Withdrawing from Benzodiazepines: Symptoms, Safety, and Treatment

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A significant minority of people withdrawing from benzodiazepines, perhaps 10% to 15%, experience a protracted withdrawal syndrome which can sometimes be severe. Tinnitus occurring during dose reduction or discontinuation of benzodiazepines is alleviated by recommencement of benzodiazepines. Dizziness is often reported as being the withdrawal symptom that lasts the longest. Benzodiazepine abuse is common in those on methadone maintenance treatment (MMT), so special consideration must be taken for those withdrawing from the drugs while on MMT [68]. These patients are more likely to die from methadone toxicity because of the synergistic effects of methadone and BZD [68]. Additionally, these patients are more likely to have comorbid substance use disorders and anxiety disorders so it can be harder to find an efficacious treatment for their withdrawal symptoms [68].

Symptomatic treatment (see Table 3) and supportive care are usually sufficient for management of mild opioid withdrawal. Opioids are drugs such as heroin, opium, morphine, codeine and methadone. Opioid withdrawal can be very uncomfortable and difficult for the patient. It is very common for people who complete withdrawal management to relapse to drug use. It is unrealistic to think that withdrawal management will lead to sustained abstinence. Rather, withdrawal management is an important first step before a patient commences psychosocial treatment.

  1. An addiction specialist can answer your questions and guide you through your options.
  2. Although these drugs vary in their effects, they have similar withdrawal syndromes.
  3. Benzodiazepine withdrawal symptoms can begin within as little as six hours to 12 hours after your last dose.
  4. Dizziness is often reported as being the withdrawal symptom that lasts the longest.

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.

Interestingly, those who used alcohol while taking BZD experienced no difference in discontinuation rate from those who did not use alcohol [64]. Benzodiazepines (BZDs) are among one of the most widely prescribed drug classes in the United States. BZDs are a class of psychoactive drugs known for their depressant effect on the central nervous system (CNS). They quickly diffuse through the blood–brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects. Related to their rapid onset and immediate symptom relief, BZDs are used for those struggling with sleep, anxiety, spasticity due to CNS pathology, muscle relaxation, and epilepsy.

Inpatient treatment

However, that doesn’t necessarily mean you will require inpatient care. 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. The best way to quit benzodiazepines is to avoid withdrawal by asking your doctor to taper down your dose.

Tapering changes

Their relative safety compared to fellow depressants or barbiturates have increased the rate at which they are prescribed [25]. The dependence on BZDs generally leads to withdrawal symptoms, which necessitates careful tapering of the medication when prescribed [26]. The beta-blocker propranolol has shown mixed results when it comes to treating BZD withdrawal and dependence. One study found that propranolol attenuated some withdrawal symptoms in patients who stopped taking either diazepam (a long-acting BZD) and those who took lorazepam (a short-acting one) abruptly [69]. However, in the same study, 27–45% of patients experienced withdrawal symptoms even while taking propranolol [69]. The control group and the experimental group had the same dropout rate in this study [69].

The ultimate concern is that such fetuses will later be susceptible to autism, learning difficulties, attention deficit disorder, and general hyperactivity [24]. Other important indications for the use of BZDs include the treatment of catatonia, seizure disorders, and alcohol and BZD withdrawal. The drug class is the mainstay of treatment for catatonia, which is characterized by postural rigidity, immobility, purposeless activity, and disturbances in one’s consciousness [10]. Catatonia presents in populations suffering from bipolar disorder, schizophrenia, or a variety of medical conditions. BZDs act on the CNS to exert anxiolytic and sedative effects and, together with electroconvulsive therapy, are the mainstay therapy for catatonia [13]. The tapering process is adjusted to suit the needs of the individual, but often, a particular percentage of the dose will be cut down every day or every other day to slowly wean the person off the benzodiazepine.

Although many symptoms subside after the acute withdrawal phase, lingering side effects are possible. People who have been through acute withdrawal often say that this phase is the most difficult. During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound. For example, how long does marijuana stay in your system blood, urine, and hair symptoms of anxiety or insomnia may come back or get worse without the drugs. Emerging research also suggests acceptance and commitment therapy (ACT) could also have benefits during benzodiazepine withdrawal. This approach helps you learn to tolerate discomfort and distress, instead of avoiding it, and choose to live according to your values.

Benzodiazepine withdrawal syndrome

To reduce the risk of relapse, patients should be engaged in psychosocial interventions such as described later in these guidelines. Patients who repeatedly relapse following withdrawal management are likely to benefit from methadone maintenance treatment or other opioid substitution treatment. Withdrawal symptoms vary according to the drug of dependence and severity of dependence, but often include nausea, vomiting, diarrhoea, anxiety and insomnia. Table 3 provides guidance on medications for alleviating common withdrawal symptoms. Research showed that 40% of people taking benzos for longer than 6 months experienced moderate-to-severe withdrawal symptoms.

Due to their toxic effect on the central nervous system, appropriate care is necessary with BZD. BZDs lead to long-lasting impairment of episodic implicit memory while it only impairs implicit memory transiently [1]. They also lead to disinhibition, impairing the user’s ability to appropriately assess the risky actions or behaviors. Elderly patients in intensive care can develop delirium if they are on a BZD [1]. For most individuals who abuse benzodiazepines, outpatient detox is not recommended. People with substance use disorders as a result of benzodiazepine abuse have already demonstrated an inability to control their use of benzodiazepines.

One study showed a potential for cognitive decline after BZD use in the elderly, but at the same time did not find a link between their use and the development of Alzheimer’s dementia [73]. The researchers in the study cautioned the prescription of BZD in the elderly due to the potential for cognitive decline [73]. One of the main categories of people with BZD prescriptions is those with insomnia. Manconi et al. explored the effects of long-term BZD use on sleep architecture and microstructure in those with insomnia.

Seizures and other serious symptoms can occur after the abrupt cessation of a benzodiazepine in anyone who’s taken this type of substance for at least one to six months. The cannabis withdrawal syndrome is typically mild, but can be difficult for the patient to cope with. Patients with cognitive impairments as a result of alcohol dependence should be provided with ongoing vitamin B1 (thiamine) supplements. In the first instance, attempt behavioural management strategies as shown in Table 2 (page 33). If this does not adequately calm the patient, it may be necessary to sedate him or her using diazepam.

This superior effect is thought to be due to its unique alpha-2 adrenergic activity, enhancing its potency for relieving panic and anxiety disorders. This same mechanism is also thought to be the cause behind alprazolam’s strong rebound hyperadrenergic effects with cessation [54,55]. Many drug therapies have been suggested as treatment for alprazolam withdrawal with few rendered effective.

Withdrawal typically begins 1-2 days after the last dose, and continues for 2-4 weeks or longer. All opioid dependent patients who have withdrawn from opioids should be advised that they are at increased risk of overdose due to reduced opioid tolerance. Should they use opioids, they must use a smaller amount than usual to reduce the risk of overdose. The greater the amount of opioid used by the patient the greater the dose of methadone required to control withdrawal symptoms.

Fatal overdoses can occur when benzos are mixed with alcohol or an opioid. Rebound symptoms are possible when someone magic mushroom side effects stops using benzodiazepines. These symptoms “rebound” because the disorders were present before the medication.


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