The Dangers of Taking a Stimulant and a Benzodiazepine at the Same Time

One of our missions at Interpersonal Psychiatry is meeting people where they are and helping them to achieve well-being through a responsible way of practicing medicine and integrating approaches to health and wellness.  The providers at the practice are very intentional in their prescribing practices to not only stay abreast of the most advanced research and knowledge of psychiatry practices when working with patients but also to be cautious and intentional about mitigating harmful practices that might seem like “quick fixes” but can lead to longer term issues around side effects and drug interactions.

One of the areas that is important for the public to understand is the risks and the issues of certain combinations of medications that may be prescribed together.  Here is some information about the combination of benzodiazepines and Stimulants that is for public health awareness.

When prescribed by a healthcare provider, stimulants and benzodiazepines are both effective medications used to treat specific conditions. Stimulants, such as Adderall or Ritalin, are commonly prescribed for attention deficit hyperactivity disorder (ADHD), while benzodiazepines like Valium or Xanax are often used for anxiety, insomnia, and seizure disorders. Although these drugs may seem like they could complement each other for individuals who have both ADHD and anxiety or other co-occurring conditions, taking stimulants and benzodiazepines together can be dangerous and should be carefully managed. Here’s why.

1. Opposing Effects on the Central Nervous System

Stimulants and benzodiazepines work in very different ways within the central nervous system (CNS).

• Stimulants, such as amphetamine-based medications, increase dopamine and norepinephrine levels in the brain, leading to increased alertness, focus, and energy.
• Benzodiazepines, on the other hand, enhance the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits brain activity, producing calming, sedative effects that help reduce anxiety and promote relaxation.

Taking these two types of medications together creates a conflict in how the brain functions. The stimulant activates the nervous system, while the benzodiazepine depresses it. This can cause the body to become confused about how to react to both opposing effects. Some of the potential consequences include:

• Diminished effects: The calming effects of the benzodiazepine may counteract the stimulating effects of the stimulant, reducing the efficacy of either drug.
• Unpredictable reactions: The body may attempt to balance the two conflicting effects, which could lead to overstimulation, extreme sedation, or erratic behavior.

In short, the combination of these drugs can create a tug-of-war in the brain, leading to a range of dangerous and unpredictable outcomes.

2. Increased Risk of Overdose and Respiratory Depression

Both stimulants and benzodiazepines can have dangerous effects on the cardiovascular and respiratory systems, especially when taken together.

• Benzodiazepines are sedative drugs that, when taken in large doses or in combination with other depressants (such as alcohol or opioids), can cause respiratory depression—slowed or even stopped breathing. This is especially dangerous for people who have a history of respiratory issues or are combining benzodiazepines with other substances.
• Stimulants, on the other hand, increase heart rate and blood pressure and can strain the cardiovascular system. When mixed with benzodiazepines, the stimulant may mask some of the sedative effects, leading a person to take more benzodiazepines to counterbalance the perceived lack of calming effect. This can increase the risk of overdose, especially if the sedative drug accumulates in the body without being noticed.

The combination can compound the risks of overdose, as one drug could intensify the harmful effects of the other. Respiratory depression, heart attack, or stroke are potential outcomes if someone is not careful with dosing or if the mix is not carefully monitored by a healthcare provider.

3. Risk of Dependency and Abuse

Both stimulants and benzodiazepines have the potential for abuse and dependency, but when used together, the risks become even more pronounced.

• Stimulants, especially those prescribed for ADHD, are sometimes misused recreationally for their euphoric effects or ability to increase focus and energy. Taking them with benzodiazepines can intensify their addictive properties.
• Benzodiazepines are also prone to misuse, especially in individuals who develop a tolerance to their calming effects. When mixed with stimulants, they might mask the side effects of the stimulant or prevent the overstimulation caused by the stimulant, leading individuals to misuse both substances.
• Combining both drugs may increase the likelihood of dependence on either one or both, making it harder to stop using them over time. This can lead to withdrawal symptoms or a cycle of escalating doses.

In some cases, the combination of both substances can become a dangerous pattern of misuse, especially if the individual is not properly monitored by a healthcare provider.

4. Cognitive and Behavioral Impairments

Taking a stimulant and a benzodiazepine together can affect cognitive functioning and behavior in harmful ways.

• Stimulants tend to enhance alertness, focus, and concentration, but when combined with a benzodiazepine, which has sedative and calming effects, cognitive functions may become impaired.

• This combination can cause confusion, memory problems, poor decision-making, and difficulty concentrating. The person may experience periods of extreme alertness followed by moments of severe sedation, which could lead to accidents, poor judgment, or erratic behavior.

For individuals who need to be mentally sharp or engaged in activities that require focus and coordination, this combination of drugs can be particularly hazardous.

5. Increased Risk of Mental Health Issues

Combining a stimulant with a benzodiazepine can also have detrimental effects on mental health.

• Benzodiazepines can cause depression, drowsiness, and mood swings in some people, especially when taken over an extended period.
• Stimulants are generally used to treat ADHD or other conditions involving focus and attention, but they can sometimes exacerbate anxiety, irritability, or paranoia, especially in high doses.

The interaction of these two substances can contribute to a mental health imbalance, making it harder for patients to cope with their emotional and psychological well-being. This could lead to feelings of increased anxiety, stress, or emotional instability.

What to Do if You Are Prescribed Both Drugs

If you are prescribed both a stimulant and a benzodiazepine, it is crucial to work closely with your healthcare provider. Here are a few important things to keep in mind:

1. Follow your doctor’s instructions carefully. Take each medication exactly as prescribed, and neveradjust dosages without consulting your provider.
2. Discuss your treatment plan. If you feel your current medication regimen is not working, or you are concerned about taking both drugs together, talk to your doctor. There may be alternative treatments or a way to adjust your medications to minimize risk.
3. Monitor for side effects. Pay attention to any changes in mood, behavior, or physical health, especially if you start taking both medications at the same time.
4. Consider tapering and monitoring. If there is a need to discontinue one or both medications, never stop abruptly. Work with your healthcare provider to develop a safe tapering plan.

At Interpersonal Psychiatry, we are extremely aware of the impact of prescribing combination of stimulants and benzodiazepines can be dangerous due to their opposing effects on the central nervous system, the risk of overdose, the potential for addiction and misuse, cognitive impairments, and mental health consequences. While these medications can be beneficial when used properly and separately for their intended purposes, taking them together without careful supervision increases the risk of serious health issues.

Always consult with your healthcare provider before combining medications, and never adjust your regimen without professional guidance. It is crucial to take a cautious, informed approach to ensure your safety and well-being.