Benzodiazepines are a class of medications that can be used to treat symptoms of anxiety, irritability, and aggression that may arise in patients with Huntington’s disease.
A few case reports have suggested that benzodiazepines also may relieve chorea, which is unpredictable, jerky limb movements, a hallmark of Huntington’s disease.
What is anxiety?
Anxiety represents an overall heightened sense of awareness and apprehension that may be directed toward anything. This is different from fear, which usually is directed toward a specific threat.
While it is normal to feel anxious during certain situations, patients who have dysfunctional circuits in areas of the brain responsible for regulating anxiety may experience anxiety severe enough to affect their quality of life.
Studies found that up to 71 percent of patients with Huntington’s disease develop anxiety, usually together with other mental health changes such as depression, irritability, and aggression.
As stress, depression, and anxiety may worsen chorea, measures of treating anxiety also may help relieve the movement symptoms of Huntington’s disease.
How benzodiazepines work
Patients with Huntington’s disease experience damage to many different circuits in the brain, causing different mood disorders. One type of chemical messenger or neurotransmitter that is known to be affected in Huntington’s disease is called gamma-aminobutyric acid, or GABA, which normally acts to “calm the brain down”. People with Huntington’s disease often have reduced levels of GABA in the brain, which causes anxiety.
Benzodiazepines work by attaching to GABA receptors in the brain and enhancing GABA’s action. This leads to neurons being less active, which is useful in combating anxiety.
Examples of benzodiazepines used in Huntington’s disease
Benzodiazepines differ in terms of how quickly they start working and how long the effects last. Generally, they can be categorized into short, intermediate, and long-acting benzodiazepines.
Ativan (lorazepam) and Xanax (alprazolam) are examples of intermediate-acting benzodiazepines whereas Klonopin (clonazepam) and Valium (diazepam) are examples of long-acting benzodiazepines that are used to treat anxiety in Huntington’s disease.
Intermediate and long-acting benzodiazepines are usually preferred over short-acting ones because there is less room for medication abuse with the former two.
Taking benzodiazepines
Some of the most common side effects of benzodiazepines are sleepiness, unsteadiness, and increased risk of falls, as well as poor concentration and memory.
Benzodiazepines also should be used only for the short-term relief of anxiety as patients who use these medications for longer periods risk developing addiction and dependency. About four in 10 people who take benzodiazepines daily for more than six weeks will become addicted.
Suddenly stopping benzodiazepines after taking them for long periods may induce withdrawal symptoms such as increased anxiety and insomnia, muscle tension, nausea, vomiting, diarrhea, seizures, blurred vision, hallucinations, trouble remembering and concentrating, mood swings, agitation, drug craving, weight loss due to reduced appetite, and twitching.
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