Part of the success was attributed to the placebo method used for part of the trial which broke the psychological dependence on benzodiazepines when the elderly patients realised they had completed their gradual reduction several weeks previously and had only been taking placebo tablets. Improved reaction times were noted at 52 weeks in elderly patients free from benzodiazepines. Younger people on benzodiazepines also experience cognitive deterioration in visual-spatial memory but are not as vulnerable as the elderly to the cognitive effects. Some worsening of symptoms were seen in the first few months of benzodiazepine abstinence, but at a 24-week follow-up, elderly subjects were clearly improved compared to those who remained on benzodiazepines. Spontaneous abortions may also result from abrupt withdrawal of psychotropic medications, including benzodiazepines. The neonatal benzodiazepine withdrawal syndrome has been reported to persist from hours to months after birth.

If you’ve been prescribed benzodiazepine medication, it’s important to follow your doctor’s instructions carefully and make sure you’re aware of the potential risks of the specific medication you’re taking. However, it’s important to note that they also have a risk of dependence and withdrawal symptoms if they’re taken for a long time, or if they’re misused. This is known as protracted withdrawal and it’s possible for these symptoms to persist for several months. During the initial phase of withdrawal, which can last a few days, you might experience anxiety, restlessness, insomnia and irritability.

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After this acute phase, you might start to experience milder withdrawal symptoms that come and go over an extended period of time. Benzodiazepine medications should not be abruptly discontinued (or a dose rapidly or substantially reduced) in patients who are likely to be physically dependent on the medication and at risk for withdrawal. The Guideline recommends tapering when the risks, which can include oversedation, falls, memory and cognitive impacts, overdose, and motor vehicle accidents, outweigh the benefits of continued benzodiazepine therapy. Long-term (typically more than four weeks) regular use can lead to physical dependence and withdrawal when the dose is reduced, or the medication is abruptly stopped.

Difficult tapers

What is certain is that surface GABAA receptor protein levels are altered in response to benzodiazepine exposure, as is receptor turnover rate. The neuroadaptive processes involved in tolerance, dependence, and withdrawal mechanisms implicate both the GABAergic and the glutamatergic systems. More serious symptoms may also occur such as depersonalization, restless legs syndrome, seizures, and suicidal ideation.

Other therapies, including counseling and cognitive behavioral therapy (CBT), may be helpful for people looking to manage symptoms without relying on other drugs. Tapering the drug by slowly reducing the prescription strength may help make withdrawal symptoms much easier to manage. Medical detox involves tapering off the benzo drug under the supervision of a doctor. Research indicates that physical dependence may begin in just a few weeks, even while taking the drugs in low therapeutic doses. However, there is still a possibility of severe reactions and withdrawal symptoms.

Benzodiazepine withdrawal syndrome

Failure to recognize discontinuation symptoms can lead to false evidence for the need to take benzodiazepines, which in turn leads to withdrawal failure and reinstatement of benzodiazepines, often to higher doses. In severe cases, the withdrawal reaction or protracted withdrawal may exacerbate or resemble serious psychiatric and medical conditions, such as mania, schizophrenia, agitated depression, panic disorder, generalised anxiety disorder, and complex partial seizures and, especially at high doses, seizure disorders. Withdrawal symptoms can be managed through awareness of the withdrawal reactions, individualized taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance, and referral to benzodiazepine withdrawal support groups.

Short-term symptoms

The medication Romazicon (flumazenil) is sometimes used off-label for withdrawal symptoms. During your taper, you may still experience some of the symptoms of withdrawal. Your doctor will help make an individualized tapering schedule based on your current dose and particular circumstances. Diazepam, a long-acting benzodiazepine, is the most common choice for dose tapering. The onset of benzodiazepine withdrawal depends on the specific medication you are taking. Benzodiazepine withdrawal can be managed with a gradual dose reduction, which will cause milder symptoms that come and go in waves.

• Benzodiazepine medications should not be abruptly discontinued (or a dose rapidly or substantially reduced) in patients who are likely to be physically dependent on the medication and at risk for withdrawal.
• Supportive counseling and other targeted therapies or medications may help a person manage the symptoms and improve their quality of life.
• You may have to pause, slow down, or speed up depending on how your body reacts to withdrawal.
• This stage usually lasts for a few weeks, but some people might experience these withdrawal symptoms for longer.
• Benzodiazepine withdrawal can also lead to disturbances in mental function that persist for several months or years after onset of symptoms (referred to as post-acute-withdrawal syndrome in this form).
• Cognitive behavioral therapy improved discontinuation success rates for panic disorder, melatonin for insomnia, and flumazenil or sodium valproate for general long-term benzodiazepine use.

