Benzodiazepine Withdrawal

[raven3davis]

SWIM agrees that ultimitely we as humans have complete control over what we do and what we injest. Some people might have genetic traits that make them more suseptible to addiction but drugs cant make you do them. SWIm feels for you and strongly recommends you get help. SWIM has had two friends who have had seizures from benzos and one of them is now in jail/rehab and the other is dead. Please seek medical attention and gain control of your addiction. Just think about SWIMs friends. It definitely sucks to be in rehab but it sure beats the hell out of being dead.

[calmascanbe]

We might have a choice to take control over our own bodies , but when the only help you can find is the bottle or the pill and doctors turn you away or give you something that only makes your life worse what's next? Jogging will help and controlled breathing will help but they only help to a point.Some of us only have self medication left.I wish it was a perfect world where everyone get's help and the problem is fixed.

[Richard_smoker]

Benzo's go with alcohol in terms of possibilities for severe reactions with attempted self-detox. One of the reasons that you must not try to get off either without the help of a medical professional is because of the risk of seizure and death from stopping either. They're both essentially the same when it comes to GABA and the effects from cessation of either.

Ironically enough, acute alcohol withdrawal is treated with benzos. But NOT a life-long prescription to benzos! it's just enough to get you 'over the hump.'

Same goes with benzo withdrawal. you get more benzo's during detox. why? to keep you from dying (again). the difference is that now you are being controled via symptomatology, not your cravings. These are both very difficult addictions to kick, even in the setting of acute medical intervention. Please be very careful with these substances. Trust your doctor. Let him take care of you, and for heaven's sake, don't try it on your own, and please don't go back to the drugs after you've gone through the trouble to detox. It doesn't ever get any easier to quit. -RS

[radiometer]

I started to write a reply, but I don't think I can really describe it properly. One of the worse aspects was simply worry about what might happen, but as I said, he luckily had no major problems. He started by reducing each dose one at a time, and he would get some general anxiety as the lower doses wore off before it was time for the next one. As each new level became comfortable he would wait a few days and then make the next reduction. Once he was at 1/8 mg three times daily, he then slowly cut out one dose at a time.

The entire process took something like 2-3 months. Very important for him was that he allowed himself the possibility of going back to the previous dose level - he very seldom did so, but knowing that it was "OK" to do so helped psychologically. As the process went on, it became easier and easier, to the point that the timing of the final removal of the 1/8 mg doses was dictated by actually forgetting to take a dose, and then deciding "OK, I guess it's all right to cut that dose out now."

[upperdecker]

I mean was the withdrawal physically/mentally bad? I thank you for your response but thats basically what I was asking. SWIM has been taking 3mg a day for idk, i guess 6 months. If SWIM were to taper down, would the withdrawal be bad? As I said, SWIM remembers coming off Paxil and it was a living hell, this is supposed to be 100 times worse.

[radiometer]

It wasn't too bad for SWIM. As mentioned previously, he had some anxiety when the lower doses would wear off, and he had a bit of insomnia in the mornings. To combat the insomnia, he would take his morning dose when he awoke, and go back to sleep while it kicked in. Remember also that SWIM was drinking nightly, and this almost certainly made the taper easier, however it is not a suggested route. He also would occasionally feel a bit lightheaded which was sort of frightening, but nothing came of it.

The other extreme can be seen in the video above.

I cannot predict what it will be like for SWIY, but 3mg daily is not a particularly heavy dose, and with some luck, SWIY might have a relatively easy time of it as SWIM did. At 6 months of daily use, SWIY should assume that he has a dependance and will need to taper. Do NOT go cold turkey, this is dangerous. Depending on his or her level of knowledge on this topic, SWIY's physician may or may not be in a position to give helpful advice on this, so SWIY may find it very fruitful to ask them these questions as well.

When tapering, SWIY should consider switching to diazepam. SWIM tried diazepam and it did not work for his issues thus he chose the hard route of tapering directly with alprazolam, but it is typical to use diazepam for tapering from benzos because of its very long half-life.

To get a flavor for what it's going to be like, SWIY could probably experiment with taking 1/2 of his normal dose once or twice.

