Benzodiazepines are a class of medications that are commonly prescribed for anxiety, insomnia, alcohol withdrawal, and seizures. They work by enhancing the effect of the neurotransmitter GABA in the brain, resulting in sedation, muscle relaxation, anti-anxiety effects, and sleepiness. Some common benzodiazepines include Xanax (alprazolam), Valium (diazepam), Klonopin (clonazepam), and Ativan (lorazepam).
Why are benzodiazepines stopped abruptly?
There are a few reasons why someone might abruptly stop taking benzodiazepines:
- They run out of their prescription early and are unable to get a refill right away
- They decide to stop taking the medication without tapering off as recommended by their doctor
- They are admitted to a hospital or incarcerated and their regular medication regimen is disrupted
Regardless of the reason, abruptly discontinuing benzodiazepines can lead to problematic withdrawal symptoms.
What is benzodiazepine withdrawal syndrome?
Benzodiazepine withdrawal syndrome occurs when someone who has been taking benzodiazepines for an extended period of time suddenly decreases their dosage or stops taking the medication altogether. This is due to the body becoming dependent on the drug both physically and psychologically.
When benzodiazepines are removed, the body is no longer inhibited by their effects and excitation increases. This leads to hyperactivity of the sympathetic nervous system. Withdrawal symptoms emerge as the body attempts to rebalance itself in the absence of the benzodiazepine.
Symptoms of benzodiazepine withdrawal
Benzodiazepine withdrawal symptoms typically begin within 24-48 hours after the last dose. However, onset can occur anywhere from 6 hours to several weeks later in some individuals. The acute withdrawal phase usually lasts about 2 weeks but some symptoms may persist for many months.
Common withdrawal symptoms include:
- Anxiety
- Irritability
- Insomnia
- Tremors
- Impaired concentration
- Depersonalization
- Depression
- Headache
- Muscle pain and stiffness
- Sweating
- Rapid heart rate
- Hypertension
- Nausea and vomiting
- Loss of appetite
- Sensory hypersensitivity
- Seizures (in severe cases)
The intensity and duration of symptoms depends on several factors:
- Dose of the benzodiazepine
- Duration of treatment
- Speed of discontinuation
- Individual variation
Dangers of abruptly stopping benzodiazepines
Abruptly discontinuing benzodiazepines can be dangerous and potentially life-threatening. Some major risks include:
Seizures
Seizures can occur in 15-20% of people who abruptly stop a high dose benzodiazepine taken for a long duration. This is because chronic use of benzodiazepines alters GABA receptor functioning, and sudden removal can trigger uncontrolled electrical activity in the brain.
Delirium
An acute confused state known as delirium tremens can arise during benzodiazepine withdrawal. It is characterized by disorientation, agitation, hallucinations, fever, and tremors. This toxic-confusional state requires immediate medical attention to avoid permanent neurological damage.
Self-harm
Benzodiazepine withdrawal can sometimes lead to overwhelming feelings of anxiety, hopelessness, and suicidal thoughts. The abrupt cessation of benzodiazepines in depressed patients warrants close monitoring.
Post-acute withdrawal syndrome
While most acute withdrawal symptoms resolve within 2 weeks, some people experience protracted withdrawal symptoms that wax and wane. These post-acute withdrawal symptoms include anxiety, cognitive deficits, and sleep disturbances that may persist for months or years.
Tapering benzodiazepines
Due to the risks of abrupt discontinuation, it is recommended to slowly taper benzodiazepines when stopping. This gradual dose reduction allows the body time to readjust to functioning without the drug.
General benzodiazepine tapering guidelines include:
- Reduce dosage by no more than 25% every 1-2 weeks
- Convert to an equivalent dose of a longer acting benzodiazepine if on a short-acting one
- Listen to your body and slow rate of taper if needed
- Under medical supervision, taper over 6-12 months or longer if used at high doses for extended periods
The table below provides an example tapering schedule for a moderate dose of alprazolam (Xanax):
| Week | Dosage |
|---|---|
| 1 | 1.5 mg daily |
| 2 | 1.125 mg daily |
| 3 | 0.75 mg daily |
| 4 | 0.375 mg daily |
During the tapering process, your doctor may prescribe other medications to help manage withdrawal symptoms like anxiety, insomnia, and muscle tension. Supportive care and psychotherapy can also help individuals struggling with the emotional aspects of withdrawal.
Seeking medical help
If you or someone you know has been taking benzodiazepines regularly and would like to stop, it is strongly advised to work with a doctor to create a controlled tapering schedule. Sudden cessation should be avoided.
Let your doctor know if you experience any concerning withdrawal symptoms or if you are having thoughts of self-harm. They may be able to adjust your taper plan, provide additional supportive medications, or refer you to detoxification services if necessary for your safety.
With careful tapering under medical supervision, most people can successfully discontinue benzodiazepines. But stopping these medications abruptly often leads to an unnecessarily painful and dangerous withdrawal.
Conclusion
Abruptly stopping benzodiazepines after regular use leads to a highly unpleasant withdrawal syndrome. Anxiety, insomnia, tremors, seizures, delirium, and depression are some of the concerning symptoms that may emerge. To avoid physical harm and severe psychological distress, it is critical to slowly taper benzodiazepines under medical supervision rather than quitting them cold turkey.
