Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence

Pharmacol Ther. 2003 May;98(2):171-95. doi: 10.1016/s0163-7258(03)00029-9.


Knowledge of the neural mechanisms underlying the development of benzodiazepine (BZ) dependence remains incomplete. The gamma-aminobutyric acid (GABA(A)) receptor, being the main locus of BZ action, has been the main focus to date in studies performed to elucidate the neuroadaptive processes underlying BZ tolerance and withdrawal in preclinical studies. Despite this intensive effort, however, no clear consensus has been reached on the exact contribution of neuroadaptive processes at the level of the GABA(A) receptor to the development of BZ tolerance and withdrawal. It is likely that changes at the level of this receptor are inadequate in themselves as an explanation of these neuroadaptive processes and that neuroadaptations in other receptor systems are important in the development of BZ dependence. In particular, it has been hypothesised that as part of compensatory mechanisms to diazepam-induced chronic enhancement of GABAergic inhibition, excitatory mechanisms (including the glutamatergic system) become more sensitive [Behav. Pharmacol. 6 (1995) 425], conceivably contributing to BZ tolerance development and/or expression of withdrawal symptoms on cessation of treatment, including increased anxiety and seizure activity. Glutamate is a key candidate for changes in excitatory transmission mechanisms and BZ dependence, (1) since there are defined neuroanatomical relationships between glutamatergic and GABAergic neurons in the CNS and (2) because of the pivotal role of glutamatergic neurotransmission in mediating many forms of synaptic plasticity in the CNS, such as long-term potentiation and kindling events. Thus, it is highly possible that glutamatergic processes are also involved in the neuroadaptive processes in drug dependence, which can conceivably be considered as a form of synaptic plasticity. This review provides an overview of studies investigating changes in the GABAergic and glutamatergic systems in the brain associated with BZ dependence, with particular attention to the possible differential involvement of N-methyl-D-aspartate and alpha-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptors in these processes.

Publication types

  • Review

MeSH terms

  • Anti-Anxiety Agents / pharmacology*
  • Benzodiazepines
  • Humans
  • Neuronal Plasticity
  • Receptors, GABA-A / drug effects*
  • Receptors, GABA-A / physiology*
  • Receptors, Glutamate / drug effects*
  • Receptors, Glutamate / physiology*
  • Receptors, N-Methyl-D-Aspartate / drug effects
  • Receptors, N-Methyl-D-Aspartate / physiology
  • Substance Withdrawal Syndrome / physiopathology
  • Substance-Related Disorders / physiopathology*
  • Synaptic Membranes


  • Anti-Anxiety Agents
  • Receptors, GABA-A
  • Receptors, Glutamate
  • Receptors, N-Methyl-D-Aspartate
  • Benzodiazepines