SWIY should first pat themselves on the back for sticking to a fairly low dose and not causing tolerance issues by abusing the clonazepam. A very wise friend once told me that people taking benzos for anxiety should never take them for recreation, and vice versa.

[Nagognog2]

It has to be withdrawn slowly and carefully. And not by a doctor who once read an article in the New England Journal of Medicine. One needs a specialist to handle this. Cold-Turkey can easily kill you. And a poor doctor can make death look like a viable option.

[ojos_de_brujo]

Somewhere in the Middle Ages, Swim was taking up to 80mg of diazepam a day for a few months.
One day, she ran out. No tapering. No doctor.

Of course it was pure hell (understatement), but...
Swim would like to know, actually how big is the risk of dying from benzo WD? What's the data on that? How likely is 'easily'?

Note that this is a question about Swim asking what she risked in the PAST.
Everybody should carefully listen to what has been said above (and in other threads) and take no risks at all. Swim did not have this information at the time. Which doesn't excuse her of course, some people choose to be dumb.

[Nagognog2]

UTFSE here for more information on this. As well as Google. You will find plenty of references to what has been called the worst withdrawl known.

[radiometer]

Here is some relavant information from Dr. Ashton's site, which I linked to above:

WHAT IS THE BENZODIAZEPINE WITHDRAWAL SYNDROME?


The Benzodiazepine Withdrawal Syndrome is believed to be caused by a dampening of the action of GABA as neuroadaptivity causes GABA to become dependent on stimulation from the benzodiazepine to initiate its primary action. In other words, when you have become dependent upon a benzodiazepine, your GABA is unable to perform its natural action without the presence of the benzodiazepine. This results in a wide variety of over-activity in different areas of your brain, causing a vast and diffuse array of symptoms. These symptoms are believed to be various manifestations of neurological over-excitation as the cells in your brain become especially sensitive to the action of excitatory neurotransmitters. The most extreme manifestation of this over-excitation is a seizure event.

The Benzodiazepine Withdrawal Syndrome is noted both for its relative severity and, in some cases, its lengthy duration, as compared to withdrawal from other classes of drugs.

Withdrawal either occurs through the development of tolerance without an attendant increase in dose, or through a decrease in dosage below your "tolerance point". Your tolerance point is the dose point below which the functioning of your receptors becomes impaired due to a deficiency in stimulation from the drug. Your tolerance point may be lower than your actual dosage, such that you can sometimes cut your dose by some amount without experiencing withdrawal symptoms.

Generally, a drug's withdrawal syndrome is the mirror of its primary effects. Thus, for benzodiazepines, you can expect sleeplessness (the mirror of its hypnotic effect), anxiety (the mirror of its anxiolytic effect), muscle tension/pain (the mirror of its muscle relaxant effect), and seizures in rare cases (the mirror of its anti-seizure effect). The only exception is that the Benzodiazepine Withdrawal Syndrome does not "mirror" the amnesic effect. On the contrary the Withdrawal Syndrome often results in increased impairment of memory and cognitive functioning. However, in all cases, after the withdrawal is complete and in total remission, cognitive functioning will gradually return to the level that it was at before you began using the drug.

For a more complete list of symptoms, see below.



WHAT ARE THE SYMPTOMS OF BENZODIAZEPINE WITHDRAWAL?

The following is a list of symptoms. As they have been reported by enough individuals they are statistically likely to be legitimate withdrawal symptoms. Keep in mind that there are a wide variety of other symptoms that have been reported that may be legitimate withdrawal symptoms as well, but have not been reported by enough individuals to be statistically significant. The determination of statistical significance is not based on hard data, but on the observations of this author in reading through thousands of posts from people in withdrawal, as well as several books and articles on the subject.

This list is broken down into psychological and physical symptoms. The double asterisk (**) indicates symptoms that occur to some degree or another, at one time or another, in virtually every person experiencing benzodiazepine withdrawal. Single asterisk (*) are symptoms that are common, and occur in most people. Others are symptoms that are common enough to be verifiable withdrawal symptoms, but probably occur in a minority of cases.

