PsychRounds: The Psychiatry Podcast Introduction to Benzodiazepines
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Oct 15, 2025 Explore the fascinating world of benzodiazepines, from their historical rise after barbiturates to their complex mechanisms of action on GABA-A receptors. Discover their approved uses, especially for anxiety and epilepsy, and the risks of long-term use, particularly for the elderly. The discussion reveals critical insights on withdrawal symptoms and tapering strategies, as well as the dangers posed by designer benzodiazepines. The benefits versus risks debate takes center stage, shedding light on the careful balance physicians must maintain when prescribing these medications.
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Benzodiazepines' Historical Turning Point
- Benzodiazepines replaced barbiturates due to a wider therapeutic index and lower fatal overdose risk.
- Their rapid adoption masked long-term harms that became clear by the 1980s.
GABA-A Subunit Effects Explain Clinical Actions
- Benzodiazepines potentiate GABA-A by increasing chloride channel opening frequency.
- Different alpha subunits mediate sedation, anxiolysis, muscle relaxation, and cognition.
Mnemonics For Kinetic Selection
- Use the LOT mnemonic (lorazepam, oxazepam, temazepam) for agents safer in liver impairment.
- Use MOAT (midazolam, oxazepam, alprazolam, triazolam) to recall short half-life benzos.