Withdrawing from Benzodiazepines: Symptoms, Safety, and Treatment

Methadone is useful for detoxification from longer acting opioids such as morphine or methadone itself. It can provide relief to many of the physical symptoms of opioid withdrawal including sweating, diarrhoea, vomiting, abdominal cramps, chills, anxiety, insomnia, and tremor. Practices such as drug tapering or using other drugs to help ease withdrawal may make early withdrawal symptoms milder and more manageable. Estimates suggest that 10 to 25% of people who take benzodiazepines for extended periods experience what’s known as protracted withdrawal. Benzodiazepines are a group of central nervous system depressants used to treat anxiety, insomnia, and seizures. Benzodiazepines are among the most commonly prescribed medications in the United States.

Prescription drug withdrawal and detox

Withdrawal management alone is unlikely to lead to sustained abstinence from benzodiazepines. The patient should commence psychosocial treatment as described in these guidelines. To avoid the risk of overdose in the first days of treatment methadone can be given in divided doses, for example, give 30mg in two doses of 15mg morning and evening.

Lifestyle Quizzes

Like other benzodiazepine withdrawal symptoms, these feelings resolve in time and should not be interpreted as abnormal or crazy. It’s incredibly important to follow your doctor’s guidance when you stop taking benzodiazepines. If you benzodiazepine withdrawal stop taking them “cold turkey,” or all at once, you may experience severe, even life threatening, withdrawal symptoms. The literature on benzodiazepine dependence and withdrawal is reviewed with an emphasis on social and psychological considerations.

Protracted withdrawal

If a fit does occur in these circumstances, it is usually only a single fit and causes no lasting damage. Other phenomena seen in rapid withdrawal are psychotic symptoms, severe confusion and delirium, but again these hardly ever occur with slow dosage tapering. By following the withdrawal schedules alcoholism symptoms outlined in Chapter II, you can be confident of avoiding these complications. Some people during benzodiazepine withdrawal report feeling unsteady on their feet; sometimes they feel they are being pushed to one side or feel giddy, as if things were going round and round. An important organ in controlling motor stability and maintaining equilibrium is a part of the brain called the cerebellum.

7. WITHDRAWAL MANAGEMENT FOR INHALANT DEPENDENCE

Motor symptoms that may persist include muscle tension, weakness, cramps, jerks, spasms and shaking attacks. Once the hallucinations, which seem real at the time, are recognised as “merely” hallucinations, they quickly become less alarming. They do not herald the onset of madness; they are simply instances of benzodiazepines playing tricks on the brain which will right itself in time.

Are There Recommended Treatments for Managing Withdrawal Symptoms?

• In a few cases, severe palpitations, muscle tremors or motor jerks develop during benzodiazepine withdrawal and hinder progress.
• Among respondents whose symptoms lasted months or years, over half said caffeine or alcohol worsened their PAWS symptoms.
• One lady had to stop all the clocks in the house because their ticking sounded unbearably loud; many have had to don dark glasses because ordinary light seemed dazzlingly bright.
• In rare cases, alcohol withdrawal can be life-threatening and require emergency medical intervention.
• Only in special situations there might be a place for an antidepressant, beta blocker, sedative antihistamine or anticonvulsant.

A minority of patients withdrawing from stimulants may become significantly distressed or agitated, presenting a danger to themselves or others. In most cases of benzo withdrawal, suddenly stopping the medication is not recommended, as it can be dangerous. There are several ways to access help from addiction experts who are best placed to support you during detox.

• From 1996 to 2013, the number of people filling benzodiazepine prescriptions increased by 67%.
• 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.
• This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses.
• Short-acting benzodiazepines are much more likely to cause rebound symptoms.
• Also common are complaints of adverse reactions to antibiotics used to treat some of the bacterial infections.
• Provide symptomatic treatment (see Table 3) and supportive care as required.

Benzodiazepine withdrawal syndrome

Unlike many other medications, there is often a significant period of time after the taper is complete where patients still experience a variety of the same symptoms they had while tapering. This can extend well beyond the time where there is any active benzodiazepine or metabolite present, sometimes for years after the completion of the taper. The physician must also assist and guide the patient through this critical recovery period.

• A patient’s score on the AWS should be used to select an appropriate management plan from below.
• Research indicates that physical dependence may begin in just a few weeks, even while taking the drugs in low therapeutic doses.
• Such a phenomenon is also seen in some individuals with alcohol problems in which such kindling is better understood.
• If the person’s original symptoms return once they stop taking prescription benzodiazepines, doctors may also prescribe a different class of medications, or other drugs or therapies, to help manage them during withdrawal.
• Improvement from the withdrawal syndromes usually occur gradually, sometimes as people taper, or slowly over the months and years after their benzodiazepine cessation.
• 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.

It can occur whether or not the patient stops using the drug, although the withdrawal syndrome is usually of a more severe nature when the drug is withdrawn. The severity of BZWS symptoms depends on many factors, and varies from imperceptible to debilitating. For an in-depth discussion of the withdrawal syndrome, please start here or go to the For Prescriber’s page and browse through the topics listed under “Dependence and Withdrawal”. Like many other issues concerning benzodiazepines, the answers to these questions are still unclear.

Table 11

• Gradual tapering, psychological support, and lifestyle adjustments are vital for successful management.
• Depression in withdrawal responds to antidepressant drugs in the same way as depressive disorders where benzodiazepines are not involved.
• Many people have found that giving up smoking is easier when they are off benzodiazepines, when the desire for nicotine may even wane somewhat.

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 during the last stages of withdrawal. It is important to finish the benzodiazepine withdrawal before starting to withdraw the antidepressant. Quite often, people taking long-term benzodiazepines are already taking an antidepressant as well.