Psychological symptoms: anxiety** (including panic attacks), depression**, insomnia*, derealisation/depersonalisation* (feelings of unreality/detachment from self), obsessive negative thoughts*, (particularly of a violent and/or sexual nature) rapid mood changes* (especially including outbursts of anger or rage), phobias* (especially agoraphobia and fear of insanity), dysphoria* (loss of capacity to enjoy life; possibility a combination of depression, anxiety, and derealisation/depersonalisation), impairment of cognitive functioning*, suicidal thoughts*, nightmares, hallucinations, psychosis, pill cravings. Note that it is far more common to fear psychosis than it is to actually experience it.

Physical Symptoms: abnormal sensitivity to sensory stimuli* (such as loud noise or bright light), muscle tension/pain**, joint pain*, tinnitus*, headaches*, shaking/tremors*, blurred vision* (and other complications related to the eyes), itchy skin* (including formication, ie sensations of insects crawling on skin), gastrointestinal discomfort*, electric shock sensations*, paraesthesiae* (numbness and pins and needles, especially in extremities), fatigue*, weakness in the extremities* (particularly the legs), feelings of inner vibrations* (especially in the torso), sweating, fluctuations in body temperature, difficulty in swallowing, loss of appetite, "flu like" symptoms, fasciculations (muscle twitching), metallic taste in mouth, nausea, extreme thirst (including dry mouth and increased frequency of urination), sexual dysfunction (or occasional increase in libido), heart palpitations, dizziness, vertigo, breathlessness.

Here, I have cited only the most commonly reported withdrawal symptoms. For more comprehensive lists of withdrawal symptoms see the Symptoms Index on this site.



I AM EXPERIENCING ONE OR MORE OF THE SYMPTOMS LISTED ABOVE, BUT I HAVE NOT BEGUN TAPERING MY BENZODIAZEPINE. IS IT POSSIBLE THAT THE SYMPTOMS ARE NOT RELATED TO BENZODIAZEPINE USE, OR COULD I ALREADY HAVE STARTED WITHDRAWAL WITHOUT EVEN TAPERING?

You are probably experiencing tolerance withdrawal. When you reach tolerance, your brain needs more of the drug to stimulate the activity of GABA, and you begin to experience withdrawal symptoms. Some people find that no matter how much they increase their dose, they are unable to obtain complete relief. This may be caused by a fast, upward tolerance spiral, or by toxicity (see above). Complete withdrawal is necessary where this occurs.

Some people mistakenly form a belief that the drug has stopped working, and no longer alleviates their anxiety disorder when in fact they are experiencing anxiety brought on by tolerance withdrawal. Unfortunately, physicians will usually reinforce this misperception and advise you to increase your dose as a result or prescribe an additional benzodiazepine and/or antidepressants.



WHAT FACTORS DETERMINE HOW SEVERE MY WITHDRAWAL WILL BE?

It is impossible to predict how severe your particular withdrawal will be, or which of the 30 or so common symptoms you are likely to experience. Duration of use, dosage, type of benzodiazepine, age, your personal body chemistry, and your method of withdrawal may all play a part. It is unclear which, if any, of these factors relate to the duration of your withdrawal syndrome as opposed to the severity.

There is some evidence that the newer, high potency benzodiazepines, especially Xanax, Klonopin, and Ativan may be associated with more severe withdrawal syndromes. However, this evidence remains anecdotal.

Bear in mind that there is wide variation in people's withdrawal experiences. For example, one person may take a low dose of a benzodiazepine for a short period of time, and suffer a very severe withdrawal. Another individual may take a high dose of the same drug for much longer, and experience very manageable withdrawal symptoms. Furthermore, an individual Valium user may have a harder time than an individual Xanax user.

Taken from a web-site on benzos

[Jatelka]

benzo withdrawal cant kill

In fact, benzos, barbiturates and alcohol are the only drugs that can cause death through withdrawal.

[rocksmokinmachine]

I second that do not stop taking benzodiazepines abruptly. It will result is terrible withdrawals. I would post a slow withdrawal schedule whereby the dose is gradually reduced over time, but it contains a forum in the link so i cannot post it. Just do a search for "Ashton Manual" and you should be able to find a tapering shedule.

