I only use benzodiazepines in the context of carefully supervised tapers to help dependent clients discontinue them safely, while focusing instead on safer, more effective, evidence-based treatments.
If you are suffering from benzodiazepine withdrawal or dependence and would like help in Richmond, Virginia or virtually in Virginia, California, or Colorado, please reach out, I would be honored to help you get off of benzos and feel well.
Resources:
Patient Guide for Tapering - https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/guidelines/benzodiazepine-tapering-2025/designed_tapering-benzodiazepine-medications-v3-final-patient-directed.pdf?sfvrsn=4f3c1aa2_4
Clinician Guide for Tapering - https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/guidelines/benzodiazepine-tapering-2025/how-to-help-your-patients-taper-from-benzodiazepines_021125-accessible.pdf?sfvrsn=76054a1c_4
The Alliance for Benzodiazepine Best Practices; Our mission is to make evidence-based improvements to the prescribing of benzodiazepines and Z-drugs. https://benzoreform.org/
Benzodiazepine Information Coalition ; Educating about the potential adverse effects of benzodiazepines taken as prescribed. https://www.benzoinfo.com/