5 Steps to Safely Withdraw from Benzodiazepines

anxietymedicationsdeprescribing
Written By Jezel

Benzodiazepines (Benzos) are medications such as alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), lorazepam (Ativan), and clonazepam (Klonopin). They help treat mental health conditions such as anxiety disorder and panic disorders. They may also be used as an antidepressant. 

Yet, there may come a time when you decide to stop your use of benzos. Adverse side effects, tolerance, and benzodiazepine addiction may be factors that motivate you to begin benzodiazepine withdrawal. When this is the case, safety becomes the primary concern. Stopping cold turkey is not a safe option. Benzodiazepine dependence requires tapering off of benzo medications.

When considering your benzodiazepine use, remember not every benzo user needs to withdraw. If benzo withdrawal is your best treatment option, you should know that everyone will have a unique experience. Many contributing factors impact the tapering process. These include genetics, physiological function, including liver function, your support system, how long you have been on the medication, the dose you are taking, and other medications you are taking.

At Levelheaded Mind, we believe in empowering through education, giving you the power to make wise healthcare choices. Therefore, in this article, you will find:

  • the five steps to safe benzo withdrawal

  • withdrawal symptoms to watch for, including some severe withdrawal symptoms

  • a list of "don'ts" to avoid

  • resources that can help

5 Steps to Safe Benzodiazepine Withdrawal

1. Talk with a healthcare provider you trust 

Your healthcare provider can help you set a protocol to come off benzos safely. Find a doctor who will cooperate with your need to stop taking benzos and who understands the importance of tapering. Here are some resources that can help in your search for a cooperating healthcare provider:

2. Have a support system 

It is important to have people supporting you who understand benzodiazepine withdrawal or are prepared to learn about it. Here is a list of support group resources that may help:

3. Have the right mindset

This is your choice. Every benzo user doesn't need to withdraw. If tapering off your benzo medication is your best treatment option, keep a positive outlook. Believe in yourself. You can do this. Be patient with your progress. Higher doses of benzos will take more time to taper off, so patience is a valuable quality. Finally, celebrate the wins. Remember, even small changes are wins.

4. Determine a withdrawal schedule

Abrupt withdrawal can be dangerous. Stopping benzo medication cold turkey can lead to severe withdrawal symptoms. In some cases, these can be life-threatening, particularly when your healthcare provider is prescribing high doses of benzodiazepines.

Your brain's natural GABA function decreases with long-term benzodiazepine use. The GABA function is part of the central nervous system. It will take time to restore this function. So don't rush it. A safe tapering schedule can take several months to one year.

Detox Clinics Vs. Home Detox

Keep in mind that detox clinics will often have a tapering schedule that is too fast. It is deemed safe when it is an inpatient detoxification or medical detox, but it can leave you with post-withdrawal syndrome. This will increase the likelihood of resuming your benzodiazepine use due to how miserable you feel.

The Ashton Manual as a Guide

An excellent guide in benzodiazepine withdrawal is the Ashton Manual. Along with your healthcare provider, the Ashton Manual can help you create a smooth, steady, and slow decline in benzodiazepine blood and tissue concentrations. This will allow the natural systems in the brain to recover their normal state.

Your healthcare provider and the use of the Ashton Manual will consider short-acting benzodiazepines vs. long-acting, the half-life of a medication, and the different potencies of each benzo medication. For instance, the available dosage formulations for Ativan 0.5 mg and Xanax 0.25 equates to Valium 5mg. For Klonopin, a dose of 0.5 mg equals 10mg of Valium. The smallest dose of Valium is 2 mg.

While following the Ashton Manual, you will most likely switch from a short-acting benzodiazepine such as alprazolam (Xanax) to a longer-acting benzodiazepine such as diazepam (Valium). Diazepam (Valium) is one of the most slowly eliminating benzo medications, with a half-life of up to 200 hours. It is also an excellent substitute for a night-time dose due to diazepam being more sedating than others. 

In this example of benzodiazepine withdrawal, you will slowly decrease the short-acting benzo, alprazolam (Xanax), while adding and gradually adjusting the long-acting benzo, diazepam (Valium).

Keep the Schedule Flexible

There is no need to draw up a schedule through the end of the process. Your unique benzodiazepine withdrawal schedule can be adjusted throughout, depending on how you feel at each stage.

