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. Protracted withdrawal is a long-term withdrawal syndrome that may come and go for several months. Patients should be observed every three to four hours to assess for complications such as worsening anxiety and dissociation, which may require medication. After withdrawal is completed, the patient should be engaged in psychosocial interventions such as described in benzodiazepine withdrawal syndrome Section 5. Provide symptomatic treatment (see Table 3) and supportive care as required.
Chapter 3: Benzodiazepine withdrawal symptoms, acute & protracted
- People looking to get off benzos should do so under the guidance of a healthcare professional, who may recommend coping strategies and other tools to make the withdrawal process more comfortable.
- They want to taper the patients off the benzodiazepines, but the patients are convinced that they need the drugs, and that their symptoms must be related to other diseases.
- Patients in benzodiazepine withdrawal should be monitored regularly for symptoms and complications.
- It is common that patients experiencing symptoms do not recognize that their poor physical and mental health is related to their long-term use of the benzodiazepines.
- Dependence and withdrawal can happen to anyone, even if you take your medication exactly as instructed.
Protracted symptoms continue to fade over a period of many months or several years. When opioids are tapered, short-acting forms of those medications can be added to ameliorate the withdrawal symptoms while the long-acting opioids are decreased over time. This strategy, however, is not recommended for benzodiazepines because of a central nervous system process called kindling.
Treatment / Management
Benzo withdrawals can be severe, and life threatening complications can occur. A healthcare professional should supervise benzo withdrawal to help monitor and manage the symptoms. Withdrawal symptoms may be mild in people who take the drugs for short periods. However, there is still a possibility of severe reactions and withdrawal symptoms. According to the British National Formulary, it is better to withdraw too slowly rather than too quickly from benzodiazepines.67 The rate of dosage reduction is best carried out so as to minimize the symptoms’ intensity and severity.
4. WITHDRAWAL MANAGEMENT FOR BENZODIAZEPINE DEPENDENCE
There is no need to avoid ordinary pain killers such as Tylenol, Feldene etc. for everyday aches and pains. 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. Low doses (10-50mg) of amitriptyline (Elavil) or doxepin (Sinequan) are remarkably effective in promoting sleep if taken at bed-time. These can be taken for short periods of a few weeks and stopped by reducing the dosage stepwise or taking the drug every other night.
Management of benzodiazepine withdrawal
- If you take benzodiazepines infrequently, such as once a week or once every few weeks to treat panic attacks, you can take them for a longer period of time.
- Neither drug had any effect on the severity of withdrawal symptoms, but the rate of taper was 25% of the benzodiazepine dose each week – a rather fast withdrawal!
- Withdrawal symptoms vary according to the drug of dependence and severity of dependence, but often include nausea, vomiting, diarrhoea, anxiety and insomnia.
- People tapering off the same original dosage of medication can have drastically different tapering experiences.
- Possible factors contributing to protracted symptoms are outlined in Table 4.
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. Symptoms will be milder than acute withdrawal and they can disappear for weeks at a time. Offer symptomatic medication as required for symptoms such as headaches, nausea and anxiety (Table 3). Patients should drink 2-4 litres of water per day during withdrawal to replace fluids lost through perspiration and diarrhoea. Multivitamin supplements and particularly vitamin B1 (thiamine) supplements (at least 100mg daily during withdrawal) should also be provided to help prevent cognitive impairments9 that can develop in alcohol dependent patients.
Benzodiazepine Withdrawal Syndrome (BWS)
- Withdrawal symptoms from short-acting drugs, such as Xanax, may come on faster than withdrawal symptoms from long-acting drugs, such as Valium.
- Nevertheless, the concentration of benzodiazepines remaining in body tissues after withdrawal must be very low, otherwise the drugs would leak back into the blood in discernible amounts.
- Just like the intensity or severity of symptoms, the duration of withdrawal can vary as well.
- In some situations, a doctor or psychiatrist might prescribe medication to help with PAWS symptoms.
- In fact, if you take your medication every other day, you may notice rebound symptoms on the day between doses.
