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Benzodiazepine Withdrawal: Symptoms, Dependence, Treatment, Timelines and Types

According to Harvard Medical School, benzodiazepines are a class of medications primarily used to treat anxiety, insomnia, and seizures. They work by increasing the activity of a neurotransmitter, or brain chemical, called GABA, which slows activity in the nervous system and produces a calming effect. These medications can be useful for treating anxiety and related issues, but with long-term use, people may become addicted to them and undergo withdrawal if they attempt to stop using benzodiazepines. It is critical to understand the risk of addiction and withdrawal that comes with benzodiazepine use in order to make informed choices about the best course of action for treating conditions like anxiety.

Benzodiazepine Dependence

Before learning about benzodiazepine withdrawal, it is first important to understand why these drugs are addictive and lead to dependence. The reason for benzodiazepine dependence is that the brain and body adapt to the presence of these drugs, and they become accustomed to increased GABA activity. This means that over time, the body cannot produce enough GABA on its own, and it becomes dependent upon benzodiazepines to increase GABA activity and calm the body. Once the body becomes dependent on benzodiazepines, if a person stops using these drugs, there will not be enough GABA activity to maintain normal functioning. This causes the uncomfortable withdrawal symptoms associated with benzodiazepines.

Different Type of Benzodiazepines and Withdrawal Timelines

While benzodiazepines are generally associated with certain withdrawal symptoms, the withdrawal experience may vary slightly between different types of benzodiazepine drugs. For example, benzodiazepines that are short-acting, meaning their effects do not last as long, will produce a withdrawal reaction about 24 hours after a person stops using, and withdrawal symptoms tend to be more severe. With longer-acting benzodiazepines, withdrawal symptoms appear a few days after drug use is stopped, and they are most intense about a week after a person stops using. People tend to become dependent on longer-acting benzodiazepines within a month or two, whereas shorter-acting drugs can create dependence in as little as one week of daily use.

For example, Halcion is a short-acting benzodiazepine that people take to treat insomnia, so a withdrawal reaction following the use of this drug would likely be intense but brief. On the other hand, Valium and Klonopin are both long-acting benzodiazepines, so withdrawal symptoms associated with these drugs may take longer to appear and reach their height within a week. The duration of Ativan’s effects are intermediate, so the withdrawal reaction may fall somewhere in the middle. What is most important to understand is that withdrawal symptoms may vary in length and intensity based upon the specific type of benzodiazepine a person has been taking.

A Focus on Xanax

There is a variety of benzodiazepine drugs on the market, but to fully understand benzo withdrawal, it is important to assess the effects of Xanax. According to a report in the Journal of Addiction Medicine, this is the most popular drug among the benzodiazepines; it is also prescribed more often than any other psychiatric medication in the United States. Sometimes referred to by its generic name alprazolam, Xanax provides insight into the realities of benzodiazepine withdrawal, as scientists have conducted an extensive body of research with this medication. Studies with Xanax show that it is a highly effective medication; in fact, a review of 84 studies found that it is more effective than a placebo pill for treating anxiety, panic, and depression, and it is just as effective as, if not more effective than, other benzodiazepines as well as antidepressant medications.

While Xanax may be effective, it can also be more addictive than other benzo drugs, especially among people who have a history of addiction. The body absorbs Xanax rather quickly, and people tend to metabolize it faster than comparable drugs like Valium, which causes Xanax to have a greater potential for abuse. Xanax also tends to create more intense withdrawal symptoms than Valium, even when people use it for just a short time. It is for this reason that experts generally recommend against long-term use of benzodiazepines, but in practice, doctors do tend to prescribe these drugs for extended periods. This contributes to the benzodiazepine withdrawal that occurs with Xanax and similar medications.

Benzodiazepine Withdrawal Symptoms

Benzo withdrawal duration may vary between drugs and be more intense with Xanax, but people can expect some common side effects. Symptoms of benzodiazepine withdrawal include:

  • Restlessness
  • Becoming irritable
  • Difficulty Sleeping
  • Tight Muscles
  • Feeling Weak
  • Blurry Vision
  • Aches and Pains
  • Elevated Heart Rate

Given the fact that benzodiazepines are used to treat anxiety and sleep problems, people may experience returning anxiety symptoms or insomnia when they stop taking these drugs.

The research has shown that the above withdrawal symptoms are common with benzo withdrawal. For instance, according to the research review in the Journal of Addiction Medicine, various studies have assessed withdrawal from the popular benzo Xanax and found that it is associated with panic attacks, malaise, weakness, sleep disturbances, dizziness, racing heart, worsened anxiety, and sleep problems. In addition, some research suggests that the sleep problems that arise from benzo withdrawal may be more significant with Xanax when compared to Valium.

