What are benzodiazepines and are there natural alternatives?
Written by: Dr. Diana Rangaves, Google Scholar, holds a Doctorate from the University of California, specializes in pharmacotherapy management, and founded ClinicalConsultantServices.com and DianaRangaves.com
CBD: A Safe Alternative to Benzodiazepine for Treating Anxiety?
One out of every 13 people lives with an anxiety disorder of some kind. In fact, anxiety disorders are the most common mental health disorder on the planet. Anxiety left unmanaged can significantly decrease an individual’s quality of life, which is why it is so important to find an effective treatment.
Some of the more dominant symptoms of anxiety disorders include unwanted thoughts that race through your head, an inability to concentrate, sweating, irritability, heart-pounding, and overall restlessness. Imagine having to live with those symptoms without any way to deal with them. As mentioned, one in 13 people doesn’t have to imagine it, because it has been their reality. Hopefully, most, or all of them have found some kind of treatment that works, though that’s unlikely.
Taking Benzodiazepines Can Be Risky Business
The unfortunate reality of anxiety disorders is that an efficacious treatment, one that is both effective and safe, has yet to be found. Doctors tend to prescribe a class of drugs known as benzodiazepines for dealing with anxiety. While they are rapidly effective, they aren’t necessarily safe to use. Benzodiazepines, called benzos for short, can cause dangerous side effects, including tolerance, dependence, suppressed breathing, addiction, and withdrawal. The withdrawal effects are considered widely unpleasant and sometimes dangerous as well, such as convulsions, insomnia, cramps, tremors, vomiting, and sweating. Those are just the serious side effects.
Benzos can have a whole slew of other side effects that are less often serious, though not totally unserious either. These include dizziness, drowsiness, sedation, nausea, vision impairment, constipation, confusion, sexual dysfunction, forgetfulness, and cognitive impairment making it hazardous to operate heavy machinery or drive. Drinking alcohol while taking benzos can also increase these effects.
There are many benzos on the market, but the most common are Xanax (alprazolam), Ativan (lorazepam), Klonopin (clonazepam), and Valium (diazepam). Xanax and Ativan are more dangerous than others for their potential for addiction.
CBD as a Safe Alternative to Benzos
There is mounting evidence that CBD, short for cannabidiol, could be a safe and effective alternative anxiety treatment to benzos. Derived from the cannabis plant, CBD is a non-psychoactive compound that may have a lengthy list of therapeutic benefits. The cannabis plant has been illegal for a long time because of its most prominent THC compound, famously known for making people feel “high.” In recent years, many US states and some countries worldwide have either legalized or decriminalized cannabis, lending to research about how it works.
CBD comes just after THC as the second-most prominent compound in the plant. Because CBD is non-intoxicating, scientific interest in its medical potential has been popularized over the last decade. One of the most common things researchers have noticed about CBD is its potential to provide anxiety relief. The fact that benzos tend to be so dangerous means that scientists are always taking note of possible alternatives, and CBD could very well be the answer. Additional populated and long-term clinical research will help show the efficacy of using CBD to treat anxiety disorders. Still, the current data is promising. In fact, it’s promising enough that many people have taken to using CBD for anxiety as an integrated approach without a proper prescription from a doctor.
The Difference Between Benzos and CBD
The way benzos like Xanax and Ativan work to relieve anxiety is through GABA receptors and their functions. Benzos boost GABA function, as GABA receptors work as inhibitors, making the brain’s neurons less excitable. As such, they have a calming effect, and the boost benzos give them makes people feel calmer. The results are quick and temporary and often tend to induce sleep as well.
CBD also impacts GABA receptor function, but indirectly. CBD doesn’t bind to GABA receptors, but CBD use can cause changes in their charge. GABA receptors can be thought of as electrical gates with positive and negative potential. A 2019 study found that CBD had different effects on GABA+ depending on if GABA was already diminished or not. People with autism have diminished levels of GABA in their dorsomedial prefrontal cortex (dmPFC). CBD was shown to boost GABA function in patients with autism in everywhere but their dmPFC. This selective functioning of CBD on GABA is a primary difference between how CBD and benzos work to relieve anxiety.
