Benzodiazepine-Induced Neurological Dysfunction or BIND, is the severe adverse reaction that develops gradually after someone has been placed on a benzodiazepine (Z drug). It is also known as benzodiazepine toxicity. The purpose of this blog is to provide an understanding of this condition to allow you or anyone you are caring for to better recognise this condition and what causes it so they are not misdiagnosed and can get the help they need. To find out more, please read on …
Throughout this blog, I shall refer to Benzodiazepine-Induced Neurological Dysfunction as BIND or benzodiazepine toxicity which is the severe adverse reactions can develop gradually after someone has been placed on a benzodiazepine or later on, when the patient is trying to wean off. Commonly prescribed benzodiazepines or Z drugs, include Valium, Ativan, Resoril, Mogadon, Rivotril, Librium, Serax, and Frisium. These drugs can also go by other names.
While BIND typically occurs after long-term use (years), it can occur much sooner, sometimes within months of taking the drug. BIND symptoms are not simply the body’s reaction to a toxin in the tissues. They are symptoms caused by actual toxic damage by the benzodiazepine to nerve cells in the brain, and are therefore classed as a neurological injury. This is corroborated by patients reporting lingering severe symptoms persisting over a year since they have stopped taking the drug. They are describing the legacy of neurological damage left by these drugs.
The largest clinical study of patients suffering from BIND (over 1,200 people) was carried out by the University of Colorado. While protracted symptoms are a well-known side effect of benzodiazepines, it had always been assumed that these symptoms were simply withdrawal symptoms that would ease with time. However, the Colorado study revealed something different, that new and often persistent severe symptoms would start while using, tapering or even after stopping these drugs.
Dr Josef Witt-Doering, a US psychiatrist specialising in helping patients taper down from psychiatric drugs, makes an important point that many people think you can only get damaged by benzodiazepines via the electrical storm created by coming off them too quickly. That is not the whole picture. Simply starting the drug alone can give people BIND. They may initially feel calmer, then start feeling toxic and sick on it. If they raise the dose, they get more toxic, if they try to taper down, they get a double whammy. So, BIND can literally leave people in a bind!
Iatrogenic Disease
Iatrogenic disease means disease induced by doctors or by treatment (i.e. a drug). Most studies looking into the iatrogenic effects of benzodiazepines found them. Most studies looking into enduring neurological dysfunction caused by these drugs found it. Most studies looking for patient improvement after stopping these drugs found it.
Common side effects of benzodiazepines
Brain and cognitive effects:
*Drowsiness and excessive sedation
*Poor concentration/reduced attention
*Short-term memory problems/forgetfulness
*Confusion and mental sluggishness
*Difficulty learning and retaining new information
Physical and neurological effects:
*Muscle weakness and reduced coordination
*Dizziness and vertigo
*Unsteadiness and impaired balance
*Slurred speech
*Blurred or double vision
*Reduced physical alertness
*Increased risks of falls and accidents
Psychological and emotional effects:
*Emotional numbness or blunting
*Reduced ability to experience pleasure or sadness
*Depression/Worsening of existing depression
*Irritability and mood changes
*Paradoxical reactions, such as agitation, aggression, impulsivity or increased anxiety
Damage To Cells
One of the mechanisms by which benzodiazepines are thought to damage brain cells is their ability to attach to the tryptophan-rich sensory proteins in mitochondria known as TSPO proteins. Mitochondria are the energy powerhouses in cells which help to keep the body healthy and toxin free. When your mitochondria work well, they can cope with a certain amount of toxicity so your cells remain healthy. TSPO proteins are involved in the brain’s response to injury, inflammation and cellular stress. They are also important in brain cells called microglia, the brain’s immune cells.
When benzodiazepines bind to TSPO proteins, mitochondria start producing too many reactive oxygen species (cell-damaging molecules) without having enough antioxidants (cell protection) to mop them up. TSPO proteins have been linked to several neurodegenerative diseases, including Alzheimer’s as well as memory, concentration and other cognitive problems.
The Brain Fights Back
The brain is constantly trying to maintain a state of balance known as homeostasis. GABA is the brain’s natural braking system. It helps us feel calm, sleep, relax our muscles and prevents excessive electrical activity in the nervous system. Benzodiazepaines make the brain’s natural brakes work harder by strengthening GABA’s calming effect so brain cells become less active.
But the brain doesn’t want to be slowed down indefinitely. It tries to restore its normal level of activity by making GABA sensors on cells less receptive to the drug, reducing some of its calming response and increasing the activity of glutamate, the brain’s main stimulating chemical.
When the drug starts to be withdrawn, its extra braking effect disappears. But the brain may still have its accelerator turned right up. The result is that the nervous system can become excessively stimulated. This can cause:
*Trembling and shaking
*Anxiety and panic
*Muscle tension and spasms
*Insomnia
*Sensitivity to light, sound and touch
*in severe cases, seizures
The important thing to remember is that the brain is not simply becoming addicted to the drug. It is physically adapting to a chemical environment that the drug has created.
Dr Witt-Doering states that neurotoxicity may or may not be reversible. He adds that most of what he has seen is reversible.
Why prescribe benzodiazepines?
