A new Open Access study published in the prestigious BMJ journal finds indication that use of benzodiazepines, widely prescribed drugs for treatment of anxiety and insomnia, is associated with an increased risk of developing Alzheimer’s disease, particularly for long-term users.
This action has the complimentary effects of reducing anxiety, increased sedation and muscle relaxation, and benzodiazepines are commonly prescribed to treat general anxiety, panic attacks, insomnia, seizures (including status epilepticus), muscle spasms (such as in tetanus cases), restless legs syndrome, alcohol withdrawal, opiate withdrawal syndrome, withdrawal from benzodiazepines themselves, and Meniere’s disease. Nevertheless, benzodiazepines continue to be widely prescribed, and use of these drugs for treatment of anxiety has been found to significantly increase healthcare costs due to accidents and other adverse effects associated with their long-term use. They note that frequency of symptoms highly correlated with prescription of benzodiazepines (anxiety, insomnia, and depressive disorders) increases in the years before a diagnosis of dementia, hence it is possible that benzodiazepines might not cause the disease but rather be prescribed to treat conditions associated with Alzheimer’s development, but that adjustment for such a reverse causality bias is not easy in observational studies. The Differential Diagnosis: The DSM-5 diagnosis of caffeine use disorder includes symptoms that may contribute to a diagnosis of caffeine intoxication and caffeine withdrawal. Caffeine Linked With Disease: Caffeine use may be also linked with caffeine-induced sleep disorder, and caffeine-induced anxiety disorder.
Addiction Professionals Surveyed: Most addiction professionals think caffeine withdrawal and dependence disorders exist and are clinically important, but they are divided on whether either should be included in the DSM.

ICD-10 Diagnostic Criteria for Research: The WHO includes caffeine on its list of psychostimulants that produce withdrawal or dependence disorders in the ICD-10. They may also be used for sedation in certain medical procedures such as endoscopies to reduce tension and anxiety, and impart pain tolerance, and in some surgical procedures to induce amnesia or to reduce anesthesia dose requirements or as the sole agent when IV anesthesia is not available or is contraindicated.
Moreover, further adjustment for symptoms that might indicate the start of dementia, such as anxiety, depression or sleep disorders, did not meaningfully alter the results. Moreover, they point out that few studies published on the topic have had sufficient power to investigate a cumulative dose relation, which makes a compelling argument for further assessment of potentially drug induced outcomes.
Both conditions should be included in the differential diagnosis as should other substance use disorders, especially those related to stimulants.
Caffeine use disorder is included in the “conditions for further study” section of the DSM-5. It has not proved to produce cancer, heart disease, or human reproductive abnormalities, but persons with generalized anxiety disorder, panic disorder, primary insomnia, gastroesophageal reflux, pregnancy, or urinary incontinence often are advised to reduce or eliminate regular caffeine use.

Trepidation about inclusion of caffeine diagnoses is related to concerns about psychiatry being criticized for including common disorders that have a relatively low clinical severity. The presence of other psychiatric conditions, such as depressive and anxiety disorders, should be assessed.
The study concluded that, when cerebral disorder is diagnosed in sedative hypnotic benzodiazepine abusers, it is often permanent.

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