Chapter 3: Benzodiazepine withdrawal symptoms, acute & protracted Benzodiazepine Information Coalition

During the first week, you can also expect physical symptoms like headaches and hand tremors. The primary difference between these drugs is the length of time they stay active in the body. However, benzodiazepines can cause physical dependence and withdrawal even when they are taken as directed. No one should attempt to get off benzo drugs without the supervision of a healthcare professional.

• This hyperexcitability is the root cause of most of the withdrawal symptoms discussed in the next chapter.
• However, the point about gradual dosage tapering at home is that people should get used to living a normal lifestyle without drugs.
• Long-term use and misuse of benzodiazepine can result in physically and mentally crippling withdrawal symptoms that can turn dangerous during abrupt cessation.
• Most withdrawal symptoms begin within 24 hours after the final dose and can last from a few days to several months, depending on several factors.

TABLE 3. SOME PROTRACTED BENZODIAZEPINE WITHDRAWAL SYMPTOMS

There are no rehabs in the United States utilizing slow, safe cessation methods for benzodiazepines. The current trend with rehabs are abrupt withdrawal and sending very sick patients home alone in a state of distress, psychosis or suicidality. Most people can research and employ slow taper protocols on their own from home (and perhaps with support from online or in-person, where available, support groups) with the support of a cooperative medical prescriber. By the third or fourth week, the intensity of withdrawal symptoms begins to decrease, though they may not completely resolve. Individuals may still experience lingering benzo withdrawal symptoms, such as mild anxiety, fatigue, and disturbed sleep patterns. Cognitive difficulties, such as trouble concentrating, may also occur during this phase.

Hallucinations, illusions, perceptual distortions

For example, doctors may recommend flumazenil (Romazicon) to help with severe withdrawal symptoms and other drugs, such as buspirone (BuSpar), to help people with severe anxiety symptoms. If the person’s original symptoms return once they stop taking prescription benzodiazepines, doctors may also prescribe Alcohol Use Disorder a different class of medications, or other drugs or therapies, to help manage them during withdrawal. Tapering the drug by slowly reducing the prescription strength may help make withdrawal symptoms much easier to manage.

Acute withdrawal

Supportive counseling and other targeted therapies or medications may help a person manage the symptoms and improve their quality of life. Although many abrupt withdrawal of benzodiazepines may result in: symptoms subside after the acute withdrawal phase, lingering side effects are possible. Acute withdrawal begins after the initial withdrawal symptoms, generally within a few days. Benzodiazepine withdrawal can also lead to disturbances in mental function that persist for several months or years after onset of symptoms (referred to as post-acute-withdrawal syndrome in this form).

Most people experience a definite improvement over time so that symptoms gradually decrease to levels nowhere near as intense as in the early days of withdrawal, and eventually almost entirely disappear. All the studies show steady, if slow, improvement in cognitive ability and physical symptoms. Although most studies have not extended beyond a year after withdrawal, the results suggest that improvement continues beyond this time. There is absolutely no evidence that benzodiazepines cause permanent damage to the brain, nervous system or body. Unfortunately, flumazenil does not at present offer a practical cure for protracted symptoms.

• Apart from their therapeutic effects in depression and anxiety, some antidepressants have a sedative effect which patients who are particularly plagued with insomnia have found helpful.
• In some cases, alternative medications may be introduced to ease the transition.
• The response to flumazenil also shows that benzodiazepines can cause longer-lasting pharmacological effects than previously believed.
• According to the American Psychiatric Association (APA), withdrawal symptoms from short-acting benzodiazepines peak on the second day and improve by the fourth or fifth.
• However, some individuals may experience protracted withdrawal symptoms, such as anxiety or sleep disturbances, lasting for months or even a year.
• In severe cases, intravenous fluids and supplements may be given to prevent or improve deficiencies.
• It is possible that sensory receptors in skin and muscle, and in the tissue sheaths around bones, may fire off impulses chaotically in response to stimuli that do not normally affect them.

Abrupt (cold-turkey) or over-rapid withdrawal, especially from high dosage, can give rise to severe symptoms such as convulsions, psychotic reactions, acute anxiety states and even death. Seizures are usually not a risk for those employing a slow taper method, with the limited exception of people who have taken benzodiazepines for a seizure disorder. Furthermore, psychosis is rare, but not unheard of, in those who taper their benzodiazepine slowly.

• Depression in withdrawal responds to antidepressant drugs in the same way as depressive disorders where benzodiazepines are not involved.
• With slow tapering, some long-term users have virtually lost all their symptoms by the time they take their last tablet, and in the majority symptoms disappear within a few months.
• Your doctor can help you weigh the potential risks and benefits of benzodiazepine use and your pregnancy.
• The results suggest that some protracted symptoms are due to the failure of the receptors to revert to their normal state after they have become unresponsive to GABA, due to the development of tolerance (See Chapter I).