Older Adults Can Withdraw from Benzodiazepine Hypnotics and Improve Their Cognitive Functioning

By Dr. Gregg D. Jacobs

Long-term use of benzodiazepine hypnotics (BZDs) is higher in older adults and is associated with a risk of dependence and abuse. Questions remain as to whether long-term use of BZDs continue to be effective in promoting sleep or simply prevent withdrawal symptoms. Because older adults are more susceptible to the effects of BZDs, the cognitive effects of long-term use of BZDs are of particular concern. Although over 100 studies have documented cognitive impairments produced by BZDs, few have focused on older adults. Few studies have tested whether withdrawal from BZDs produces improvements in cognitive functioning.

In a recent study published in the journal Psychological Medicine (2003, 33, 1223-1237), a London research team led by Dr. H. Valerie Curran investigated the effects of withdrawal from BZDs in a large primary care sample of older adults. The patients were adults age 65 or older who were taking BZD hypnotics on a daily basis for at least 6 months. Patients who wished to discontinue their BZD medication were gradually tapered from the medication over an eight week period and were compared to a group who did not wish to taper their BZD medication. All patients were tested on a variety of cognitive functions and measures of sleep and BZD withdrawal symptoms at baseline and then at 3 months and 6 months from baseline.

The researchers found that 80% of patients were able to successfully withdraw from BZDs. The patients who withdrew from BZDs showed improved cognitive functioning at the six month testing period compared to those who continued their medication while the "continuers" showed a decline in their cognitive performance. The researchers also found little evidence of any problems associated with withdrawal. For example, withdrawers did not rate withdrawal symptoms such as anxiety or depression as higher than continuers. An interesting finding was that, the more BZDs patients were taking at baseline, the greater their reported sleep problems. This finding suggests that chronic use of BZDs does not improve sleep.

These findings suggest that long-term use of BZDs in older adults disturbs sleep and compromises cognitive function. Additionally, older patients can successfully withdraw from BZDs without withdrawal symptoms and can experience improved cognitive functioning as a result.