Author: Alex Thompson

Benzodiazepine Withdrawal: Symptoms, Timeline, and Treatment

While many patients who want to get off benzodiazepines have an understandable desire to withdraw from the medication as quickly as possible, rapid withdrawal is often the riskiest and most dangerous once signs of physical dependence are present. Whether patients are working closely with a prescriber or withdrawing with limited assistance, they should taper at the most comfortable rate. No patient should ever be made to taper or forced off benzodiazepines against their will. As the methods here indicate, once a patient chooses to withdraw, there are many ways to accomplish that goal without relying on rapid tapers, oversized reductions, or cold turkeys.

Tapering can help take the edge off withdrawal symptoms like tremors and nausea, though it may not prevent withdrawal symptoms entirely. Patient and clinician education are needed so that patients taking benzodiazepinesare aware of both their appropriate and time-limited use and the risks involved ifexposure is prolonged. Further research into protracted benzodiazepine withdrawal isurgently needed.

This will prevent you from altering the taper, but it might mean frequent trips to the pharmacy. Medical professionals do not want to hear a long story as they are very pressed for timeb. Approach the prescriber loaded with all the knowledge you can, but keep your presentation simple and precise. Be sure you have absorbed as much information as possible and have a good idea of what taper you wish to try.

Signs and Symptoms of Benzodiazepine Withdrawal

Aminority of respondents (6.1%) stated they had been ‘clearly warned’ or ‘warned, butnot sufficiently’ (7.9%). A small number of respondents (3.1%) had no recollectionof whether or not they were told about benzodiazepine risks. Symptoms occurred in the majority of patients, with certain symptomspersisting for a year or more (see Table 2). The best resource in your quest to quit benzodiazepines is your prescribing doctor. If you prefer someone else, any primary care physician or psychiatrist can help you taper your dose. Your doctor will help make an individualized tapering schedule based on your current dose and particular circumstances.

Highly sensitive airways werereported by 30.1% only after benzodiazepine use. Sensitivity to food additives orother chemicals that occurred only after benzodiazepine use was reported by 41.2% ofrespondents, including monosodium glutamate and soy (31.6%). Falls andfractures were reported to be a problem in about one-third of respondents, with 5.9%saying such events had occurred before they started benzodiazepines while 21.0% saidthese problems began after starting benzodiazepines. Most respondents (76.2%) said their health care providers ‘definitely did not’ tellthem that benzodiazepines were intended for short-term use and discontinuation mightbe difficult, and 5.6% said they were ‘probably not’ given this information.

Long-term treatment after benzodiazepine withdrawal will depend on your reasons for taking them in the first place and your reasons for quitting. If you have a psychiatric condition that was managed by the benzodiazepines, you will need an alternative plan to manage your condition. Typically, this is a combination of therapy and pharmacologic support. However, that doesn’t necessarily mean you will require inpatient care.

This withdrawal syndrome can last anywhere from eighteen to twenty-four months, or in some cases much longer, up to many years. A slower, more-gradual dose reduction can lessen the severity of withdrawal and the risk of PAWS. In some rare cases, a rapid withdrawal might be considered a lesser evil—for example, if the drug produces a paradoxical response, which happens very infrequently.

APPROACH TO THE PATIENT

Some people even start to crave these medications and use more than prescribed or develop an addiction to them. It is most often used after procedures to reverse the effects of benzodiazepines and help you to wake up. However, if you use benzodiazepines regularly, flumazenil can cause you to go into sudden and severe withdrawal — even causing seizures or death. For this reason, it is important to tell your healthcare providers that you take benzodiazepines and how much. A 45-year-old woman with a history of anxiety and insomnia transferred to our clinic requesting alprazolam (Xanax), which she had been taking for the past year.

1. There are many reasons long-term benzodiazepine or Z-drug users are counseled to stop.
2. This is particularly true if you are also giving up other substances, like alcohol or opioids.
3. If you take an intermediate-acting benzodiazepine, like alprazolam, or a long-acting benzodiazepine, like diazepam, it may take longer for withdrawal symptoms to appear.
4. The survey link was posted for a month three different times (October 2018, November2018, and January 2019).

The best way to quit benzodiazepines is to avoid withdrawal by asking your doctor to taper down your dose. Tapering means taking progressively smaller doses over the course of a few weeks or months. Longer-acting benzodiazepines like Klonopin (clonazepam) can stay in the system longer, which means it can be one to two days or even longer before withdrawal symptoms start. They can design a taper schedule to decrease your benzo dose gradually. This may involve prescribing lower doses of medication(s) so you do not need to cut up higher-dose pills. An addiction treatment facility or specialist can also help with this process if your doctor is not available or you’d like additional treatment or support.

Respondents were allowed to make free-form comments at the conclusion of the surveyand hundreds of comments were entered. In fact, the write-in comments providedprofound insights into benzodiazepine-related adverse effects and how patients dealwith them. Several particularly relevant comments have been selected and are offeredhere. The authors identifiednine broad themes and selected relevant comments to represent each. During your taper, you may still experience some of the symptoms of withdrawal.

Materials and methods

Medical experts continue to debate the best way to taper these medications, so there’s no single agreed-upon approach. Among respondents whose symptoms lasted months or years, over half said caffeine or alcohol worsened their PAWS symptoms. Dependence and withdrawal can happen to anyone, even if you take your medication exactly as instructed. One problem that respondents mentioned was their difficulty in findingknowledgeable and appropriate help to manage their physiologic dependence.

A “cut and hold” method involves reducing the current dose by a set amount (not more than 5% to 10% of the current dose) and holding the new dose until symptoms subside. It often takes several weeks after a reduction for the nervous system to settle. According to the National Center for PTSD, the most beneficial kind of therapy for benzodiazepine withdrawal is cognitive behavioral therapy (CBT).

There were adverse consequences in their personal and professional lives

Most people do okay with tapering their benzodiazepines at home with the help of their primary care doctor or psychiatrist. You should plan to stay in touch with your doctor regularly during the tapering process, either by phone or during office visits. For those of us working in the mental health field, it may not be surprising to hear that psychological support makes a big difference. However, studies like these are important as they establish that what we do works.

For example, some patients taking diazepam benefit from evenly dividing their doses and taking it two or three times a day; some on clonazepam benefit from dosing three or four times a day; and some taking lorazepam need to dose four or five times a day. Some patients on alprazolam require five or six daily doses to maintain steady serum levels. The underlying physical changes resulting in benzodiazepine tolerance and withdrawal are unknown.