Severe Withdrawal Symptoms from Benzodiazepines

The aforementioned symptoms of benzodiazepine withdrawal are the side effects commonly associated with the discontinuation of these drugs. While most of these side effects are relatively mild, some symptoms of withdrawal can be severe. According to Harvard Medical School, severe side effects are rare but occur most often when a person has been taking large doses of a short-acting benzodiazepine for an extended period of time, or when people suddenly stop taking a short-acting medication. The most severe symptoms typically include seizures or hallucinations.

According to a report in The Journal of the Oklahoma State Medical Association, benzo withdrawal seizures can sometimes be severe, causing coma or even death.Much like the report from Harvard Medical School, this report indicates that severe reactions typically occur when a person has been taking high doses of benzos over a lengthy time period, but in some cases, people who have been taking prescribed doses of these drugs for just two weeks can experience seizures.

Severe Xanax Withdrawal

In rare occurrences, Xanax in particular may cause severe withdrawal symptoms, per the research. For example, some case studies have found that Xanax withdrawal can cause people to become delirious or suffer from psychosis. Other case studies have shown that some patients may require ICU treatment for serious cardiovascular problems arising from Xanax withdrawal. While there isn’t as much research linking other benzodiazepines to such severe withdrawal symptoms, this does not mean that Xanax is the only drug that can cause serious complications during withdrawal. Anyone who is looking to stop benzodiazepine use should therefore exercise caution and work with a medical professional while withdrawing.

Managing Benzodiazepine Withdrawal

As previously stated, benzodiazepine withdrawal is most likely and more severe when someone has been taking large doses of these drugs over the long-term, and/or when a person abruptly stops using a benzo medication. Given this fact, most doctors recommend that patients undergo benzodiazepine withdrawal while gradually tapering their daily doses. Since Xanax is associated with some of the most significant withdrawal symptoms, tapering from this benzo medication may present some unique difficulties. Per the authors of the report in the Journal of Addiction Medicine, patients may substitute Xanax with another benzo, such as Klonopin, when tapering. Klonopin is useful for managing benzo withdrawal, as it has a relatively long half-life of up to 60 hours and tends to have less intense withdrawal symptoms when compared to other benzo drugs. Per a report in The New England Journal of Medicine, doctors also commonly switch patients to Valium when helping them to withdraw from other benzos. For anyone who is wondering how to handle withdrawal symptoms from benzodiazepines, talking with a doctor about tapering the daily dose and/or switching to a longer-acting benzo while tapering can be the first step toward coming off these drugs.

Benzodiazepine withdrawal treatment medication may also be useful for managing benzo withdrawal. For example, carbamazepine has shown benefits for the treatment of Xanax withdrawal, as it can potentially increase GABA levels and alleviate withdrawal side effects like sleep problems, anxiety, and mood swings. Clonidine is sometimes used to treat withdrawal, and the anti-seizure medication gabapentin may reduce discomfort and benzo cravings. While these medications can be effective, doctors must exercise caution and weigh both the risks and benefits of using such medications, as they, too, can cause withdrawal symptoms when a patient discontinues their use.

How Does Benzo Detox Look?

In most cases, people who are looking to detox from benzos will complete the process on an outpatient basis. The goal of outpatient detox is to help patients safely undergo withdrawal while minimizing uncomfortable side effects as much as possible. Outpatient detox typically involves working with a doctor to gradually taper doses until a person no longer requires a benzo. According to a doctor writing for The New England Journal of Medicine, experts agree that benzodiazepine doses should be reduced gradually over a period of four to six weeks, with some patients requiring as many as eight weeks to complete the tapering and withdrawal process. While the detox and withdrawal process can generally be completed while patients remain at home, those who have been taking significantly high doses may require hospital admission to begin tapering and withdrawing from benzos.

Alternatives to Benzodiazepines

To avoid the physical dependence and withdrawal symptoms that come along with benzodiazepines, some people may work with their doctors to choose alternative medications. SSRI drugs, most commonly known as antidepressants, are an acceptable alternative to benzos. SSRIs are just as effective for treating anxiety and panic, and they are safe for long-term use, as they are less likely to cause people to become dependent upon them. Sometimes, doctors may taper a person’s benzodiazepine dose gradually while introducing an SSRI, and then eliminate the benzo as the SSRI takes effect. Another anti-anxiety medication, called buspirone, may treat anxiety, but not as effectively as benzodiazepines do. An advantage of buspirone is that it has a lower risk of addiction when compared to benzos.

