Benzodiazepine withdrawal carries with it some of the most unbearable symptoms of any known drug.
How to Safely Manage Benzo Withdrawal Symptoms
Along with the almost endless list of physical and mental symptoms is the fact that many abusers end up feeling the grueling effects for weeks, months and even years. Plus, withdrawing improperly from benzos actually can lead to death.
And while opioid abuse deservedly gets a lot of attention in the media today, the startling truth is that benzodiazepine use is on the rise (by 37% since 1996 in fact), and kicking this habit can be fatal.
A Crucial Note About the Dangers of Benzodiazepine Withdrawal
It’s worth pointing out immediately that anyone considering detoxing from benzos should seek the medical advice of a trained professional.
Going off of benzodiazepines without the proper guidance or knowledge is incredibly dangerous and can result in death.
Benzodiazepines are quite common in healthcare, making their abuse even more likely. Here is a list of some of the most common benzos:
- Xanax (alprazolam)
- Ativan (lorazepam)
- Valium (diazepam)
- Klonopin (clonazepam)
- Librium (chlordiazepoxide)
- Restoril (clorazepate)
By making the choice to detox alone from any of these or from any other benzodiazepines, you’re essentially risking your life. It’s simply not worth it.
Benzo Withdrawals: Deadlier Than You Think
Unlike many other illicit substances, the symptoms of withdrawal from benzo dependence can in fact be fatal. Unfortunately, not everyone knows this fact before they try to quit using.
Part of this comes from the perception that there are “harder” drugs than benzodiazepines. Heroin, cocaine, and crystal meth, for example, are considered by many to be the most dangerous substances of abuse.
However, the truth is that withdrawals from these substances aren’t actually fatal by themselves. Incredibly uncomfortable, true, but not deadly.
Withdrawals from two substances in particular have been shown to be potentially deadly: alcohol (due to a condition known as “delirium tremens”) and benzodiazepines.
How Do Benzodiazepines Affect the Brain?
Before getting into why detoxing without proper benzodiazepine withdrawal management can be fatal, it’s crucial to know just how exactly these drugs affect the brain.
Benzodiazepines are one of three different kinds of central nervous system (CNS) depressants. The other two are non-benzo sleep medications (like Ambien and Lunesta) and barbiturates (like Mebaral and Nembutal).
Generally, these drugs interact with the brain’s chemistry to essentially slow down its activities. Insomnia and anxiety, unsurprisingly, are some of the main disorders that these drugs are prescribed to treat.
Benzos in particular stimulate the production of gamma-Aminobutyric acid (or GABA), a neurotransmitter that helps to calm many of the brain’s processes. However, researchers found that continued abuse actually leads to dopamine surges, flooding the brain with pleasure chemicals and eventually resulting in addiction.
Utilized properly though, benzodiazepines can help stimulate the production of GABA in the brain and thus cool down any impulses that have gotten out of control. For patients with severe anxiety or insomnia, these drugs can end up being a true lifesaver.
Why Are Withdrawals from Benzodiazepines So Deadly?
Like coming off of other substances, benzo withdrawals occur as a result of your body not being properly prepared.
Over time, our brains essentially get used to what we put into our systems and they eventually start to compensate for them. This adaptation is the foundation for why we build up tolerance.
But when we take away these substances, our brains are still functioning as if they were still there.
With benzodiazepine withdrawal, the neurotransmitter the drugs target (GABA) isn’t as powerful as it used to be. And since your brain is still working as if the effects of GABA were as intense as before, it tends to overcompensate.
Think of it as if you were pushing up against a wall with all your might. If that wall were to suddenly disappear, you’d go flying through the room.
Similarly, your brain is launched into a flurry of over-activity after removing benzos completely, resulting in wide variety of symptoms like anxiety, mania, sleep disturbances, and much much more.
This state of heightened activity has also been shown to lead to severe and life-threatening grand mal seizures and is the main reason benzodiazepine withdrawal is so deadly.
The benzo withdrawal seizure risk typically is highest the first two weeks into withdrawal and is much more likely to occur with abrupt cessation rather than gradual tapering.
Substances That Lower the Benzo Seizure Threshold
There are a variety of substances that can lower the benzo seizure threshold even further, thereby increasing the risk of an episode and potentially of death.
You should always discuss any substances you are taking with your doctor before any detox but you should pay particular attention to the ones listed below.
- Fluoroquinolone Antibiotics
DP/DR: One of the Benzo Withdrawal Symptoms You Haven’t Heard About
DP/DR stands for depersonalization (DP) and derealization (DR). The Mayo Clinic defines the disorder as having persistent or repeated feelings that “you’re observing yourself from outside your body or you have a sense that things around you aren’t real, or both.”