SWIM once stopped benzodiazepines cold turkey using a combination of carbamazepine (to stop any potential seizures) 100mg in the day time, and 200mg controlled release at night, along with 15mg of zopiclone for sleep. SWIM still experienced terrible withdrawals...not advisable.

"Around 4mg daily is when addiction occurs"

Not true, one can become dependant on benzodiazepines no matter what the dosage, after just 2 weeks.

[truth]

SWIM has been taking xanax for 3 weeks... SWIM has done numerous drugs since he has been 12 years old. SWIM has never felt addicted to substances at all. Alazopram on the other hand SWIM ran out and had none last night. SWIMs left leg was numb for 5 hours and had 2-3 panic attacks in the duration of the time. Xanax helps a great deal with SWIMs panic disorder, more then any drug(s) out there. SWIM only smokes cannabis now and rarely does any drugs. SWIM in the past used to do a lot of ecstasy. oxy contin, and too many to name like all these other SWIMers. SWIM does not feel addicted yet, but has urges sometimes like he wants them. SWIM feels though once he needs to get off them. if ever, it will be the hardest thing in SWIMs life. Not only because they help SWIM get over his panic attacks, but because it makes SWIM normal like others around him.

and here SWIY goes for some real facts also... [quotes from wiki]....


Withdrawal symptoms can occur when benzodiazepine dosage is reduced. Abrupt or over-rapid dosage reduction can produce severe withdrawal symptoms. Withdrawal symptoms can even occur during a very gradual and slow dosage reduction but are rarely serious. The withdrawal symptoms may include:

Insomnia ,Rebound REM (or dreaming) sleep,Hypnagogia,Nightmares,Anxiety, possible panic attacks,Tachycardia,Hypertension,Depression, possible suicidal ideation,Tremor,Perspiration,Loss of appetite,Dysphoria,Depersonalization,Derealisation (Feelings of unreality),Tinnitus,Gastrointestinal problems (Stomach and abdomen),muscular spasms or cramps, fasciculations


An abrupt or over-rapid discontinuation of benzodiazepines may result in a more serious and very unpleasant withdrawal syndrome that may additionally result in:

Convulsions, which may result in death,Catatonia, which may result in death,Delusions,Homicidal ideation,Violence,Psychosis,Mania ,Effects similar to delirium tremens

Reputation Comments on this post:

Good Info

[Graduisic]

swim has come to understand that it's partially about how long swiy has used benzos, but it also about how much. swim has taken .5 mg alprazolam frequently for years, and he thinks that a lot of the side effects at that level are psychological. like swim says about xanax... once the effects wear off, the after-effect makes one think "damn, i need another xanax!". the anxiety generated often makes swim crave them, but the physical side effects weren't too bad. when swim upped the dose and was taking, like 4-5mg of alprazolam a day, then the side effects are terrible. alprazolam seems to have a particularly distinguished career for addiction over most benzos. it's hard for swim to resist them if he can get them, but when he has been without them for about two weeks he is okay. but, he has never severely abused benzos. they are some of the worst drugs to quit, but one would have to have been taking them regularly for more than a month to feel addiction. psychological addiction can occur after the first pill.

Reputation Comments on this post:

always good info-truth

[drab4]

Yes as said above, Swim agrees that dose used is very important with regards potential withdrawals

Swim has used benzos daily over long periods (several months) and experienced little or no withdrawal on cessation. This is because Swim was careful never to use more than a low dose

However, when a person starts upping the dose, withdrawals can potentially become nasty, as I'm sure you have heard. In the one occasion where he found himself using high doses of benzos every day then Swim tapered himself off by switching to valium (pretty long half-life) and decreasing the dose slowly and gradually over a period of some weeks

As for how long withdrawals last, Swim cannot be of any help as he has always followed the above protocols and so avoided bad withdrawals. Swim wonders whether withdrawals might be similar to those experienced from alcohol though. In which case the first week is a living hell and potentially dangerous, and the next couple of weeks are not so bad, merely involving feeling like you are unwell with the flu or something like that. This is purely guesswork based on stuff read about the similarities between alcohol and benzo addiction and Swim's own experiences with alcohol withdrawal

[Dickon]

I usually lie...so take what is useful from the following tall story...

