Withdrawing from Benzodiazepines: Symptoms, Safety, and Treatment

He received an additional 12mg of buprenorphine in addition to 45mg of diazepam. A multimodal approach to symptom control was attempted involving olanzapine 10mg, gabapentin 300mg, phenobarbital 260mg, and ondansetron 4mg. Not everyone who cuts down or stops taking benzodiazepines will experience withdrawal symptoms. Some people experience no withdrawal on discontinuation, even with cold-turkey cessation—although there is no way to know who these people will be ahead of time, so it is not recommended. Others might experience a few weeks or months of uncomfortable, but bearable, symptoms. Unfortunately, there is another group of individuals that may experience severe symptoms, often for months or years on end.

How severe are the symptoms of withdrawal?

Improvement from the withdrawal syndromes usually occur gradually, sometimes as people taper, or slowly over the months and years after their benzodiazepine cessation. More lower symptom or symptom–free days  start to occur and symptoms reduce in severity and number for most people. Sometimes, however, some people remain in severe withdrawal that persists, without windows, as the “baseline” condition” for quite some time, even years in some cases, until the “baseline” begins to improve. There have also been reports of withdrawal that spontaneously improves or vanishes overnight after the person had been suffering intensely for years before. In time, the majority of people recover completely—often experiencing good mental and physical health for the first time in a long time. Some, however, continue to have changes in their cognitive abilities following long-term benzodiazepine prescription.

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To reduce the risk of relapse, patients should be engaged in psychosocial interventions such as described later in these guidelines. Patients who repeatedly relapse following withdrawal management are likely to benefit from methadone maintenance treatment or other opioid substitution treatment. Withdrawal symptoms vary according to the drug of dependence and severity of dependence, but often include nausea, vomiting, diarrhoea, anxiety and insomnia.

Protracted Withdrawal Syndrome (PWS)

• Should they use opioids, they must use a smaller amount than usual to reduce the risk of overdose.
• Although I refer to protracted withdrawal as drug neurotoxicity [emphasis added], it is still a bad idea to give the doctor a diagnosis rather than to present symptoms.
• These symptoms were often reported as de novo and distinct from the symptoms for which the benzodiazepines were originally prescribed.
• As withdrawal progresses, patients often find their physical and mental health improves with improved mood and improved cognition.

Many of these benzodiazepine users are at elevated risk for BIND, which may go undiagnosed. While most benzodiazepine users do not develop BIND, the risk factors for BIND are not known. Since benzodiazepines are among the most frequently prescribed drugs in the United States, treatments for BIND represent an urgent unmet medical need [25]. A total of 763 respondents reported they had discontinued benzodiazepines, of whom 426 stated they had been off benzodiazepines for a year or more. Adverse life consequences reported by those who had discontinued benzodiazepines for a year or more were deemed severe or worse by 55.9% to 83.6% of respondents.

Provide symptomatic treatment (see Table 3) and supportive care as required. This dose of diazepam (up to a maximum of 40mg) is then given to the patient daily in three divided doses. Even if the patient’s equivalent diazepam dose exceeds 40mg, do not give greater than 40mg diazepam daily during this stabilisation phase. Patients should drink at least 2-3 litres of water per day during withdrawal to replace fluids lost through perspiration and diarrhoea. Patients should be monitored regularly (3-4 times daily) for symptoms and complications.

• If consent was waived for your study, please include this information in your statement as well.
• As many as 5% of these patients may develop delirium tremens (DT) when they withdraw from chronic alcohol use.
• The survey asked about 23 specific symptoms and more than half of the respondents who experienced low energy, distractedness, memory loss, nervousness, anxiety, and other symptoms stated that these symptoms lasted a year or longer.
• The patient may be scared of being in the closed setting, or may not understand why they are in the closed setting.
• For example, doctors may recommend flumazenil (Romazicon) to help with severe withdrawal symptoms and other drugs, such as buspirone (BuSpar), to help people with severe anxiety symptoms.
• In the first instance, use behaviour management strategies to address difficult behaviour (Table 2).

Management of moderate to severe opioid withdrawal

Signs of chronic alcoholism may include spider angiomata, flushed facies, paralysis of extraocular muscles (Wernicke encephalopathy), poor dentition, skull or facial trauma (as a result of falls) and tongue lacerations (biting tongue during seizures). Other features of chronic alcohol use disorder include ascites, hepatosplenomegaly, severe benzodiazepine withdrawal syndrome and melena. Thinning of hair, spider angioma, and gynecomastia are all also seen in patients with chronic alcohol use disorder. The signs and symptoms of alcohol withdrawal may range from a simple tremor to a fully blown delirium tremens characterized by autonomic hyperactivity, tachypnea, hyperthermia, and diaphoresis.

Associated Data

If you take away the blockades gradually, your brain can reduce its chemical traffic to match. But if you remove the drug all at once, your brain doesn’t have enough time to prepare, and you can develop life-threatening symptoms like seizures. They can range in severity, though for some people, they remain mild and manageable. If you’re predisposed to seizures, your risk of having a seizure may also increase during the withdrawal period. Consequently, experts recommend you take benzodiazepines for no more than 2 weeks if you use them daily. If you only use them once every few days, you may be able to take them for up to 4 weeks.

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• Among people taking benzodiazepines for longer than six months, about 40% experience moderate to severe withdrawal symptoms when they quit suddenly.
• This is because the term detoxification has many meanings and does not translate easily to languages other than English.
• Low doses of clonidine can help reverse central adrenergic discharge, relieving tachypnea, tachycardia, hypertension, tremor, and craving for alcohol.
• There is some evidence that lithium carbonate may be an effective medication for cannabis withdrawal management.
• If we had a true account of how many people (millions) worldwide were taking benzodiazepines long-term, 10-15% of those would, no doubt, extrapolate to an enormous number of individuals at risk for protracted illness from benzodiazepine withdrawal.

Briefly addressing such elements of discussion would certainly contribute to making the article more comprehensive and well-rounded, which would be advisable in light of the uniquely consequential issues arising fron BDZs abuse. It is also worth mentioning the impact of the COVID-19 pandemic on abuse dynamics overall. The article has qualities and strengths which make it a praiseworthy scientific research contribution. It has considerable elements of novelty, relevance and thorougness as far as its stated objective is. The article is clear and straightforward overall, and the tables are meaningful and well conceived. More depth needs to be added to the Discussion, also mentioning “substitute” BDZ substances and the threat they pose in terms of detection and control, in addition to the psychiatric implications.

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