BenzoDIAZEPINES ("BENZOS")

WHAT ARE BENZODIAZEPINES?

Benzodiazepines, sometimes referred to as “benzos”, are medications with sedative-hypnotic (sleep-inducing) and anxiolytic (anti-anxiety) effects. They are often prescribed for symptoms of anxiety and panic disorder and are also used for treating patients during and after a treatment such as chemotherapy and surgeries to manage anxiety, stress and help them sleep. Xanax, the most widely used psychiatric drug in the the USA, is a benzodiazepine.

HOW DO BENZODIAZEPINES WORK?

Benzodiazepines act on the central nervous system by attaching itself to GABA brain receptors. GABA is a natural neurotransmitter that plays a role in calming the body. It helps us relax when we are anxious and under stress.

CAN benzodiazepines be habit forming?

Patients tend to develop tolerance to this class of medications, requiring higher and higher dosages, and there is high potential for addiction. Benzodiazepines are among the most difficult types of medications to discontinue.  Withdrawal may be associated with significant physical and emotional symptoms, and in some cases can even be life-threatening.

WHAT ARE the withdrawal effects from stopping benzodiazepines?

When you take a benzodiazepine, the body depends on the drug to feel calm and may develop limited ability to do so on its own. When you stop taking a benzodiazepine (or develop tolerance to the drug), you are likely to feel severe anxiety and may experience some of the following symptoms:

  • Sleep disturbance
  • Irritability
  • Increased Tension, Anxiety, and Panic Attacks
  • Hand Tremor, Sweating, Palpitations, Headache, Muscular Pain and Stiffness
  • Difficulty with Concentration and Memory
  • Confusion and Cognitive Difficulty
  • Nausea, Dry Retching, and Weight Loss
  • Seizures
  • Hallucinations, Paranoia, and Suicide

Rebound Anxiety and insomnia

Benzodiazepines are mainly prescribed to treat generalized anxiety disorder and insomnia. Many people who stop taking these medications experience increased anxiety or restlessness. This is called the rebound effect.

Rebound effects from benzo withdrawal, such as anxiety or insomnia, typically last 2 to 3 days.

After someone numbs their anxiety with benzos for a long time, feelings of nervousness can come back in greater force than before. Even people who had no previous signs of general anxiety often have rebound anxiety as a symptom of withdrawal. The same is true of rebound insomnia.

Duration of Withdrawal

Benzodiazepines’ half-lives (time spent in the body after consumption) vary by brand. Withdrawal symptoms from shorter-acting benzos begin sooner than those from longer-acting ones because it takes a shorter amount of time for the drug to leave the user’s system.

The first signs of withdrawal usually start within 6 to 8 hours for shorter-acting benzos and 24 to 48 hours for longer-acting benzos.

Short-acting benzos are notable because of the intense and serious withdrawal symptoms people experience when they quit taking them. Long-acting benzos cause less intense withdrawal symptoms, and it takes longer for symptoms to start.

Short acting Benzos are Xanax, Ativan, Halcion. Long acting Benzos include Valium, Klonopin, Librium

Taking benzos more frequently, in higher doses, in more potent forms and/or for a prolonged time all increase the duration of withdrawal. In cases of mild addictions, it may take as little as seven days to overcome withdrawal symptoms. Other cases can take up to three months as the user is slowly weaned off the drug to prevent life-threatening withdrawal symptoms.

Benzodiazepine Withdrawal Timeline

The withdrawal timeline for benzos is different for every user. The following table is just a guideline, as most people have to taper down their benzo use over several weeks.

First 6-8 hrs. The first signs of withdrawal, typically anxiety and insomnia, may emerge within several hours after stopping use. This depends on how long it takes for the substance to leave the system. Withdrawal symptoms usually appear in 6-8 hours for those taking short-acting benzos.

Days 1-4. Rebound anxiety and insomnia peak after a couple of days. During this time, intense discomfort from insomnia and increased anxiety are common. Other symptoms that peak during this time are increased heart and breathing rate, sweating, and nausea. People who used longer-acting benzodiazepines start feeling the first signs of withdrawal during this time.

Days 10-14. The symptoms of withdrawal typically continue for at least 10-14 days before fading away completely. The withdrawal symptoms tied to longer-acting benzos begin to peak during this time, eventually fading within 3-4 weeks from the quit date.

Days 15+. People who are heavily dependent on benzodiazepines may experience protracted withdrawal syndrome (PAWS). These are random periods of sharp withdrawal symptoms months after quitting. Tapering down benzo use with the help of a doctor can prevent PAWS.

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Benzo Detox

The first step in treating a benzodiazepine addiction is removing the drug from the addict’s system. This process is known as detox and can cause dangerous side effects if not done properly. Quitting cold turkey can even be lethal in some circumstances. A supervising physician must be present to monitor for potentially fatal symptoms, including seizures and suicidal behavior.

“A grand mal seizure may occur in perhaps as many as 20-30 percent of individuals undergoing untreated withdrawal from these substances.” Diagnostic and Statistical Manual of Mental Disorders, 5th Ed.

A medically supervised detox helps people stay safe and healthy while they get clean. Medical detox also reduces the discomfort of withdrawal, which in turn reduces the chances of relapsing into addiction. Detox can last several months depending on the drug taken and the duration of use.

Tapering Down Benzodiazepine Use

Medical detoxification from benzodiazepines often involves tapering down from the drug. Tapering down can mean reducing the dose or prescribing a less potent benzo. The strategy used is determined by the severity of addiction and the type of drug that was abused.

Benzos used for detox may include diazepam (Valium) or clonazepam (Klonopin). These drugs are used for tapering down because they are long-acting and less potent than other benzos. These drugs keep withdrawal symptoms at bay while the user reduces their dose.

It takes most people an average of 10 weeks using the tapering down method to fully detox from benzodiazepines.

Benzo Detox Medications

Although most people gradually reduce their dose until it’s safe to stop taking the drug altogether, there are also medications that can help relieve withdrawal symptoms during the detox period. Some of these include:

Buspirone

People with generalized anxiety disorder who have a history of substance abuse are often prescribed buspirone. This drug doesn’t cause physical dependence and can relieve the emotional effects of withdrawal. The only downside is that buspirone takes 2-3 weeks before it begins to take effect. Patients in detox may begin taking buspirone as they taper down their benzo doses.

Flumazenil

This drug is primarily used to treat benzodiazepine overdoses, but has shown some success in reducing withdrawal symptoms of long-acting benzos. Flumazenil is able to block the effects of benzos and relieve withdrawal symptoms because it attaches to the same pleasure centers in the brain as benzodiazepines. It may also be used for rapid detox as the drug forces benzodiazepines out of the body. This drug should be used with caution as rapid detox can make withdrawal worse.

Treatment for Benzo Addiction

Detox on its own is rarely enough to build long-lasting sobriety. Many people choose an inpatient rehab that offers benzo detox. People with mild benzo addictions may choose an outpatient detox instead of an inpatient rehab center. Outpatient care allows people to get treatment without upsetting their daily schedule. Counseling and support groups are also an important part of recovery. Many former benzo addicts continue therapy and support after rehab to prevent a relapse.