Benzodiazepine Withdrawal Symptoms, Timeline, and Effects

It is usually inadvisable to stick to a strict exclusion diet; with a normal balanced diet and sensible general health measures, including regular exercise, gastrointestinal symptoms due to withdrawal gradually abate. None of these drugs should be used as alternative sleeping pills or sleeping draughts during benzodiazepine withdrawal. All can cause a similar type of dependence and some are more toxic than benzodiazepines. Once started on an antidepressant for depression, the treatment should be continued for some months (usually about 6 months) to avoid recurrence of the depression. Benzodiazepine tapering can continue during this time, and the antidepressant will sometimes act as a welcome umbrella benzodiazepine withdrawal syndrome during the last stages of withdrawal.

Tapering changes

• After withdrawal the ex-user is left in a vulnerable state with a decreased ability to deal with stressful situations.
• Others might experience a few weeks or months of uncomfortable, but bearable, symptoms.
• A third factor may operate in people who have had frightening experiences during withdrawal.

Patients requiring inpatient treatment due to seizures, delirium, or other medical diagnoses follow the same treatment regimen. As with alcohol withdrawal, supportive care and evaluation and treatment of comorbid conditions are equally crucial to the treatment of the patient’s withdrawal syndrome. There is a large body of literature on BZWS, ranging from peer-reviewed publications to personal anecdotes.

Difficult tapers

If you stop taking them “cold turkey,” or all at once, you may experience severe, even life threatening, withdrawal symptoms. At week 5 of the taper, he had completed the reduction to 0.75 mg by mouth twice daily (a 25% dose reduction) but had not further decreased to 0.5 mg twice daily for an unknown reason (see the Table). He reported feeling unwell following a 2-day lapse in clonazepam before obtaining a refill and resuming 1.5 mg by mouth once daily at which time his symptoms improved back to baseline. As he was still interested in tapering, he was instructed to decrease his clonazepam dose to 1 mg in 2 divided doses daily (a 50% reduction from his initial starting dose).

Other drugs

As for management of mild alcohol withdrawal, but patients in severe alcohol withdrawal also require diazepam sedation. This may involve very large amounts of diazepam, many times greater than would be prescribed for patients in moderate alcohol withdrawal. Alcohol withdrawal symptoms appear within 6-24 hours after stopping alcohol, are most severe after 36 – 72 hours and last for 2 – 10 days. Codeine phosphate alleviates opioid withdrawal symptoms and reduces cravings. Because of its pharmacological action (partial opiate agonist), buprenorphine should only be given after the patient begins to experience withdrawal symptoms (i.e. at least eight hours after last taking heroin). Offer accurate, realistic information about drugs and withdrawal symptoms to help alleviate anxiety and fears.

• Several types of benzodiazepines are sold under popular brand names like Valium (diazepam), Xanax (alprazolam), and Klonopin (clonazepam).
• In general, though, PAWS is recorded as lasting a few weeks to a few months after stopping use.
• Withdrawal symptoms can occur after as little as one month of use, even on small, therapeutic doses.
• Note that, unlike most addiction-prone drugs, there is little evidence of post-taper patients craving benzodiazepines.

Acute withdrawal symptoms

People who are not dependent on drugs will not experience withdrawal and hence do not need WM. Refer to the patient’s assessment to determine if he or she is dependent and requires WM. In the first week of tapering off, your doctor may reduce your dose as much as 30% to get you to a safe amount. After that first leap, the steps become smaller, usually 5% to 10% of the original dose.

There is some research that indicates that some people who took benzodiazepines long-term prior to discontinuation may have persistent or permanent problems with concentration, learning, memory, and/or a reduced tolerance to stress. It is estimated that percent of patients taking benzodiazepines long-term (past the 2-4 week prescribing guidelines) will experience protracted withdrawal or a “post-withdrawal syndrome”. There may be a genetic predisposition or gene expression phenomenon that occurs during the withdrawal syndrome to shift into a protracted withdrawal syndrome and damaged central nervous system. Experts agree that the alcoholism treatment incidence of protracted symptoms in those who have abruptly stopped a benzodiazepine is higher, and those who have undergone a slow taper at the patient’s individual pace is almost certainly very much lower. An estimated 50-80% of people who have taken benzodiazepines continually for a few weeks or longer will experience withdrawal symptoms when reducing the dose; a smaller percentage will experience severe withdrawal.

These drugs mimic the effects of a neurotransmitter called gamma aminobutyric acid (GABA). GABA acts as a sort of speed bump that helps all the other chemical messengers travel through your brain at a reasonable pace. Among respondents whose symptoms lasted months or years, over half said caffeine or alcohol worsened their PAWS symptoms. Medical detox involves tapering off the benzo drug under the supervision of a doctor.

• These reactions are caused by the abrupt exposure of adaptations that have occurred in the nervous system in response to the chronic presence of the drug.
• Patients should be observed every three to four hours to assess for complications such as worsening anxiety and dissociation, which may require medication.
• Indeed, prescriber adherence to prescription guidelines for benzodiazepine use would negate most of the risk of kindling, except for a minority of patients who develop physiologic dependence within a period of time shorter than 4 weeks.
• CBT assumes that there is a relationship between a person’s thoughts, feelings, and behaviors.
• Since recent sleep research indicates that certain stages of sleep (REMS and SWS) are important for memory functions, it is likely that the dreams and the memories are connected.

Most digestive symptoms get better after withdrawal but in a few people they persist and become a protracted symptom, raising fears of food allergy or candida infection. These questions are discussed further in the section on protracted symptoms. Thus these sensory symptoms, though disconcerting, are usually nothing to worry about. Very occasionally, they may persist (see section on protracted symptoms). Meanwhile, the same measures suggested under muscle symptoms (above) can do much to alleviate them, and they usually disappear after withdrawal.

Overall effects on everyday life

However, although protracted sensory and motor symptoms may sometimes seem to be almost permanent, they do in fact decline in severity over the years, even without flumazenil, and they do not signify a major neurological illness. Such symptoms may be partially alleviated by relaxation techniques; some motor and sensory systems may respond to carbamazepine (Tegretol) and motor symptoms may respond to propranolol (Inderal). It is impossible to give an exact time for the duration of withdrawal symptoms. It depends on where you start from, how much support you need and receive, how you manage your taper and many other factors. 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.

Short Opioid Withdrawal Scale7

Such skills are normally acquired continuously from childhood to middle age or later as experience of life accumulates. Their development may be blocked for a period of years during which benzodiazepines are taken. After withdrawal the ex-user is left in a vulnerable state with a decreased ability to deal with stressful situations.