The effect, as you can imagine, can be quite disturbing. Sufferers describe the state as almost an out-of-body experience or like you’re living in a dream.
Many users have reported experiencing this state during withdrawals from benzodiazepine.
And while the symptom itself isn’t necessarily painful, it can be quite unnerving and may make it difficult to perform tasks like going to work, socializing with friends, or interacting with family members.
DP/DR With Co-Occurring Disorders
It’s been shown that people who have substance use disorders show a markedly higher rate of being afflicted with mental disorders as well. In fact, studies show that people diagnosed with a substance use disorder are twice as likely to also have a mood disorder.
Though one doesn’t necessarily cause the other, this can make treating addiction in such patients especially difficult as the two generally feed off of one another.
What’s more, the dissociative symptoms of withdrawals from Xanax, Ativan, Klonopin, and other benzos can in fact make the DP/DR symptoms of pre-existing conditions worse. Borderline personality disorder sufferers, for example, may be at an even greater risk of DP/DR when trying to come off of benzo dependence.
This is just one of the many reasons why anyone trying to detox from benzodiazepines should seek out proper treatment. Doing so will help ensure you’re under the care of medical professionals that know how to properly treat co-occurring conditions.
From Weeks to Years: “Normal” Can Be a Long Way Off
With such a long list of symptoms it’s no wonder so many people have such a hard time getting through benzo withdrawals. In fact, many people who have been through the painful process claim that it’s even more unbearable than withdrawal from substances like heroin.
But beyond the discomfort caused by the symptoms themselves is the fact they may last for a particularly long time. Some users have reported symptoms subsiding after a couple weeks while others are still feeling the effects for years after their last dose.
One user on the popular benzodiazepine recovery forum Benzo Buddies reported that he was still experiencing the effects of Xanax withdrawal a full 8 months after last using.
He/she recounts the later days in the process as “a whole new level of suffering and torture to the point I really [didn’t] know if I [could] hang on much longer.”
Another user posted that after 5 months he was still experiencing significant DP/DR effects. “This is so maddening,” he/she says. “This is where I am at 5 mos… no better and worried.”
The Benzodiazepine Withdrawal Timeline
No matter how long the benzo withdrawal duration, the process typically will move through two distinct phases: the acute phase and the protracted phase.
The acute phase is marked by the most intense bouts of the symptoms of benzo withdrawal listed above and, depending on the benzodiazepine being abused, could last for several months.
The protracted phase is generally longer and involves symptoms that are a bit more subdued than during the acute phase. While not everyone will actually go through this phase, there have been cases where the symptoms appear again later.
Below, we’ve gathered drug-specific timeline information from Mental Health Daily to help you gauge your progress. It’s worth mentioning, however, that everyone will experience withdrawal from benzos differently and your experience might vary significantly.
In general, the symptoms of withdrawal are brought on quicker in faster-acting benzos with a shorter half-life.
- Xanax Withdrawal – Xanax’s half-life is around 6-12 hours and withdrawal symptoms can begin any time after that point. For many people, the symptoms will reach a peak at around week 2 and may decrease in intensity from there.
- Ativan Withdrawal – You’ll likely start experiencing lorazapam withdrawal after the drug’s 10-20 hour half-life. From there, most people will experience the most severe effects for at least a week though many experiences will differ.
- Klonopin Withdrawal – Klonopin’s half-life is around 18-50 hours and dependent users can expect withdrawal symptoms to happen after that point. As Klonopin takes 5-14 days to break down completely, many report that the most uncomfortable symptoms begin then.
- Valium Withdrawal – Valium has the longest half-life of the group. Its active metabolite can remain active in your system for 36-200 hours. As such, the acute phase can start anywhere from 1-4 days after your last dose.
The Importance of Tapering
One of the most effective benzodiazepine withdrawal treatment protocols is implementing a tapering system. As you now know, abruptly removing benzos from your body all at once can be incredibly dangerous or even fatal.
As such, a tapering system lets your body slowly adjust to a lower dosage of benzodiazepines over time.
Many tapering programs utilize Valium as a benzo substitution because it has one of the highest half-lifes. This makes its effects far less pronounced and less likely to cause further addiction (though it is still possible without proper guidance).
Klonopin has also been used similarly for the same reasons.
The best way to come up with a personally tailored tapering schedule is by consulting with your doctor. But for an immediate idea on what a detailed and proven tapering schedule looks like, have a look at Professor Ashton’s various slow withdrawal schedules to get started.
While tapering is by far one of the most effective methods of benzo withdrawal treatment, it should be noted that the process can be quite lengthy – sometimes lasting many weeks or even years.
Recognizing this fact before beginning treatment can help you prepare appropriately and ensure future recovery success.