5. Pay attention to your body 

Physical dependence can lead to symptoms of withdrawal. Monitor your process and know how to react if you experience withdrawal symptoms.

Some commons withdrawal symptoms are:

  • Hypersensitivity to light

  • Headaches

  • Poor Memory / Concentration

  • Insomnia

  • Irritability

Some more serious withdrawal symptoms  are:

  • Restlessness

  • Hand tremors

  • Sweating

  • Anxiety

  • Panic attacks

The most severe withdrawal symptoms that, in some cases, could become life-threatening include:

  • Hyperventilation

  • Racing Pulse

  • Muscle spasms

  • Hallucinations

  • Seizures

For mild to moderate symptoms of withdrawal, it can be helpful to contact a mental health professional. Cognitive Behavioral Therapy (CBT) can be an effective treatment option. Also, try meditation, exercise, deep breathing, and support groups. As the brain's GABA system recovers, symptoms will ease over time. Be sure to inform your healthcare provider of your benzodiazepine withdrawal symptoms and how you are responding.

If you experience withdrawal symptoms that are severe, it is crucial to contact your healthcare provider immediately. Post-withdrawal syndrome can occur in 10-25% of people who choose benzodiazepine withdrawal. However, this typically correlates with those who withdraw rapidly or cold turkey.

Here Are Some Don'ts

  • Compare yourself to someone else. This is your mental health journey. Your benzodiazepine use and tapering process are unique to you.

  • Set a deadline. Monitor your symptoms of withdrawal and adjust your tapering schedule based on how you feel.

  • Go backward. If you begin to experience difficulty, hold steady. Continue on your current dose for each medication in consultation with your healthcare provider. Your withdrawal symptoms may be short-term and can ease in time.

  • Take extra tablets. Holding back pills and then taking them when you experience withdrawal symptoms will prolong the progress. Stay at your current dose.

  • Compensate with alcohol, cannabis, non-prescription drugs, or sleeping pills such as Zolpidem, Zopiclone, or Zaleplon. All of these have similar actions as the benzos.

  • Try to withdraw from other medications at the same time. Keep all other medications consistent as you go through benzodiazepine withdrawal.

  • Withdraw from benzos if you have an alcohol addiction or substance abuse issue. If you are addicted to alcohol, seek addiction treatment in order to go through alcohol withdrawal first. It is the same for other substance use disorders. Complete your addiction treatment before beginning benzodiazepine withdrawal.

Help For the Next Steps

By following the tapering procedure found in the Ashton Manual and with the help of healthcare providers and mental health professionals, you can safely and effectively withdraw from your benzodiazepine use. Plus, there is more good news. If for any reason, you do not (or did not) succeed at your first attempt at benzodiazepine withdrawal, you can always try again.

At Levelheaded Mind, Jezel Rosa, PMHNP-BC, is available to help with your benzodiazepine withdrawal. You can speak directly with Jezel by scheduling an initial mental health coaching session.

For more information about benzo withdrawal, watch the corresponding video here!

Disclaimer: All the information on this website is for educational purposes and not intended to be specific/personal medical advice or substitute for diagnosis and treatment of any conditions discussed herein. Furthermore, watching these videos or getting answers to comments/questions does not establish a provider-patient relationship. Please consult with your own healthcare provider for proper diagnosis and treatment.

Resources:

The Ashton manual https://www.benzoinfo.com/ashtonmanual/https://www.benzo.org.uk/index.htm

The Benzodiazepine Crisis https://amzn.to/45EkZij

Article: New FDA Study Shows Benzodiazepines Can Cause Long-Term Injury https://www.madinamerica.com/2020/12/fda-benzo-cause-injury/

Article: How Long Does Withdrawal From Benzodiazepines Last? https://www.verywellmind.com/benzodiazepine-withdrawal-4588452

Disclaimer: All of the information on this channel is for educational purposes only and not intended to be specific/personal medical advice or substitute for diagnosis and treatment of any conditions discussed herein. Furthermore, watching these videos or getting answers to comments/questions, does not establish a provider-patient relationship. Please consult with your own healthcare provider for proper diagnosis and treatment.

Note: Some of the links are affiliate links, meaning I may earn a small commission from purchases made through links.

Jezel
Previous

The Risks Associated with Benzodiazepines
Next

Trintellix: Treatment for More Than Just Depression