What Is BIND, Or Benzodiazepine-Induced Neurological Dysfunction?
Benzodiazepines are classified as depressants and are frequently used in the United States and worldwide to treat and reduce anxiety, seizures, insomnia, muscle spasms, and other similar symptoms by slowing down brain and nervous system functioning. Due to their strong effects, they are typically regulated and require a prescription. Unfortunately, this class of drug is addictive. According to the National Institute on Drug Abuse, 17.1% of adults who used a benzodiazepine the previous year abused the drug, and around 2% developed an addiction.
For this reason, most professionals suggest short-term use when prescribed this class of drug. However, in some cases, when long-term use is recommended or drugs have been abused, a condition known as benzodiazepine-induced neurological dysfunction (BIND) may occur.
What is BIND?
Benzodiazepine-induced neurological dysfunction is a multi-symptomatic disorder resulting from neuroadaptation or neurotoxicity to benzodiazepines. Symptoms typically begin while the patient lowers their dosage and may result in physical and mental symptoms lasting a week, month, or over a year. One study showed that up to 76.6% had symptoms lasting over one year.
Symptoms of BIND include anxiety, fear, poor sleeping, lethargy, heart palpitations, nerve sensations, stomach pain, and more. People with BIND also commonly experience adverse life circumstances, such as new or increased difficulties with marriage, work, and relationships.
Withdrawal vs BIND
BIND has only recently been differentiated from benzodiazepine withdrawal. Withdrawal refers to removing the medication from the body, typically lasting up to 28 days. Symptoms range from mild to severe, including shaking, seizures, hallucinations, cramping, anxiety, and dizziness. It was commonly believed that the undesired effects were merely the recurrence of old ailments. However, new research points to a different medical situation when symptoms occur during and after quitting benzodiazepines.
BIND covers a multitude of new symptoms that outlast the typical withdrawal period. As the brain goes through a neuroadaptation process, the patient may experience a new or worsened range of side effects. Only recently are these persisting symptoms more openly associated with previous benzodiazepine use instead of being dismissed.
Underlying Mechanisms
One of the proposed reasons for BIND is due to disrupted homeostasis. For example, when someone’s system begins to regulate the drug, it lowers gamma-aminobutyric acid (GABA) receptors, known for its naturally calming effect. The downregulation of these receptors leads to a nervous system that is highly sensitive to everyday stimuli and impaired functioning of the neurotransmitters that regulate muscle tone, emotional well-being, blood pressure, and more.
Increased chemicals like glutamate can further alter the synaptic activity and lead to raised excitability, the opposite effect than desired for most benzodiazepine users. This can also create hippocampal changes, resulting in decreased memory and learning ability, excess neuroinflammation, and lowered brain neuroplasticity.
This is all without mentioning the original reason the user went on the medication, which may be anxiety or other psychological or physiological problems. Without proper treatment for the core issue, users may feel unequipped to handle increased stress levels after quitting, only intensifying the effects.
Risk Factors for BIND
Some populations may be more vulnerable to BIND. By assessing these risk factors, patients and doctors can work together to discuss whether longer-term benzodiazepine use is the proper treatment.
Elderly individuals may be in a higher danger due to age-related neurological changes and decline. This is like other populations with neurological conditions such as Alzheimer’s and dementia. Children and adolescents are also highly vulnerable due to the critical developmental period their brain is undergoing that may be disrupted by continued drug use.
Other potential at-risk groups include anyone who already suffers from addiction, people already taking central nervous system depressants or other drugs, those who do not metabolize drugs well, and anyone prescribed or taking a higher dose of benzodiazepines than average.
How to Help Prevent BIND
One of the best ways to prevent BIND is through high-quality patient screening before prescribing benzodiazepines and, when prescribed, using them for the shortest time possible and at the lowest dose to get the desired effects.
Patients should also be educated on alternative or complementary therapies to treat anxiety, sleep disorders, and other conditions frequently diagnosed in these patients. Whether it’s a substitute medication or natural aids like relaxation techniques and treatment, a complete picture of options and risks is necessary. They should also be made explicitly aware of the impact of long-term use and the possibility of new symptoms arising after withdrawal.
Once prescribed, many patients will also benefit from cognitive assessments that can monitor neurological changes and inform users if they are at an even greater risk for adverse side effects before they begin or worsen.
If a patient is already taking benzodiazepines, they can help prevent severe withdrawal and potentially BIND by gradually reducing the dosage before quitting, under their doctor’s supervision, of course.
There are several tapering methods. The most common is simply reducing the medication dosage until it is the smallest available and then gradually no longer taking the drug by alternating the days they take it. Some medical professionals suggest swapping the current benzodiazepine for another with fewer withdrawal symptoms. This is only recommended if done under the watchful care of a professional and with their recommended prescription. Substitution of prescription drugs with alcohol or street drugs can exacerbate the problem.
Managing BIND
SSRIs have been proven highly effective treatments for depression, PTSD, and panic disorder. They can potentially improve a person’s quality of life significantly but, unfortunately, come with the risk of unwanted sexual side effects such as erectile dysfunction, decreased sexual desire, and decreased sexual arousal. Awareness of the specific SSRIs more likely to cause these side effects can help individuals make more informed decisions about their treatment options.
If you experience sexual side effects while taking SSRIs, don’t hesitate to contact your healthcare provider and have an honest and open conversation about what you are experiencing. They can help you explore potential solutions, such as lowering medication dosage, switching medications, or adding additional medications to counteract the unwanted side effects. Although everyone is unique, your clinical professional will help you find a solution to restore sexual function while properly treating your mental illness.
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