When symptoms increase periodically during protracted withdrawal, physiological changes may be present, including dilated pupils as well as an increase in blood pressure and heart rate. A slow withdrawal rate significantly reduces the risk of a protracted or severe withdrawal state. For this reason, discontinuation is sometimes carried out by first substituting an equivalent dose of a short-acting benzodiazepine with a longer-acting one like diazepam or chlordiazepoxide. One study found that after one year of abstinence from long-term use of benzodiazepines, cognitive, neurological and intellectual impairments had returned to normal. According to a 2015 Cochrane review, cognitive behavior therapy plus taper was effective in achieving discontinuation in the short-term but the effect was not certain after six months.
When do benzodiazepine withdrawal symptoms start?
Often nicknamed “benzos,” these drugs can become highly addictive if they aren’t used properly. There are many different formulations of benzodiazepines, along with many different brand names. These guidelines are intended to help inform clinical decision making by prescribers and patients. Patients who have been taking BZD for longer than a month should not abruptly discontinue the medication, but rather should gradually taper the dosage over a period of time under clinical supervision. Depending on your situation, your doctor may reduce your dose on a monthly, weekly, or even daily basis. So, your doctor may recommend a slower taper schedule as a safety precaution.
Those who remained on benzodiazepines experienced a 5% decline in cognitive abilities, which seemed to be faster than that seen in normal aging, suggesting the longer the intake of benzodiazepines, the worse the cognitive effects become. One study reported one-third of mothers who suddenly discontinued or very rapidly tapered their medications became acutely suicidal due to ‘unbearable symptoms’. Discontinuing benzodiazepines or antidepressants abruptly due to concerns of teratogenic effects of the medications has a high risk of causing serious complications, so is not recommended. A withdrawal syndrome is seen in about 20% of pediatric intensive care unit children after infusions with benzodiazepines or opioids. Those who have a prior history of withdrawing from benzodiazepines may have a sensitized or kindled central nervous system leading to worsening cognition and symptomatology, and making each subsequent withdrawal period worse.
Failure Benzodiazepine withdrawal to recognize discontinuation symptoms can lead to false evidence for the need to take benzodiazepines, which in turn leads to withdrawal failure and reinstatement of benzodiazepines, often to higher doses. In severe cases, the withdrawal reaction or protracted withdrawal may exacerbate or resemble serious psychiatric and medical conditions, such as mania, schizophrenia, agitated depression, panic disorder, generalised anxiety disorder, and complex partial seizures and, especially at high doses, seizure disorders. Withdrawal symptoms can be managed through awareness of the withdrawal reactions, individualized taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance, and referral to benzodiazepine withdrawal support groups.
If you stop or reduce your dose suddenly, you will experience withdrawal symptoms. The authors, however, cited a study in younger patients who at a 3.5-year follow-up showed no memory impairments and speculated that certain memory functions take longer to recover from chronic benzodiazepine use and further improvements in elderly people’s cognitive function may occur beyond 52 weeks after withdrawal. The study reported physicians generally are not aware of the severe consequences of abrupt withdrawal of psychotropic medications such as benzodiazepines or antidepressants. This may suggest a role for flumazenil in treating protracted benzodiazepine withdrawal symptoms. A significant minority of people withdrawing from benzodiazepines, protracted withdrawal syndrome which can sometimes be severe. Over-rapid withdrawal, lack of explanation, and failure to reassure individuals that they are experiencing temporary withdrawal symptoms led some people to experience increased panic and fears they are going mad, with some people developing a condition similar to post-traumatic stress disorder as a result.
Benzodiazepine withdrawal: symptoms, timeline and treatment
- After this acute phase, you might start to experience milder withdrawal symptoms that come and go over an extended period of time.
- The primary difference between these drugs is the length of time they stay active in the body.
- Most tapering schedules fall somewhere in between these two extremes.
- They could rate each problem as nonexistent, mild, moderate, severe, quite severe, or enormous.
A slow withdrawal regimen, coupled with reassurance from family, friends, and peers improves the outcome. Psychological interventions may provide a small but significant additional benefit over gradual dose reduction alone at post-cessation and at follow-up. Such people sometimes simply need to persist as they may not feel better until they have been fully withdrawn from them for a period of time. Anecdotally, a slow rate of reduction may reduce the risk of developing a severe protracted syndrome. The rate of dosage reduction is best carried out so as to minimize the symptoms’ intensity and severity. Increased glutamate excitatory activity during withdrawal may lead to sensitization or kindling of the CNS, possibly leading to worsening cognition and symptomatology and making each subsequent withdrawal period worse.
