Image by Pete Linforth from Pixabay

Many people, especially women, develop feelings of anxiety and worry. Some call it “bad nerves.” This predisposition to feeling anxious can cause problems with everyday living, coping, and sleeping. I have assessed and interviewed many older people with a range of problems with anxiety. Feeling anxious is a completely normal reaction to stress or a situation where you may feel fearful. However, being in a continuous state of feeling afraid can cause problems both mentally and physically. Some say they feel like they are “trembling inside.”

Anti-anxiety medications (also known as “nerve pills”) are used by many people. These pills come from the family of “benzodiazepines.” Some of the commonly prescribed anxiolytics in Canada or the United States include (but not limited to):

• Clonazepam (Rivotril)
• Alprazolam (Xanax)
• Lorazepam (Ativan)
• Diazepam (Valium)

A commonly prescribed non-benzodiazepine that acts like one is Zopiclone (eszopiclone in the USA). It is commonly used as a “sleeping pill.”

Generally, benzodiazepines end in “pam” or “lam.” Use of these medications can initially improve symptoms by offering a sedating effect, however, they can also be addictive. Side effects of these drugs include increasing the risk of cognitive impairment, confusion, delirium, falls, fractures, drowsiness, and motor vehical accidents. They are not recommended for use by older adults. In fact, older people are recommended to gradually reduce their dosage (a slow and steady decrease is recommended over a sudden discontinuance due to withdrawal symptoms). Always talk to a doctor about any changes to your medication. As the dose is gradually reduced and preferably stopped, it is important to identify and optimize alternatives to managing any underlying issues. These alternatives are preferably not other medicines.

Sometimes these medications are used on an “as needed” basis. For example, if you are afraid of flying, and you need to go on an airplane, you can take one of these medications (prescribed by your doctor) to use in specific situations. Or, if you have claustrophobia and you need to go for a scan such as an MRI, taking this medication may make it more bearable.

I have also seen where these medications are prescribed for help with sleep. People who have an anxiety disorder may be prescribed this classification of medications to see if it helps reduce anxiety or panic attacks. In older people, antidepressants are the preferred class of medications to help with anxiety.

Some other key tips to remember:

• Avoid taking benzodiazepines with opioids or alcohol.
• These medications are more often prescribed to women (Almost 1 in 5 Canadian women report to have used in the past year).
• Almost 1 in 10 Canadians in Quebec have been reported to have an addiction to benzodiazepines.
• If a benzodiazepine addiction is present, consider there may also be other substance use disorders or behaviours present (e.g, alcohol, opioids, marijuana, gambling).
• If you are older, it’s best not to start taking benzodiazepines.
• If the addiction is getting worse, an admission to a treatment facility may be necessary.

If you are finding yourself feeling “addicted” or “dependent” on these medications (or other substances or behaviours), you are “craving” these drugs, or you are needing to increase your dosage, you may want to see your doctor to discuss alternatives. Reducing the risk of harm is key.

For more details, The Canadian Coalition for Seniors Mental Health has published the Canadian Guidelines on Benzodiazepine Receptor Agonist Use Disorder Among Older Adults (2019) and is found online: https://ccsmh.ca/wp-content/uploads/2019/11/Benzodiazepine_Receptor_Agonist_Use_Disorder_ENG.pdf

Angela G. Gentile, MSW, RSW