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Diltiazem and other ccbs--are we hooked on benzos?

Posted by Not_in_Kansas 
Diltiazem and other ccbs--are we hooked on benzos?
July 06, 2022 05:32AM
I found this gem and was wondering if anyone had thoughts or could vouch for the science? Scary stuff, especially for someone on Diltiazem, which is a benzothiazipine.

Thanks so much,

"Usually people with depression have shown increased level of Monoamine oxidase A. This MO-A results in low levels of serotonin and other neurotransmitters. This is the basic idea about what causes depression.

In case of calcium channel blockers too it's the same mechanism where MO-A is replaced by the calcium channel blockers. To make it clear, let me give an example.

Calcium channel blockers mainly include the hydroxypiridines and benzothiapines.

These benzothiapines are very similar in structure to a neurotransmitter inhibitor called benzodiazepines. Hence, when our body is dragged in a condition with high levels of benzothiapines, due to long term use of calcium channel blockers, these benzothiapines convert to benzodiazepines with a fusion of diazepine ring with the benzene ring in benzothiapines. This leads to selective inhibition of neurotransmitter like serotonin.

In case of hydroxypiridines in the calcium channel blockers. These hydroxypiridines contain amlodipine. This amlodipine again becomes a sympathetic system inhibitor with long term consumption. Leading to reduced level of tyrosine and triiodotyronin which are also responsible for our emotions.

Hence, calcium channel blockers act as depression causing agents when consumed in long term, due their ability to reduce the level of serotonin."

Edited 1 time(s). Last edit at 07/06/2022 05:43AM by Not_in_Kansas.
Re: Diltiazem and other ccbs--are we hooked on benzos?
July 06, 2022 09:40AM
So.. what does this mean? I take a calcium channel blocker (since last summer). I also take a small amount of xanax to sleep. I had weaned off it but then a few months ago said screw it. I need sleep. (For example last night I took half a 0.25). I am not depressed. I do have anxiety from time to time. (Mostly either doc appts or public place that are more crowded than I like to be in). I do know a lot of families with kids the spectrum that take beta blockers for anxiety. And it works great. I guess if CCB acts like a xanax I would not be disappointed LOL. But maybe I am misunderstanding this. (I have gone up and down on the CCB amounts based on other factors, drugs taken and ablation).
Re: Diltiazem and other ccbs--are we hooked on benzos?
July 06, 2022 11:01AM
Not in Kansas, can you please cite the source of your quote?

Studies have shown a mild association between depression and calcium channel blockers (CCBs), beta blockers (BBs), and angiotensin receptor blockers (ARBs). And actually, BBs have the strongest relationship, not CCBs. Those three classes of drugs are the mainstays of treatment for hypertension, heart failure, MI, and tachy-arrhythmias. The trouble is, to my knowledge all the studies showing this association have been retrospective, so cause and effect can't be established. It's equally possible that hypertension and the other diseases they treat are the causative factors, not the drugs. In fact, I think it's very likely that heart failure and MI lead to depression and would be surprised if there aren't studies showing that..

In any case, I don't find it to be scary stuff. Millions of people worldwide take these drugs and there has never been a strong association with depression observed.
Re: Diltiazem and other ccbs--are we hooked on benzos?
July 06, 2022 11:44AM
Thank you so much for your replies, I greatly appreciate it.

The quote is not from a research article, just a quora posting from one Dhanush Adithyan with the title "By what mechanism do calcium channel blockers cause depression?" My chemistry is not sufficient to ascertain the accuracy of Mr. Adithyan's.

The most compelling work on CCBs and depression I have seen is a 1989 BMJ note by Birielli et al. They are Swedish and Australian authors who give case reports of diltiazem apparently triggering depression in 5 patients, including a Canadian and Australian man. But of course as Carey notes millions of people take this drug worldwide and the side effect profile for many people is not worrisome.

What was of greatest interest to me was the argument this little posting was making that over time diltiazem would act like a benzodiazepine. Getting off benzos is notoriously fraught, and so I was looking for more info.

I agree with you Carey that the directionality of the relationship between depression, cardiac troubles and the drugs and procedures used to treat them is complex.

Bettylou I am glad to hear of your good experience and that your CCB is doing its job for you!
Re: Diltiazem and other ccbs--are we hooked on benzos?
July 09, 2022 08:39AM
Other than depression and tapering issues, one reason that this bold quora claim matters is because there is a strong and growing body of literature showing that benzodiazepine use significantly increases the risk of dementia, even with relatively short term (3 to 6 months use).

I think the literature on diltiazem and dementia has been mixed, but there is very little of it, mostly on animal models as far as I can tell.

Any thoughts welcome!
Re: Diltiazem and other ccbs--are we hooked on benzos?
July 09, 2022 12:17PM
Interesting, but a quick review of the literature doesn't show what I'd call a strong body of literature. The results seem to be all over the map from multiple studies, with some finding no relationship and others finding modest relationships. Strangely, at least one study found a relationship between short-term benzo use but not long-term. That sounds to me like artifact or a poorly designed study, but I haven't read enough in detail to really know.

What I would question is the Quora quote. I'd like to see an authoritative source that confirms all that chemistry.
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