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The Benzodiazepines:

From Molecular Biology to Clinical Practice

edited by Erminio Costa, M.D.
Raven Press, New York, 1983

Reviewed by Mira de Vries

Many of the books I read are borrowed from the library of the medical faculty at one of Amsterdam’s universities. There, by the way, I also have unlimited access to the drug advertisements in medical journals that the Dutch government doesn’t want me to see.

This book I bought for one Euro (about one US dollar) from among the books that were being removed from the library’s collection. Contrary to most such books, it was not falling apart, dog-eared, or marked up by former readers. In fact, it looked like nobody had ever borrowed it, which may be why it was being removed.

Rather than considering it obsolete, I find the book’s age extra interesting. Every once in a while an article pops up in newspapers about the benzos as though some new fact about them was uncovered, whereas this book demonstrates that all these things were already well-known twenty years ago.

Each chapter except the last is written in the style of an article for a medical journal, and authored by a different researcher. The book is chock-full of molecule structures, drawings, illustrations, diagrams, tables, charts, graphs, and electronmicroscopic autoradiograms. It is not always clear whether these refer to people or rats.

Early in the book we learn that benzos, like neuroleptics, were developed from dyes. In fact, it is stated, their properties approach those of chlorpromazine, causing “a taming effect in monkeys.” Later in the book another author points out that benzos often work just as well for treating conditions that are ordinarily treated with antidepressants or neuroleptics. He argues that benzos should be used more often instead of other psychoactive drugs as they cause fewer side effects. Such a proposition rather patently exposes the non-specific nature of both “mental illnesses” and their treatments.

Apparently the authors worked independently of each other, as there is a great deal of repetition in the book. Many chapters open with some variation of the statement that benzos are the most prescribed drug. One author even calls it a “benzodiazepine bonanza.” Another laments that in 1980 (unwarranted) prescriptions for cimetidine (for treating stomach acidity) outstripped the benzos, as though there were a contest over which we can drug more, the brain or the stomach. Some authors point to the high proportion of traffic accidents caused by drivers on benzos, many more than are caused by drunk driving. And many authors acknowledge that benzos cause physical addiction.

One author implausibly claims that side-effects of benzos only occur in people who take them against epilepsy. He admits that side effects are very common, and sometimes necessitate termination of treatment. If people suffering from epilepsy prefer seizures to benzos, one wonders about the other people taking them.

Among the side-effects mentioned throughout the book are impairment of psychomotor function, or in plain English, loss of control over your body. Others are drowsiness, lethargy, retardation, depression, slurred speech, confusion, disorientation, and dementia. Also mentioned are impairment of reaction time, judgment, coordination, alertness, concentration, efficiency, short-term memory, reactive skills, cognitive performance, manual dexterity, vigilance, and divided attention performance. Yet another side-effect is a rise in the secretion of growth hormone. That’s quite a list for the most prescribed class of drugs in the world.

As about a quarter of the contributors, including the writer of the preface, are clearly identified as employees of the drug manufacturer Hoffmann-La Roche, it’s not surprising that some play down the drawbacks of benzos. One author, for instance, claims that only alcoholics become addicted to benzos. True, he admits, some benzo addicts have never touched alcohol, but if you investigate further, you’ll discover that the reason they haven’t is because … there is alcoholism in the family!

Considering the drug company influence, many authors are surprisingly frank in condemning the widespread prescription of benzos. One author writes, “…we should do well not to mitigate the unpleasant immediate effects of such events [that cause anxiety] by administering antianxiety drugs. For, under certain conditions, these agents rather clearly prevent the development of [the ability to deal with anxiety]… the use of antianxiety drugs will impair the normal development of tolerance to such stress.” He couldn’t say it any clearer. In the long run, benzos do more harm than good. I have yet to see the same be acknowledged about neuroleptics, though it is even more so.

Here are two more such statements: “It is not uncommon for elderly patients to be admitted to the hospital in a helpless, depressed, and confused state after being prescribed … benzodiazepines… It is remarkable to see the slow but steady improvement in such patients when they are kept away from drugs.” And: “… many individuals are probably being put at an increased risk of accidents unnecessarily by benzodiazepines that they do not need.”

Another frequently made criticism in the book is that most studies “suffer from severe methodological deficiencies.”

A truth I was happy to see acknowledged, is that measuring the concentration of the drug in blood plasma says little about how it is affecting the brain. There may be none detectable in the blood anymore, but that doesn’t mean that the person isn’t having a whopper of a rebound psychosis.

I wouldn’t want to leave you with the impression that all the authors unanimously condemn the (over)use of benzos. One points out that “most patients are not puritans or stoics, are not masochists, and … have every right to be free from anxiety,” meaning, every right to take benzos, prescribed by physicians, but not to resort to “alternative coping options,” listed by that author as “drinking of alcohol, overeating, smoking of cigarettes, smoking of marijuana, the snuffing of cocaine, … or the use of other illicit drugs.” The message is clear: Don’t indulge yourself. Let your doctor do it for you.

So that Hoffmann-La Roche won’t have invested their money in vain, I leave you with this highly scientific explanation of why we should all take lots of benzos, which appears about two-thirds of the way through the book:
When created, man emerged from a dream-universe, a state of oneiric confusion, but that state possessed its own stability and certainty. Being forced to go through the experience of original sin, man is able to attain to (sic) an understanding of logic, a consciousness of what is possible, and therefore, an experience of anxiety.

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