Why do some people feel so strongly about daily long term BDZ use an
Evidence based medicine does not have strong support for the link between dementia and bzd use.
Meta analysis showing that, while there is a link between BZDs and dementia, when corrected for reverse causation ( anxiety and sleep disturbance are prodromal symptoms of dementia, so benzodiazepines are often prescribed because of early undiagnosed cognitive change. ) the link disappeared.
AlDawsari A, Bushell TJ, Abutheraa N, Sakata S, Al Hussain S, Kurdi A. Use of sedative-hypnotic medications and risk of dementia: A systematic review and meta-analysis. Br J Clin Pharmacol. 2022 Feb;88(4):1567-1589. doi: 10.1111/bcp.15113. Epub 2021 Nov 11. PMID: 34679196.
risk was slightly higher at minimal exposure (HR 1.25) but not at the highest exposure (HR 1.07, 95% CI 0.82–1.39), and there was no faster cognitive decline. the opposite of a true dose response.
Gray SL, Dublin S, Yu O, Walker R, Anderson M, Hubbard RA, Crane PK, Larson EB. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ. 2016 Feb 2;352:i90. doi: 10.1136/bmj.i90. PMID: 26837813; PMCID: PMC4737849.
The following study found no link between benzodiazepine use and dementia, though it did detect accelerated hippocampal/amygdalar volume loss without a clear dose-response.
Hofe, I.v., Stricker, B.H., Vernooij, M.W. *et al.*Benzodiazepine use in relation to long-term dementia risk and imaging markers of neurodegeneration: a population-based study. BMC Med 22, 266 (2024). https://doi.org/10.1186/s12916-024-03437-5
Straight from up to date:
It remains uncertain whether long-term use of medications such as benzodiazepines is associated with an increased risk of cognitive decline; the data are conflicting.
Interpretation of observational data is difficult in large part because benzodiazepines are prescribed to treat insomnia and anxiety, which can be prodromal symptoms of dementia.In studies that attempted to control for the prodromal phase and the potential for reverse causation, some have found an increased risk of dementia with benzodiazepine use, while two did not.
Nonbenzodiazepine benzodiazepine receptor agonists (eg, zolpidem) have also been associated with dementia risk, again with some inconsistencies; these studies are subject to the same concerns as those for benzodiazepines.
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Now I get it, no need to give a patient BZDs if they don’t need them due to risk of dementia, but for some reason everyone seems to be so against it, as if it is a very strongly supported effect of BZD use, when it is not.
Why do some people have such strong feelings about chronic BZD usage without evidence based medicine backing them up?
Thank you