So why are benzodiazepines prescribed in the first place and who does most of the prescribing? These drugs are prescribed in the UK for a variety of reasons, but their most familiar use is to relieve anxiety and help people sleep. They are powerful drugs because they slow down activity in the central nervous system. They are also used in hospitals, including treatment of prolonged seizures and sedation in intensive care. GPs are the principal prescribers in community primary care. Many patients are left on these drugs for years.
In the seventies, Valium was handed out to patients like toffees. My mother was given a Valium prescription when she moved to Northern Ireland and felt homesick for Gloucestershire. She remained on the drug for decades and became so addicted that she would order repeat Valium prescriptions by phone for myself and my father so she could take higher than prescribed doses. Nobody ever questioned this or revised the repeat prescriptions for the while family!
When I was at Oxford University in the late seventies, I fell ill with a serious brain infection that has left its mark even on current MRI scans. One of the symptoms was vertigo and my GP prescribed a drug she said would help with the debilitating symptoms. Unknown to me, this was a powerful benzodiazepine which actually made my dizziness much worse and stopped me from thinking clearly. My GP clearly hadn’t read the side effects brochure. This was before I learned about taking responsibility for my own health instead of leaving the decisions to the GP! Taking a benzodiazepine was particularly stressful during Oxford final exams. I felt I had morphed from an A grade student to someone completely stupid! There is a particularly distressing side effect of such drugs known as medical spellbinding - the inability to attribute the side effect to the medication! My last Oxford year passed in a cognitive blur similar to that caused by someone on heroine. I eventually weaned off this disastrous and useless drug but experienced severe visual disturbances in the process without the right nutritional support. A consultant had told me just to come off it!
Sadly, nearly half a century later, most GPs and psychiatrists seem unaware of the existence of BIND and don’t appear to have the training to give patients a safe taper down experience. Prescriptions for psychiatric drugs have risen sharply in the last few decades and there were approximately 5.48 million prescriptions written for benzodiazepines in England alone between 2025 and 2026.
There are specialist doctors and clinicians who give patients support in tapering down from psychiatric drugs. But you have to hunt for them. I am lucky enough to have a local doctor near me who can do this privately for patients. I have included a list of resources at the bottom of this article.
There are many underlying physical causes for the symptoms that GPs prescribe benzodiazepines for. They should be looked for by the right blood tests and listening to the patient. Doctors are very good at starting patients on benzodiazepines but not so good at deprescribing them. It takes five minutes to write a prescription but often years of misery for the patient getting off them. And the problem most face is that they feel they have to do this alone!
The Importance of Informed Consent
Informed Consent is a fundamental part of UK medical law. It is not simply a good medical practice or a courtesy offered by doctors. Patients have a legal right to be told the risks and side effects of benzodiazepines (such as physical dependence, tolerance and withdrawal difficulties), reasonable alternative treatments as well as the consequences of having no treatment. This is something patients need to be aware of and demand as their right. The doctor cannot selectively decide which risks the patient needs to know about. How many patients would accept a benzodiazepine prescription if they were told they risked long term or permanent brain damage?
Resources for Safe Taper Down
Important notice: Patients should never attempt to stop or reduce psychiatric medications on their own. Withdrawal should always be carefully planned and supervised by a trained doctor experienced in safe tapering.
Educating yourself about safe withdrawal so you can discuss taper down with your clinician is a good idea. Here are a few resources:
Book: Psychiatric Drug Withdrawal by Dr Peter R. Breggin
taperclinic.com - Dr Josef Witt-Doerring: Psychiatric Deprescribing Leader (only works in the US but good information for patients online).
Citizens Commission on Human Rights: Mental Health Care: What is the alternative to Psychotropic Drugs? online booklet
PostScript360
Dr Mark Horowitz - co-author of the 2024 Maudsley Deprescribing Guidelines.
Online article: Benzodiazepines: Brain-Disabling Effects of Benzodiazepines by Dr Peter R Breggin
Dr Rory McGill, Plymouth
If any of the above issues are affecting you or you would like to explore the root causes of your condition, please get in touch with the Good Health Clinic on goodhealthclinic@outlook.com to request a free 30 minute Enquiry Call or book an appointment. Please note that an Enquiry call is not a consultation but an exploratory call to see if this is a clinical approach you wish to pursue.To your very good health,
Suzanne Jeffery (Nutritional Medicine Consultant)
M.A.(Oxon), BSc.(NMed), PGCE, GNC, BSEM, MNNA, CNHC
The Good Health Clinic at The Business Centre, 2, Cattedown Road, Plymouth PL4 0EG
Tel no: 07836 552936/ Answer phone: 01752 774755
Disclaimer:
All advice given out by Suzanne Jeffery and the Good Health Clinic is for general guidance and informational purposes only. All advice relating to other health professionals’ advice is for general guidance and information purposes only. Readers are encouraged to confirm the information provided with other sources. Patients and consumers should review the information carefully with their professional health care provider. The information is not intended to replace medical advice offered by other practitioners and physicians. Suzanne Jeffery and the Good Health Clinic will not be liable for any direct, indirect, consequential, special, exemplary or other damages arising therefrom.