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Others taper slowly over the course of several months. There is no standard tapering schedule for you to follow. Symptoms will be milder than acute withdrawal and they can disappear for weeks at a time. Protracted withdrawal is a long-term withdrawal syndrome that may come and go for several months. However, some people find they last for several weeks.
How Long Does Withdrawal From Benzodiazepines Last?
At 52 weeks after successful withdrawal, a 22% improvement in cognitive status was found, as well as improved social functioning. A study of the elderly who were benzodiazepine dependent found withdrawal could be carried out with few complications and could lead to improvements in sleep and cognitive abilities. Environmental measures aimed at easing the symptoms of neonates with severe abstinence syndrome had little impact, but providing a quiet sleep environment helped in mild cases.
Treatment
Diazepam, which is commonly known by its brand name, Valium, is a type of benzodiazepine medication. There are lots of different types of benzodiazepines, each with their own unique properties and uses. This is what happens when your body is trying to get used to the absence of benzodiazepines and attempting to regain its usual balance, or equilibrium. Withdrawal symptoms happen when your body has become physically dependent on having the drug in its system. Benzodiazepine withdrawal is a complex process that can be challenging, both physically and emotionally. Benzodiazepines, which are commonly known as ‘benzos’, are a type of prescription drug, designed to alleviate anxiety, insomnia and other conditions.
Benzodiazepine withdrawal symptoms
- Tinnitus occurring during dose reduction or discontinuation of benzodiazepines is alleviated by recommencement of benzodiazepines.
- During the acute withdrawal phase, doctors may monitor the person and recommend other drugs to control problematic symptoms.
- A popular way to begin a benzodiazepine detox is through tapering, which involvesgradually weaning off of benzo usage.
- Benzodiazepine withdrawal syndrome (BZD withdrawal) is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence on them and then reduces the dose or stops taking them without a safe taper schedule.
Additionally, medical supervision allows doctors to respond much more quickly to potential side effects and withdrawal symptoms. More severe reactions or withdrawals may also be more likely when taking strong drugs either for long periods or alongside other types of medications. Along with these symptoms, the person may experience severe cravings for the drug or other drugs to sedate them. Withdrawal symptoms may begin after as little as 3–6 weeks of use, even when a person uses the drugs as the doctor directed.
It is recommended to consult with a medical professional before beginningthe detox process. The timeline of Benzo withdrawal lasts variable amounts of time and is dependent on several factors. Everyone has a different reaction during benzodiazepine detoxification. This reaction is due tohow the drug actson neurotransmitters.
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Dependence appears to occur in a similar way to how it does with other addictive drugs. A 2018 analysis also revealed that drug misuse accounts for about 17% of benzodiazepine use among adults in the United States. According to the classification, these drugs have a low potential for abuse and low risk of dependence. The Drug Enforcement Agency (DEA) classify benzodiazepines as a Schedule IV controlled substance. Although not everyone will experience the same symptoms, some are more common.
Depending on which benzodiazepine you are currently taking, your doctor may want to switch you to a different one before your taper begins. Benzodiazepine withdrawal can be risky, so it is best to work with a doctor. Tapering means taking progressively smaller doses over the course of a few weeks or months. In 2016, estimates suggest that about half a million people in the United States misused sedative drugs. However, benzodiazepines can cause physical dependence and withdrawal even when they are taken as directed.
During the acute withdrawal phase, doctors may monitor the person and recommend other drugs to control problematic symptoms. Withdrawal symptoms from short-acting drugs, such as Xanax, may come on faster than withdrawal symptoms from long-acting drugs, such as Valium. Early withdrawal symptoms, sometimes called rebound symptoms, occur shortly after a person stops taking benzodiazepines. Benzodiazepine, or benzo, withdrawal happens when a person suddenly stops taking benzodiazepine drugs, which doctors do not recommend. There is a risk that people who quit benzodiazepines without a taper may experience a life-threatening grand mal seizure. Estimates suggest that 10 to 25% of people who take benzodiazepines for extended periods experience what’s known as protracted withdrawal.
There is no definitive guide to the symptoms, timeline, or severity of benzo withdrawal. These drugs are habit-forming and can easily result in physical dependence. Benzodiazepines are a group of drugs called nervous system depressants. If you prefer someone else, any primary care physician or psychiatrist can help you taper your dose. If you have a psychiatric condition that was managed by the benzodiazepines, you will need an alternative plan to manage your condition. Your doctor can help you weigh the potential risks and benefits of benzodiazepine use and your pregnancy.