Psychomotor Performance of Long-Term Benzodiazepine Users Before, During, and After Benzodiazepine Discontinuation

Abstract

Long-term (mean, 8 years) users of benzodiazepines (BZs) were administered a small battery of cognitive tests on three occasions (before BZ taper, and 5 and 12 weeks post taper) as part of their BZ discontinuation program. Ninety-six patients had 5-week and 77 patients had 12-week data. For taper successes, BZ-free status was confirmed by weekly BZ plasma level determinations. Age and education, as well as baseline test scores, were used as covariates for all data analyses. Patients who successfully tapered off BZ were able to complete symbol copying (SC) and digit symbol substitution (DSST) tasks faster than patients still taking BZ (p < 0.05). In addition, using an adjective check list, patients with taper success, i.e., BZ-free patients, reported lower levels of mental and physical sedation and higher levels of tranquilization (p < 0.05) than did patients still taking BZ. These results were confirmed in two multiple regression analyses with SC and DSST as the dependent variables. Higher baseline, younger age, and successful taper status (off BZ) were selected as significant independent predictors of SC and DSST scores. In summary, cognitive functions improved for many long-term BZ users after discontinuing their BZ intake.

Mechanisms Underlying Tolerance after Long-Term Benzodiazepine Use: A Future for Subtype-Selective Receptor Modulators?

“…However, another study reported tolerance to the acute amnesic effects of alprazolam after chronic use [40]. A major concern is that loss of memory associated with benzodiazepine use may be lasting, even after treatment discontinuation [62, 63], although other studies reported improved cognitive functioning after discontinuation with increased speed and accuracy of information processing, improved reaction time and working memory [50, 64–66]. Collectively, clinical data do not support the existence of tolerance to benzodiazepine-induced cognitive impairments.…”

Adverse performance effects of acute lorazepam administration in elderly long-term users: Pharmacokinetic and clinical predictors

“…However, clinical treatment often extends beyond 3 weeks (e.g., years), increasing the associated morbidity and mortality (Hampton et al, 2014; Tamblyn et al, 2005; Pariente et al, 2008). Conversely, discontinuation of BZPs in long-term users is generally associated with an improvement in cognitive function, with no significant adverse effects (Kitajima et al, 2012; Rickels, 1999). …”

Pregabalin in the discontinuation of long‐term benzodiazepines' use

“…Long-term benzodiazepine (BDZ) use leads to tolerance and dependence, affecting also adversely users' cognitive functioning (Ashton, 2005;Golombok et al, 1988;Rickels et al, 1999;Stewart, 2005). Among the available pharmacological means the most efficacious are, thus far, the gradual rather than the abrupt discontinuation of BDZ and the use of carbamazepine as an adjunctive medication (Denis et al, 2006).…”