Acute withdrawal begins after the initial withdrawal symptoms, generally within a few days. During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound. This dependence may lead to a difficult withdrawal if the person chooses to stop taking the drugs. The best resource in your quest to quit benzodiazepines is your prescribing doctor. If your reasons for quitting benzodiazepines are that you were misusing them or unable to control your use, then you may require further substance use treatment.

Protracted withdrawal syndrome

They emphasized that a taper that is too rapid can be dangerous and potentially life-threatening. Those who had a prior psychiatric diagnosis had a similar success rate from a gradual taper at a two-year follow-up. Cognitive behavioral therapy improved discontinuation success rates for panic disorder, melatonin for insomnia, and flumazenil or sodium valproate for general long-term benzodiazepine use. Inpatient drug detox or rehabilitation facilities may be inappropriate for those who have become tolerant or dependent while taking the drug as prescribed, as opposed to recreational use. Some studies found that the abrupt substitution of substitutive pharmacotherapy was actually less effective than gradual dose reduction alone, and only three studies found benefits of adding melatonin, paroxetine, trazodone, or valproate in conjunction with a gradual dose reduction.

Medical detox

• Sometimes altering your tapering schedule can reduce withdrawal symptoms.
• The best way to detox from a benzodiazepine is under medical supervision and in the care of addiction specialists.
• Benzodiazepines are used to treat anxiety, epilepsy, insomnia, and alcohol withdrawal.
• Among respondents whose symptoms lasted months or years, over half said caffeine or alcohol worsened their PAWS symptoms.

After that first leap, the steps become smaller, usually 5% to 10% of the original dose. You may have to pause, slow down, or speed up depending on how your body reacts to withdrawal. In most cases, your doctor will reduce your dosage by 5% to 25% in the first week.

In fact, if you take your medication every other day, you may notice rebound symptoms on the day between doses. Short-acting benzodiazepines are much more likely to cause rebound symptoms. Experiencing rebound symptoms means the symptoms you had before taking benzodiazepines come back even stronger than before. Benzodiazepine withdrawal can involve short-term symptoms, rebound symptoms, and long-term symptoms. It’s incredibly important to follow your doctor’s guidance when you stop taking benzodiazepines. Tapering can help take the edge off withdrawal symptoms like tremors and nausea, though it may not prevent withdrawal symptoms entirely.

Types of benzodiazepines

Others taper slowly over the course of several months. There is no standard tapering schedule for you to follow. Symptoms will be milder than acute withdrawal and they can disappear for weeks at a time. Protracted withdrawal is a long-term withdrawal syndrome that may come and go for several months. However, some people find they last for several weeks.

This will prevent you from altering the taper, but it might mean frequent trips to the pharmacy. This can happen after each dose reduction. Protracted withdrawal rarely lasts longer than one year. During the first week, you can also expect physical symptoms like headaches and hand tremors. You can expect to feel anxious and on edge for several weeks.

Benzodiazepine withdrawal is when the body begins to rid itself of the drug, which can lead to a state of shock. The best way to detox from a benzodiazepine is under medical supervision and in the care of addiction specialists. Emerging research also suggests acceptance and commitment therapy (ACT) could also have benefits during benzodiazepine withdrawal. According to the National Center for PTSD, the most beneficial kind of therapy for benzodiazepine withdrawal is cognitive behavioral therapy (CBT). People with benzodiazepine tolerance may take supratherapeutic doses because the recommended range no longer provides relief for their symptoms.

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The higher dose may help ease your symptoms, but it can also increase your risk of overdose and Benzodiazepine withdrawal severe withdrawal symptoms. Tapering can also involve some complications if you’re tapering off supratherapeutic doses of benzodiazepines. Tapering may not prevent benzodiazepine withdrawal, but it can help minimize the symptoms you experience.

A free, quick-reference digital tool for patients, friends, and family on benzodiazepine tapering. A series of live webinars intended for clinicians to gain expertise to navigate the complexities of safely tapering benzodiazepines. Long-term use raises your risk of experiencing withdrawal symptoms when you stop taking the medication.