Benzodiazepine Withdrawal Symptoms, Timeline, and Treatment

Benzodiazepine Withdrawal Symptoms, Timeline, and Treatment July 17, 2019 More in Addiction Drug Use Prescription Medications Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Opioids Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery In This Article Table of Contents Expand Overview Signs and Symptoms Coping and Relief Warnings Long-Term Treatment Resources Benzodiazepines are a group of central nervous system depressants used to treat anxiety, insomnia, and seizures. Benzodiazepines (or benzos as they are often called) are among the most commonly prescribed medications in the country. There are several different types of benzos sold under popular brand names like Valium, Xanax, and Klonopin. The primary difference between these drugs is the length of time they stay active in the body. Benzos are sometimes abused for their relaxing and euphoric effects. Even at therapeutic doses, however, benzos can cause physical dependence and withdrawal.   Verywell / Gary Ferster   Overview Benzodiazepine use has become widespread. From 1996 to 2013, the number of people filling benzo prescriptions increased by 67 percent. Benzodiazepine abuse and dependence has become more significant among all age groups, from teens to elderly adults. In 2016, estimates suggest that about half a million people in the United States were misusing sedative drugs. Benzodiazepines can be habit-forming. Anyone taking them on a daily basis can develop a tolerance and dependence. When you are physically dependent on a drug, it means your body can’t operate normally without it. If you stop or reduce your dose suddenly, you will experience withdrawal symptoms. Withdrawing from benzos can be a difficult, even dangerous process. You can expect to feel anxious and on-edge for several weeks. You might feel irritable and hypersensitive to everything around you. Insomnia is also common. During the first week, you can also expect physical symptoms like headaches and hand tremors. Benzo withdrawal can be managed with a gradual dose reduction, which will cause milder symptoms that come and go in waves. Beware, if you have been using benzos for longer than six months, suddenly stopping your dose can cause grand mal seizures and deliriumâ€"this is why its best to involve your doctor or healthcare professional in your process of withdrawal. Signs and Symptoms Withdrawal symptoms can occur after as little as one month of use, even on small, therapeutic doses. Among people taking benzos for longer than six months, about 40 percent experience moderate to severe withdrawal symptoms when they quit suddenly. The other 60 percent experience mild symptoms. The severity of withdrawal symptoms is associated with a variety of factors, including: your current dosehow long you’ve been taking itwhether you take more than one benzowhether you take other sedating drugsany substance abuse issueswhether you are quitting more than one substance at a time The onset of benzodiazepine withdrawal depends on the specific drug you are taking. Short-acting drugs like alprazolam (Xanax) and lorazepam (Ativan) leave the system quicker, which means withdrawal symptoms can appear in as little as eight to 12 hours.  Longer-acting benzos like clonazepam (Klonopin) can stay in the system longer, which means it can be one to two days or even longer before withdrawal symptoms start.  Possible symptoms include: AnxietyInsomniaIrritabilityRestlessnessHand tremorsMuscle spasmsHeadacheSweatingRacing pulseHyperventilationNausea or vomitingAches and painsPanic attacksHypersensitivity to stimuli like light and touchAbnormal bodily sensations (skin-crawling, goosebumps)DepressionProblems with concentration and memoryVisual disturbances (flashes of light or blurred vision)Auditory, tactile, or visual hallucinationsFeelings of unrealityDeliriumGrand mal seizures According to the American Psychiatric Association (APA), withdrawal symptoms from short-acting benzos peak on the second day and improve by the fourth or fifth. However, some people find they last for several weeks. Estimates suggest that  10 to 25 percent of chronic benzo users experience what’s known as protracted withdrawal. Protracted withdrawal is a long-term withdrawal syndrome that may come and go for several months. Symptoms will be milder than acute withdrawal and they can disappear for weeks at a time. Protracted withdrawal rarely lasts longer than one year. Coping and Relief The best way to quit benzos 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.   You can taper your dose on your own, but it is best to work with a doctor. Depending on which benzodiazepine you are currently taking, your doctor may want to switch you to a different one before your taper begins. Short-acting benzos complicate withdrawal with too many ups and downs. Diazepam, a long-acting benzo, is the most common choice for dose tapering.   There is no standard tapering schedule for you to follow. Your doctor will help make an individualized tapering schedule based on your current dose and particular circumstances. Some people taper quickly, finishing up within two to three weeks. Others taper slowly over the course of several months. During your taper, you may still experience some of the symptoms of withdrawal. This can happen after each dose reduction. If your symptoms are intolerable, your doctor can pause or slow down the taper. Most doctors choose not to reverse the taper and up the dose in response to withdrawal symptoms. To cope with these breakthrough symptoms, it helps to have a backup plan for dealing with anxiety. Helpful strategies include: Cognitive behavioral therapyMeditationMindfulness trainingExercise Warnings Benzodiazepine withdrawal can be dangerous when not handled properly. There is a risk that people who quit benzos without a taper may experience a life-threatening grand mal seizure. If you go into withdrawal without tapering, you also risk experiencing delirium and hallucinations that cause you to lose touch with realityâ€"a terrifying and dangerous experience. Some drugs are safe to quit on your own, but benzodiazepines are not. However, that doesn’t necessarily mean you will require inpatient care. In fact, most people do okay with tapering their benzos 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. Depending on your situation, your doctor may think it best to prescribe very small amounts of medication at a time. This will prevent you from altering the taper, but it might mean frequent trips to the pharmacy.   Some people, such as those with a history of complicated withdrawal, seizures, or severe mental illness, may be better suited for in an inpatient setting. This can involve living at a detox facility or hospital for several weeks, where you can receive constant medical monitoring and psychological support. Quitting benzos means that underlying psychiatric symptoms can reemerge worse than ever before. These may include: Panic attacksOCD symptomsPTSD symptomsSevere anxietyObtrusive thoughtsDepression Inpatient treatment can be very expensive, depending on the facility, but it is covered by many insurance companies. If you are pregnant or thinking about becoming pregnant, talk to your OBGYN or psychiatrist right away about your plans. Benzodiazepine use in pregnancy carries some risks, however, going through any kind of withdrawal during pregnancy carries its own risks.  Your doctor can help you weight the potential risks and benefits around Benzodiazepine use and your pregnancy. Long-Term Treatment Long-term treatment after benzo 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 benzos, you will need an alternative plan to manage your condition. Typically, this is a combination of therapy and pharmacologic support. If your reasons for quitting benzos are that you were abusing them or unable to control your use, then you may require further substance abuse treatment. This is particularly true if you are also giving up other substances, like alcohol or opioids. Psychotherapy can help you understand the root cause of your substance abuse problems. It can also help you learn to identify psychological triggers that may cause you to relapse so that you can avoid them in the future. Resources The best resource in your quest to quit benzos is your prescribing doctor. But if you would prefer someone else, any primary care physician or psychiatrist will be able to help you taper your dose. To find a psychiatrist or psychologist who specializes in substance abuse issues, you can use this searchable directory from the Substance Abuse and Mental Health Services Administration (SAMHSA). You can also call SAMHSA’s national helpline at 1-800-662-HELP (4357) to find a provider in your area. A Word From Verywell Benzodiazepines are powerful drugs that can be very useful in the short-term, but if you’ve been taking them for a while there are potential risks and side-effects such as sedation and cognitive issues. For a lot of people, quitting benzos feels like waking up from a long dream. Of course, waking up isn’t always easy. To achieve your best health, talk to your doctor about the best way for you to quit and how you can maintain long-term success. Symptoms of Addiction