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Alcohol vs Benzodiazepines as neurotoxic risk factors for Alzheimer's Disease

Vastness

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I believe (someone correct me if I'm wrong) that evidence is mounting somewhat for benzodiazepines, especially when used long term, being a potential risk factor for Alzheimer's disease as a consequence of structural changes occurring within the brain, some of which may be permanent.

I'm also aware that alcohol is itself a neurotoxin (or, at least, can act as a neurotoxin in certain cases, especially after long term and frequent exposure).

However what I would be very interested to see, if it has been done (which I don't think it has been) is some kind of quantitative comparison between the relative harm done by these 2 drugs (or more accurately, one drug and one class of very similar drugs) compared to each other.


Obviously the comparison may be somewhat difficult to do because of the vastly different ways in which these substances are consumed, as well as the social climate in which we live. I think the different ways in which these things are reported, and the reaction to this reporting, is somewhat interesting in that alcohol is an accepted part of everyday life, for the most part, despite everyone knowing that it is bad for you, and whenever a study comes out that analyses the already known neurologically damaging effects of alcohol in some new way, no-one really bats an eyelid. Benzos on the other hand are medically prescribed psychiatric drugs, so there is an interesting duality between somewhat justified outrage at the idea that these widely prescribed substances might actually be causing patients harm, as well as a general lack of concern (except in the vaguest sense) from others at the idea, feeling either that the dangers are overblown or just that it's no surprise they could be dangerous in some way but this danger never factored into their decision to use them.

Anyway I would be interested if anyone with some understanding of both these substances and the mechanism by which they cause irreversible neurological deficits (if indeed they do) would like to hazard an educated guess (or, better yet, point me towards an actual study) at which of these substances are more harmful in the long term, given roughly equivalent dose quantities and dosing frequencies. I know dose quantities cannot be directly compared but perhaps there is some way to reach an approximate comparison by either some arbitrary measure of "level of intoxication", or, more scientifically, by comparing binding affinities?

My gut feeling is that alcohol is likely still the most harmful one, being a particularly dirty drug with negative effects on a huge range of biological systems. Although please note - for the purposes of this discussion I am only interested in direct effects on the brain - so please do not take potential liver damage, for example, or any non-neurological effects into account.

Thanks in advance for any responses!


As a secondary query, I wonder out of the benzodiazepines if there has been any analysis of which ones are the least damaging - I believe I read something recently that suggested that shorter acting ones such as alprazolam typically caused less significant lasting changes than longer acting ones such as diazepam and clonazepam, which really surprised me because I had always considered diazepam especially to be a very benign substance, whereas my limited experience with alpazolam seemed to cause more negative side effects. Obviously if this is true though it just goes to show the subjective anecdote of a single person is no indicator whatsoever for the true properties of any substance... anyway if anyone can point me towards any kind of study or information on this, I would be very grateful also.
 
Egg came before the chicken. Born this way. Dementia process involves sleep/anxiety issues. We are just self medicating. Don’t mind the meds.
 
The biggest problem with your proposed study is that they really are incomparable. There is no rough equivalence.

Benzos attach to very specific subunits of one general receptor. They promote the binding of GABA with small variations in a few of them. E.g. midazolam is a delta ligand, alprazolam has some antidepressant effect. But generally speaking, they don't deviate.

Alcohol is thought to work mostly by promoting the binding of GABA, but it has very significant effects on other neurotransmitter systems. It's almost relevant here to state what systems it doesn't affect, rather than lay out all those that it does. But for starters, there is dopaminergic release independent of GABA, along with beta-endorphin, serotonin, glutamate, and acetylcholline release in the effects of alcohol. While there are paradoxical effects from benzos and alcohol alike, I haven't heard of anyone being stimulated in intense academic thought as some alcoholics are. Maybe that would help to explain the differential effects a bit more on the external front.

I'm going to try to humor this a bit more. I don't see why you would rule out damage to other organs/organ systems.

In people who have an anxiety disorder that significantly lowers their functionality in everyday life, one would suppose that taking a benozdiazepine would reduce neurotoxicity by reducing excitotoxic effects of glutamate (the main excitatory neurotransmitter in the CNS). Otherwise, in these instances, the increased social interactions aided by the benzo would ultimately render the brain more healthy, as isolation is very, very bad for it.

Alcohol has been around for thousands and thousands of years. But I don't think its ever been advised as a medication to treat a chronic condition, discounting being in a solution of paregoric or the like. It's meant, and as far as I'm aware has always in human society meant to be, a catalyst to celebrate, not a medication to treat a chronic disorder...

Since one of the metabolites of alcohol is acetylaldehyde, you can likely deduce that it's not fit to chronically medicate with.

That answer things enough?
 
Thank both of you for replying. And yes, AMP, I guess that does answer things enough.

AlphaMethylPhenyl said:
I haven't heard of anyone being stimulated in intense academic thought as some alcoholics are.
This is an interesting observation.

I suppose my question was very much an apples and oranges type of thing. I guess in my mind alcohol and benzos are more equivalent than they actually are. For what it's worth I wasn't intending to make any kind of value judgement about either substance even if it seemed that way from my vague attempt at sociological analysis of the place these 2 substances have in society. I'm just interested in their effects on the brain, specifically, and I feel like the other physiological effects - at least with alcohol - are fairly well understood already and not necessarily worth revisiting in the context of this topic.


AlphaMethylPhenyl said:
In people who have an anxiety disorder that significantly lowers their functionality in everyday life, one would suppose that taking a benozdiazepine would reduce neurotoxicity by reducing excitotoxic effects of glutamate (the main excitatory neurotransmitter in the CNS). Otherwise, in these instances, the increased social interactions aided by the benzo would ultimately render the brain more healthy, as isolation is very, very bad for it.
This is an interesting proposition, I've heard similar arguments before of course but I've never heard the idea stated in such a precise way. Just to run with this a little more, although this is kind of off-topic - are you aware of the fact, or do you think it is likely - that glutamatergic excitotoxic damage is one of the primary neurochemical causes of the harmful effects of prolonged isolation?

Obviously I can understand the idea in more everyday terms, ie, the less people you interact with, the less novel experiences you will have, and the more the brain will turn in on itself, so to speak, and start to fabricate dysfunctional patterns of thought... but, from a neurochemical perspective - would it be accurate to consider your description as a mechanism by which this "endogenous excitotoxicity" occurs?
 
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