The primary difference between these drugs is the length of time they stay active in the body. Benzos are sometimes abused for their relaxing and euphoric effects. Even at therapeutic doses, however, benzos can cause physical dependence and withdrawal.
Overview of Benzodiazepine Withdrawal
Benzodiazepine use has become widespread. From 1996 to 2013, the number of people filling benzo prescriptions increased by 67%. Benzodiazepine abuse and dependence has become more significant among all age groups, from teens to elderly adults. In 2016, estimates suggest that about half a million people in the United States were misusing sedative drugs. When you are physically dependent on a drug, it means your body can’t operate normally without it. If you stop or reduce your dose suddenly, you will experience withdrawal symptoms. Withdrawing from benzos can be a difficult, even dangerous process. You can expect to feel anxious and on-edge for several weeks. You might feel irritable and hypersensitive to everything around you. Insomnia is also common. During the first week, you can also expect physical symptoms like headaches and hand tremors. Benzo withdrawal can be managed with a gradual dose reduction, which will cause milder symptoms that come and go in waves. Beware, if you have been using benzos for longer than six months, suddenly stopping your dose can cause grand mal seizures and delirium—this is why it’s best to involve your doctor or healthcare professional in your process of withdrawal.
Signs and Symptoms of Benzodiazepine Withdrawal
Withdrawal symptoms can occur after as little as one month of use, even on small, therapeutic doses. Among people taking benzos for longer than six months, about 40 percent experience moderate to severe withdrawal symptoms when they quit suddenly. The other 60% experience mild symptoms. The severity of withdrawal symptoms is associated with a variety of factors, including:
your current dose how long you’ve been taking it whether you take more than one benzo whether you take other sedating drugs any substance use issues whether you are quitting more than one substance at a time
The onset of benzodiazepine withdrawal depends on the specific drug you are taking. Short-acting drugs like alprazolam (Xanax) and lorazepam (Ativan) leave the system quicker, which means withdrawal symptoms can appear in as little as eight to 12 hours. Longer-acting benzos like clonazepam (Klonopin) can stay in the system longer, which means it can be one to two days or even longer before withdrawal symptoms start. Possible symptoms include:
Anxiety Insomnia Irritability Restlessness Hand tremors Muscle spasms Headache Sweating Racing pulse Hyperventilation Nausea or vomiting Aches and pains Panic attacks Hypersensitivity to stimuli like light and touch Abnormal bodily sensations (skin-crawling, goosebumps) Depression Problems with concentration and memory Visual disturbances (flashes of light or blurred vision) Auditory, tactile, or visual hallucinations Feelings of unreality Delirium Grand mal seizures
According to the American Psychiatric Association (APA), withdrawal symptoms from short-acting benzos peak on the second day and improve by the fourth or fifth. However, some people find they last for several weeks. Estimates suggest that 10 to 25 percent of chronic benzo users experience what’s known as protracted withdrawal. Symptoms will be milder than acute withdrawal and they can disappear for weeks at a time. Protracted withdrawal rarely lasts longer than one year.
Coping With Benzodiazepine Withdrawal
The best way to quit benzos is to avoid withdrawal by asking your doctor to taper down your dose. Tapering means taking progressively smaller doses over the course of a few weeks or months. You can taper your dose on your own, but it is best to work with a doctor. Depending on which benzodiazepine you are currently taking, your doctor may want to switch you to a different one before your taper begins. Short-acting benzos complicate withdrawal with too many ups and downs. Diazepam, a long-acting benzo, is the most common choice for dose tapering. There is no standard tapering schedule for you to follow. Your doctor will help make an individualized tapering schedule based on your current dose and particular circumstances. Some people taper quickly, finishing up within two to three weeks. Others taper slowly over the course of several months. If your symptoms are intolerable, your doctor can pause or slow down the taper. Most doctors choose not to reverse the taper and up the dose in response to withdrawal symptoms. To cope with these breakthrough symptoms, it helps to have a backup plan for dealing with anxiety. Helpful strategies include:
Cognitive behavioral therapy Meditation Mindfulness training Exercise
Benzodiazepine Withdrawal Warnings
Benzodiazepine withdrawal can be dangerous when not handled properly. There is a risk that people who quit benzos without a taper may experience a life-threatening grand mal seizure. If you go into withdrawal without tapering, you also risk experiencing delirium and hallucinations that cause you to lose touch with reality—a terrifying and dangerous experience. Some drugs are safe to quit on your own, but benzodiazepines are not. However, that doesn’t necessarily mean you will require inpatient care. In fact, most people do okay with tapering their benzos at home with the help of their primary care doctor or psychiatrist. You should plan to stay in touch with your doctor regularly during the tapering process, either by phone or during office visits. Some people, such as those with a history of complicated withdrawal, seizures, or severe mental illness, may be better suited for in an inpatient setting. This can involve living at a detox facility or hospital for several weeks, where you can receive constant medical monitoring and psychological support. Quitting benzos means that underlying psychiatric symptoms can reemerge worse than ever before. These may include:
Panic attacks OCD symptoms PTSD symptoms Severe anxiety Obtrusive thoughts Depression
Inpatient treatment can be very expensive, depending on the facility, but it is covered by many insurance companies. If you are pregnant or thinking about becoming pregnant, talk to your OBGYN or psychiatrist right away about your plans. Benzodiazepine use in pregnancy carries some risks, however, going through any kind of withdrawal during pregnancy carries its own risks. Your doctor can help you weight the potential risks and benefits around Benzodiazepine use and your pregnancy.
Long-Term Treatment for Benzodiazepine Withdrawal
Long-term treatment after benzo withdrawal will depend on your reasons for taking them in the first place and your reasons for quitting. If you have a psychiatric condition that was managed by the benzos, you will need an alternative plan to manage your condition. Typically, this is a combination of therapy and pharmacologic support. If your reasons for quitting benzos are that you were abusing them or unable to control your use, then you may require further substance use treatment. This is particularly true if you are also giving up other substances, like alcohol or opioids. Psychotherapy can help you understand the root cause of your substance abuse problems. It can also help you learn to identify psychological triggers that may cause you to relapse so that you can avoid them in the future. Follow Now: Apple Podcasts / Spotify / Google Podcasts
Resources
The best resource in your quest to quit benzos is your prescribing doctor. But if you would prefer someone else, any primary care physician or psychiatrist will be able to help you taper your dose.
A Word From Verywell
Benzodiazepines are powerful drugs that can be very useful in the short-term, but if you’ve been taking them for a while there are potential risks and side-effects such as sedation and cognitive issues. For a lot of people, quitting benzos feels like waking up from a long dream. For more mental health resources, see our National Helpline Database. Of course, waking up isn’t always easy. To achieve your best health, talk to your doctor about the best way for you to quit and how you can maintain long-term success.