One of the dangers of benzos is that they cause increased GABA receptor activity, which then causes the brain to decrease not only the natural GABA pathways, but also the production of GABA receptors at large. That’s why people end up with tolerance to benzos, because as they continue taking them, they need more to provide the same effects. Without continuing to take them, the body will immediately begin to feel withdrawal symptoms, not to mention end up more anxious than they started, leading to dependence and addiction. CBD does not cause those same dangerous side effects because it does not offset the balance in the brain.
CBD can also impact the 5-HT1A receptor, which is the principal serotonin receptor. Serotonin is involved with reducing anxiety as well, plus reducing the body’s response to chronic stress. CBD is a direct activator of 5-HT1A. This increases serotonin levels, then leading to feelings of well-being and happiness while at the same time decreasing anxiety.
Evidence of this has been shown in many studies, though this 2011 controlled study stands out in particular. The study tested CBD's use for its effects on anxiety-related to public-speaking with participants pre-diagnosed with social anxiety. The results showed that the CBD group reported significant anxiety improvement as evidenced by their Negative Self Statement Scale Assessment whereas the placebo group’s anxiety did not improve. In fact, CBD reportedly “abolished” negative thought symptoms. This was true even though all participants had clinical diagnoses of social anxiety and went through a situation (public speaking) known to give almost everyone anxiety.
A large review of numerous studies from 2015 also found preclinical evidence that CBD showed effectiveness in treating generalized anxiety disorder, panic disorder, and social anxiety disorder, among others.
CBD Versus Benzos in Terms of Safety
As mentioned, benzos, especially Ativan and Xanax, have some serious safety concerns related to tolerance, addiction, and withdrawal. While more long-term studies are needed to confirm the safety of CBD use, current research shows that CBD is non-habit-forming and does not cause severe nor serious side effects. The most common side effects are diarrhea and weight and appetite changes, but they are not common and generally remain mild to moderate in intensity.
What’s more, while benzos tend to cause addiction, CBD has even been found to be a potentially effective treatment for addiction. Aside from that, CBD has not been found to cause tolerance nor withdrawal symptoms. This is at the very least true for abruptly ending short-term CBD use. Studies looking into potential withdrawal from long-term CBD use are still needed.
Because the use of common pharmaceutical anti-anxiety treatments, like benzodiazepines, have been shown time and again to be dangerous, it seems that CBD would be a better option, as long as it works. The main thing to be aware of when taking CBD, for anxiety or anything else, is that it can negatively interact with certain medications. That research is still largely underway, but what has been found so far in terms of CBD and drug interactions is that it could be quite dangerous if taken simultaneously with blood thinners and the benzodiazepine clobazam. When taking other medications, it’s always best to consult with your doctor when adding a new substance to your life, including CBD.
Taking CBD with Benzos Can Be Dangerous
Taking CBD simultaneously with benzos like Xanax and Ativan can be problematic because the same liver pathway processes CBD and benzos. As such, taking them together could lead to elevated or longer-lasting effects from the benzos. In addition to that, doubling up on anti-anxiety treatment through substances is not a good idea either.
CBD has been known to help with opioid withdrawal symptoms, so taking CBD specifically to help deal with benzo withdrawal should be timed accordingly to when the benzos will start to wear off. That can depend on things like your weight and liver function, but it’s generally safe to take CBD four to six hours after taking a benzo. Still, before mixing any substances, especially ones known to have negative interactions, it’s wise to consult with your doctor about it beforehand.
While benzodiazepines do not have serious adverse effects on all users, all patients looking for anxiety treatment should be aware of these drugs' potential dangers before beginning to use them. Anyone with a prior substance-abuse issue or addiction in their family might steer clear of benzos for their potential risk. Thankfully, CBD, a new, safer substance with evidence for its efficacy in treating anxiety disorders is finally entering the scene. With all the information out there about CBD’s potential therapeutic effects for anxiety, it seems like a smart decision to at least give it a try before diving into the world of benzos. If CBD works widely to treat anxiety without all the risk, it seems society will be much better off. This becomes even more relevant considering that one in 13 people suffer from an anxiety disorder.