Withdrawal from benzodiazepines is an uncomfortable process with the potential to last for several weeks (or longer). Gamma hydroxybutyrate is a GABAB receptor agonist now commonly abused at nightclubs and all-night parties. The withdrawal response is mild and resembles a sedative withdrawal syndrome with psychotic symptoms. Severe withdrawal symptoms tend to occur in chronic users and can also present with seizures and rhabdomyolysis. As with alcohol withdrawal, benzodiazepine and barbiturate withdrawal are potentially life-threatening and require aggressive management. If you’ve taken benzodiazepines at high doses for an extended period, you may experience long-term withdrawal symptoms, also alcohol rehab called post-acute withdrawal syndrome (PAWS) or protracted withdrawal.
- Like many other issues concerning benzodiazepines, the answers to these questions are still unclear.
- Symptomatic treatment can be used in cases where residual withdrawal symptoms persist (Table 3).
- To find a program that will help you get off benzodiazepines for good, call AAC free now at .
- There is no doubt that benzodiazepine withdrawal leaves in its wake a nervous system that is exquisitely sensitive to all sensory and motor stimuli.
- These results have raised the question of whether benzodiazepines can cause structural brain damage.
Lifestyle Quizzes
It is important for those attempting to quit a benzodiazepine to get help from a program that can safely usher them into the recovery process. To find a program and get help now, call American Addiction Centers (AAC) free today. The alcohol withdrawal syndrome is a spectrum and ranges from anxiety and mild tremors to potentially life-threatening delirium tremens characterized by autonomic hyperactivity, tachypnea, hyperthermia, and diaphoresis. Symptoms of insomnia, anxiety, and mild tremors can occur while there is still a detectable alcohol level in the patient’s blood work. Alcoholic hallucinosis is characterized by visual and tactile hallucinations, with an otherwise clear sensorium, and one can understand that the hallucinations are not real. Due to the kindling effect of alcohol withdrawal, more severe and progressive symptoms occur with subsequent withdrawal episodes.
Among people taking benzodiazepines for longer than six months, about 40% experience moderate to severe withdrawal symptoms when they quit suddenly. The severity of benzodiazepine withdrawal symptoms can fluctuate markedly and withdrawal scales are not recommended for monitoring withdrawal. Rather, the healthcare worker should regularly (every 3-4 hours) speak with the patient and ask about physical and psychological symptoms. Stopping benzodiazepines all at once can be dangerous, so your doctor will likely guide you through a tapering regimen that involves gradually reducing your dose over time. If you experience severe withdrawal symptoms during tapering, tell your doctor so they can adjust your care plan as needed. At week 7, he returned and reported decreasing his dose to 1 mg daily in the morning despite the recommendation of splitting the total daily dose into twice daily dosing.
The mechanisms of these bizarre symptoms are probably similar to those which cause delirium tremens (hallucinations, classically of pink elephants or rats, in the “DTs” of alcohol withdrawal). In regular benzodiazepine users REMS and SWS tend to return to pre-drug levels (because of tolerance) but the initial deficit remains. On withdrawal, even after years of benzodiazepine use, there is a marked rebound increase in REMS which also becomes more intense. As a result, dreams become more vivid, nightmares may occur and cause frequent awakenings during the night. This is a normal reaction to benzodiazepine withdrawal and, though unpleasant, it is a sign that recovery is beginning to take place.
Is there a difference between acute and post-acute withdrawal syndrome?
Another drawback of antidepressants is that they, too, cause withdrawal reactions if they are stopped suddenly, a fact which has not always been appreciated by doctors. Antidepressant withdrawal symptoms include increased anxiety, sleep difficulties, influenza-like symptoms, gastrointestinal symptoms, irritability and tearfulness – not much different, in fact, from benzodiazepine withdrawal symptoms. These reactions can be prevented by slow tapering of the antidepressant dosage over about 1-3 months (See Table 2). Most people who have withdrawn from benzodiazepines will be experts at tapering dosages when the time comes to stop the antidepressant and will be able to work out a rate of withdrawal that suits them. Not everyone who cuts down or stops taking benzodiazepines will experience withdrawal symptoms.