Benzodiazepines are used in various anxiety disorders as sleep aids, and they can be helpful in the acute manic and mixed phases of bipolar disorder. Where anxiety symptoms and agitation often accompany bipolar spectrum disorders, these medications are frequently used, clonazepam (Klonopin) in particular. Some also have indications as anti-seizure medications and muscle relaxants. There are many medications in this family, and perhaps the best known are diazepam (Valium), alprazolam (Xanax), lorazepam (Ativan), and clonazepam (Klonopin). The majority of these medications are metabolized in the liver, with the notable exception of oxazepam (Serax), a short-acting benzodiazepine largely excreted by the kidneys.
The major side effects of these medications include sedation and mental slowing. They are much safer than older sedatives, such as the barbiturates, in overdoses. If combined with other sedating medications and narcotics (heroin, methadone, oxycodone, etc.), however, they have been associated with death from respiratory depression.
Taken over time, benzodiazepines can cause physical tolerance and dependence quite similar to alcohol dependence. Someone who has been on benzodiazepines for an extended period of time (more than a few weeks) will need to be tapered off them in order to avoid a withdrawal syndrome that could include dangerous elevations in blood pressure, delirium and even seizures.
Benzodiazepines can be abused, and care needs to be taken when a person with bipolar disorder also has problems with substance abuse and dependency. In people who abuse opiates, they should be avoided altogether or used with extreme caution and careful supervision, the combination of benzodiazepines and opiates, such as heroin, methadone, oxycodone (Oxycontin), etc., can be especially lethal.