Treatment after Benzodiazepine Withdrawal

The most common course of treatment for benzodiazepine withdrawal is gradually reducing doses, while sometimes using medications to manage withdrawal or prescribing alternative medications, such as antidepressants, to treat underlying anxiety or panic. While these strategies can be effective for treating benzo withdrawal, psychological treatments are often necessary to treat any underlying conditions that lead to anxiety, sleep disturbances, or addiction.

For example, people who are suffering from anxiety that has led to a benzodiazepine dependence may benefit from ongoing therapy to help them overcome anxiety. A specific type of counseling called cognitive behavioral therapy can help to address symptoms of anxiety. This type of treatment helps people to overcome unhelpful thoughts and feelings and replace them with healthier ways of thinking. For example, if a person tends to catastrophize and assume that the worst will happen in everyday situations, cognitive behavioral therapy can teach a person to cope and develop more rational ways of thinking. If a person has been abusing benzos simply to get high or because of an underlying problem with substance abuse, cognitive behavioral therapy can also be helpful. A person who has been living with an addiction may feel that it is impossible to cope with life without benzos, but therapy can teach a person to identify healthier ways of coping.

Beyond individual therapies, some people who have undergone benzodiazepine withdrawal may benefit from a comprehensive benzodiazepine addiction treatment program. In addition to individual therapy, these programs often involve psychoeducational groups, where people learn about drug addiction, as well as relapse prevention programs, that teach people to identify triggers that might lead to drug use and learn healthy ways of managing these triggers to stay abstinent.

Ongoing treatment, whether to address mental health issues like anxiety, an underlying substance use disorder, or perhaps both, is a necessary component of fully recovering after benzodiazepine withdrawal. Tapering off of drugs and completing the withdrawal process is just the first step toward living a life that is free from benzodiazepine dependence. Psychological treatment is imperative for addressing the underlying factors that contributed to benzo addiction or dependence; without this sort of treatment, underlying issues remain in place, and a person is at risk of returning to benzo use or abuse.

Benzodiazepine Withdrawal FAQs

Benzodiazepine withdrawal can vary from person-to-person, depending upon the specific benzo from which a person is withdrawing, as well as upon the dose he or she was taking and the length of time a benzo was used or prescribed. Despite variations in withdrawal symptoms, some common FAQs provide succinct information about what to expect when withdrawing from benzos:

What is benzodiazepine withdrawal?

When describing benzodiazepine withdrawal, it is important to understand that this phrase can refer to both the process of tapering off of benzos after a period of use, as well as the uncomfortable symptoms that are seen when a person reduces or discontinues their use of benzos. For example, a person who is tapering off of Xanax under the direction of a doctor may say she is undergoing “benzodiazepine withdrawal.” At the same time, someone who has been taking Xanax for several months and abruptly stops taking it may experience uncomfortable side effects and say that he is suffering from benzodiazepine withdrawal.

What is acute benzodiazepine withdrawal?

Acute withdrawal typically refers to the initial symptoms that occur after a person stops taking benzos or significantly reduces his or her daily dose. These symptoms can include aches and pains, tight muscles, sleep problems, irritability and restlessness, and in extreme cases, hallucinations or seizures.

Are there dangers of benzodiazepine withdrawal?

For most people, benzodiazepine withdrawal is uncomfortable, and the worst symptoms pass within a week, but for some, withdrawal may be severe and lead to seizures and even death. While not always dangerous, benzo withdrawal can be severe for some people.

How long do you have to take benzos to withdrawal?

Benzodiazepine drugs were not meant to be taken over the long-term, but many people do take them for longer periods than recommended. That being said, some benzos can cause withdrawal symptoms after just a week of taking them, whereas longer-acting drugs may not cause withdrawal until a person has used them for several months. Regardless of how long a person has been taking benzos, it is important to have a discussion with a doctor before stopping their use.

The best practice when withdrawing from benzodiazepines is to work with a medical professional. In most cases, a doctor will consult with patients to gradually reduce their benzo doses over a period of several weeks, in order to ease withdrawal symptoms and reduce the risk of serious side effects, like seizures, hallucinations, or death. Some people may choose to withdraw from benzos on their own and experience only mild discomfort, but others can suffer serious consequences if they attempt to withdraw from these drugs without medical advice, making it important to always consult with a professional.

Sources:

  1. https://www.health.harvard.edu/mind-and-mood/benzodiazepines_and_the_alternatives
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846112/
  3. https://pubmed.ncbi.nlm.nih.gov/21815323/
  4. https://www.nejm.org/doi/full/10.1056/NEJMra1611832