I've not read through all the posts. There are a lot of them, so apologies if I add nothing new. I will first off repeat what the medical profession say: DO NOT QUIT BENZOS QUICKLY. There is one particularly scary problem with doing that I've seen mentioned on a prevelant benzo-help site, together with a plausable bio-mechanical explanation therefore, and that is this : if you quit quickly from a large dose you can cause irreperable (or seriously long-term) damage that CANNOT be reversed simply by resuming the benzos at the old or even a higher dose. The recommended way is to first switch to a long acting benzo, usually valium (remember Xanax is really dangerously addicting, I'm speaking both from personal experience, and from (although I have no sources) medical opinion. The reason being that it is both strong, and short acting), and then taper off very carefully.

Right having covered my bases with what we've been told to do, let me give you my own experience of benzo withdrawals. I once had back in the mid-late 90s what I suppose is a fairly high habit of 1st generation benzos (by pill henceforth I mean 10mg valium 25 mg Librium(chlordiazepoxide), 20mg Temazepam, and on rare occasions 50mg Oxazepams). I picked up the habit in Berlin when I was already on 150mg methadone a day, and because of the health-insurance system, doctor shopping was particularly easy. All I'd do was go round 3 or 4 doctors a day and get scripts for legitimate but large doses. I'd come back usually about 12 days later (assuming a 14 day script) so as not to arouse suspision. Usually you just got shoved on a computer, and you just had to see the receptionist. Anyway I built up my habit to about 20-40 pills a day (the maximum being 90 temazepam in 24 hours and 100 valium). Anyway I was at this for at least a year, I think quite a lot longer. I decided to quit, I didn't feel particularly addicted to them, and stopped cold-turkey. I didn't really notice much until one night at my Dad's I had a fit in front of him. I did know this was a possible side effect, so I thought I'd resume, but did so at a much more modest 3-5 pills a day. I'm not sure how long I continued on this dose regime, but fairly soon after I went to rehab, and being very blazee and saying Benzos were not a problem I got given a 10 day detox from 3 librium (i.e. 75 mg), essentially a linear taper. I also detoxed from 200mg methadone, dropping to 100mg day 2, and 0 thereafter. The only medical assist was clonidine and the benzo taper. I was not a pretty picture for the first month or so, but I survived it, and emerged better than new at the end of it, and stayed clean for 23 months or so. I was incredibly nervy and anxious at first, but I was so high at being clean that I almost didn't notice it at the time.

My next experince, again with first generation benzos, had me using for 6 months (I can't remember the doses, but fairly small ones. maybe 5-10 pills a day), and I went to some benzo-help-group. I don't mean to denigrate anyone, but what a sad looking lot of people. The healthcare woman who ran the thing advised me on pain of death (almost) not to stop cold turkey. Dickon is not a good advice taker, when the source of advice seems dubious, so I quit cold turkey. I experienced a week or two of unpleasant anxiety, but then regained my equalibrium, and thought what a clever Toad I'd been to ignore this stupid woman's advice: I've got this problem with knowing best some days...

On a few more years, and I've got addicted two or three or maybe more times for fairly short periods using the newer benzos, inter alia, Xanax, Klonopin, Midazolam, and of course my old fave Temazepam now in 30mg form. The frightening thing was how quickly I got hooked and how nasty the w.d.s were. I'm talking from weeks, maybe months of use. I'm not sure if this is a function of my having got addicted before, or of the fact that these newer things are nastier. I'm inclined to think they are. Let me stress I've only ever used benzos regularly with opiates, but don't know how opiate use affects benzo addiction and w.d. The w.d.s were very intense, but of shorter duration as would be expected.

God willing I got out unscathed. Please do not do as I did, except under a doctors advice. All I am giving is one man's experience, and maybe a slight slight hint that you may get away with a quicker taper than is recommended. But seek independent professional advice, although feel free to quote anything here as a case study with a sample size of 1.

Best of luck to all quitting nast drugs (I'm quitting methadone at the moment, and am thankfully long off the benzos!)

Dr D.