Benzodiazepine Withdrawal
Some benzodiazepines are widely and successfully used as short-term treatment in certain settings such as in hospitals as pre-medication before operations, for nervous patients before a dental procedure, and in the treatment of some forms of epilepsy and movement disorders. They are also used in the management of alcohol withdrawal as they work to alleviate delirium tremens. While many doctors are aware of the dependency and withdrawal issues related to their long-term use, others are still limited in their knowledge and may consequently give substandard care, often putting their patients’ safety at risk.
The following are useful points to be considered when withdrawing a patient from a benzodiazepine:
Symptoms
When taken long-term (more than four weeks), the patient can become dependent on the drug and may experience withdrawal symptoms when it is discontinued. This withdrawal experience is unique and symptoms vary according to individual. Common physical symptoms include: profuse sweating, headaches, nausea, dizziness, gastric disturbances, palpitations, chills, muscle pain, twitches, spasms and tremors. Psychological symptoms such as feelings of depersonalisation, derealisation, anxiety, panic attacks, nightmares and distorted perception are also common.
There are doctors who are very aware of this and are able to reassure their patients that the symptoms are indeed withdrawal-related and will disappear once withdrawal is over. Sadly, this is not always the case and many patients with no pre-existing psychological problems end up being misdiagnosed and treated for schizophrenia, bipolar and other mental health disorders.
Cold-Turkey
A patient should never be advised to discontinue taking a benzodiazepine abruptly. "Then stop taking it" was the reply of a well-intentioned doctor when I expressed my concern that the drug had lost its efficacy. Fortunately, I found information online which recommended a slow taper using diazepam (because of its longer elimination half-life) and was able to successfully wean off. It is surprising that many doctors still give this advice and our Helpline often receives frantic emails from people experiencing extremely distressing symptoms as a result. Quitting cold-turkey is dangerous and can cause serious problems including seizures and psychosis.
Tapering
The decision to withdraw should be the patient’s and she or he must be allowed to taper off the drug at a comfortable pace using the most appropriate weaning process. The more common methods are: substituting with diazepam, titration by crushing the tablet into a powder and mixing it with water, and the direct method where the dosage is very slowly reduced. Factors to be considered include personal circumstances, overall general health, the stressors in the patient’s life, stamina, support available and previous experience with drugs. It is most important that the patient feels in control of the process. Apart from the usual withdrawal challenges, being pressured into tapering too quickly can cause additional anxiety and hinder recovery.
Duration
The conflicting reports regarding the duration of withdrawal and whether or not protracted withdrawal exists poses one of the biggest problems for patients. Withdrawal can last as short as between 5 and 28 days for those with mild dependencies. However, there are many cases where symptoms persist for longer and these patients are told the withdrawal period has ended and the problems are "all in the head". Furthermore, as alternative diagnoses are queried additional emotional energy is expended awaiting diagnostic tests results which are usually negative. When every test is exhausted, the suggestion that the problems are psychogenic in origin and nothing to do with withdrawal is inevitably made. This misinformation does not augur well for the unfortunate patients who then become concerned about the implied possibility of psychological disorders only to find that the symptoms disappear once the protracted period ends.
Benzo-wise doctors will agree that while many people recover within a six to eighteen-month period, it is not uncommon for a percentage of patients to experience symptoms (often interspersed with windows of normality) for two to three years or longer in rare cases.
Pre-existing Anxiety Myth
Because many patients are prescribed benzodiazepines for anxiety-related issues, the consensus is usually that the post-withdrawal syndrome or any protracted symptoms are in fact due to a resurgence of the pre-existing anxiety. I was prescribed a benzodiazepine for a neuromuscular condition and had no history of anxiety, depression or any other psychological problem. The anxiety I experienced especially during acute withdrawal was inconceivable. I have also communicated with others who were prescribed benzos for medical problems and experienced intense organic fear and numerous anxiety-related symptoms. Pre-existing anxiety or not, a nervous system in a hyper-excitable state due to the down-regulation of GABA receptors can reduce the most grounded and stable person to literally a ‘quivering wreck’.
It is the responsibility of every doctor who prescribes a benzodiazepine to give the patient information on which the decision to take or not take the drug can be based. When treating p 1ff8 atients for anxiety, insomnia or other related conditions, a doctor might understandably be hesitant and conclude that imparting too much information will only make matters worse. However, keeping patients ignorant of the addictive properties of a drug is not in their best interest and this is the reason for the ‘unpleasant surprise factor’ that presents in the form of withdrawal.
These are only the basics from an ex-patient’s perspective. The most comprehensive guide is the Ashton Manual - Benzodiazepines: How They Work & How To Withdraw which should be compulsory reading for every healthcare professional. It has additional information on symptoms, tapering schedules, Z drugs which are similar to benzos, effects of other medication such as quinolones, and everything required to ensure that a patient withdrawing from a benzodiazepine is given the best possible care.
By: V Baylissa Frederick
Benzodiazepine withdrawal: Xanax
in particular since I have more collected info about this class of drug than the other 4 classes of psychotropic meds I’ve withdrawn from. … Go here to read the rest.
A Fatal Case of Benzodiazepine Withdrawal.
Given the inconsistent clinical presentation and the findings at autopsy, we suspect that she suffered from benzodiazepine withdrawal and not an overdose as initially reported. Although it is possible that the zolpidem.
Benzodiazepine Withdrawal
Because many patients are prescribed benzodiazepines for anxiety-related issues, the consensus is usually that the post-withdrawal syndrome or any protracted symptoms are in fact due to a resurgence of the pre-existing anxiety. …
Mail this post
The drug is now easily available online, without much of a hassle and along with a privilege that has sure attracted millions of customers and that is a low price, cheap diazepam that can be obtained without any need of a prescription. Now there are two sides to this kind of scheme; the good and the bad side. The good side is that those people, who cannot afford the expensive price of obtaining the medicine over real counters, can now easily have access to it via a simple click online and at not much of the cost either. Similarly, if a person needs the drug but is living in a country that does not issue it, then again online purchase does the trick. If a person is reluctant to go to a doctor to discuss about his mental problems of anxiety and insomnia, then he too can obtain the drug easily and curing himself of his maladies. All this is for the good side. Now, the bad side to this is the abuse of the drug. 8 out of 10 people end up abusing drugs, because they become totally dependent on the drug to cure them of the malady. Prescription or no prescription, these people need the drug and with easy access to it, start ordering huge amounts of it and using them in excess of the limit. This is very dangerous, when a patient does not take any suggestion from a doctor and resorts to buying the drugs without any idea of what harm he has caused to his body.
