Benzodiazepine withdrawal syndrome
Benzodiazepine withdrawal syndrome (or as I call it, benzodiazepine withdrawal injury) is a variable compilation of physical and mental symptoms that can occur when a person who is physically dependent on benzos reduces their dose. Physical dependence can occur even when the medication was prescribed by a doctor and taken as prescribed.
Widely ranging symptoms
A wide variety of complaints characterize benzodiazepine withdrawal syndrome. I have documented a list myself. The following is not an exhaustive list, but these symptoms are documented in the literature and frequently cited in support groups. Sleep disturbances, irritability, increased tension and anxiety, panic attacks, hand tremors, muscle tremors, sweating, difficulty concentrating, intense dreams during sleep, confusion and cognitive problems, memory problems, retching and nausea, weight loss, palpitations, headache, muscle pain and stiffness, a large number of perceptual changes including hypersensitivity to light and sound, change in taste registration in the mouth, hallucinations, seizures, psychosis, [1] an increased risk of suicide [2] [3]. Furthermore, these symptoms are notable for their waxing and waning tendencies. They can disappear and vary in severity from day to day or week after week rather than steadily decreasing in a simple linear fashion. [4]
Tapering too quickly is not without risk
HBWS can be a critical condition, have a complex course, and healing often takes a long time. [5] [6] Long-term use of benzodiazepines, defined as daily use for at least four weeks is not desirable due to the associated increased risk of physical dependence, loss of efficacy, increased risk of accidents and falls, especially for the elderly, [9] as well as cognitive, neurological, intellectual and emotional limitations. The use of short-acting hypnotics, although effective in initiating sleep, worsen the second half of sleep due to withdrawal symptoms. (REM sleep) [12] Nevertheless, long-term users of benzodiazepines should never be forced to taper the medication against their will. [5] Benzodiazepine withdrawal can be severe and can cause life-threatening withdrawal symptoms such as seizures [13], especially with abrupt or rapid dose reduction. [5] Despite gradual dose reduction or relatively low doses in short-term users, severe withdrawal syndrome can still occur [14]. It has even been shown to occur after a single large dose in an animal study. [15] [16] A minority of people will experience a long-term withdrawal syndrome. In this situation, the symptoms may persist at a subacute level for months or even years after benzodiazepine discontinuation. The probability of developing long-term withdrawal syndrome can be minimized by a slow, gradual dose reduction [17].
Neurological/physical change
Regular exposure to benzodiazepines causes neurological and physiological changes that counteract the effects of the drug, leading to tolerance and dependence. [18] Despite taking a therapeutic dose, long-term use of benzodiazepines can lead to withdrawal symptoms, particularly between intakes. [19] When the drug is stopped, or the dose is reduced, withdrawal symptoms can occur and persist until the body reverses the physiological adjustments [20]. The withdrawal symptoms may be identical to the symptoms for which the drug was initially taken, but can be part of the withdrawal symptoms. [21] In severe cases, the withdrawal reaction is more likely to aggravate symptoms, it may resemble serious psychiatric and medical conditions, such as mania, schizophrenia, and, especially at high doses, epileptic disorders. [22] Failure to recognize withdrawal symptoms may lead to an incorrect assessment of the need to take benzodiazepines, which in turn leads to failure of a quit attempt and restart of benzodiazepine use, often in higher doses because otherwise, the symptoms will not disappear [22]
To increase the chances of a successful taper, you need awareness of withdrawal symptoms. Also, individualized tapering strategies that take into account the severity of the complaints that arise and the deployment of alternative approaches such as continuous reassurance and referral to benzodiazepine withdrawal support groups. [23.24]
Bronnen
1. Petursson, H. (1994). "The benzodiazepine withdrawal syndrome". Addiction. 89 (11): 1455–9. doi:10.1111/j.1360-0443.1994.tb03743.x. PMID 7841856.
2. Colvin, Rod (26 August 2008). Overcoming Prescription Drug Addiction: A Guide to Coping and Understanding (3 ed.). United States of America: Addicus Books. pp. 74–76. ISBN 978-1-886039-88-9. “I have treated ten thousand patients for alcohol and drug problems and have detoxed approximately 1,500 patients for benzodiazepines – the detox for the benzodiazepines is one of the hardest detoxes we do. It can take an extremely long time, about half the length of time they have been addicted – the ongoing relentless withdrawals can be so incapacitating it can cause total destruction to one’s life – marriages break up, businesses are lost, bankruptcy, hospitalization, and of course suicide is probably the most single serious side effect.”
3. Dodds TJ (2017). "Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature". Primary Care Companion for CNS Disorders. 19 (2). doi:10.4088/PCC.16r02037. PMID 28257172.
4. C. Heather Ashton DM. "Chapter III: Benzodiazepine withdrawal symptoms, acute & protracted". Institute of Neuroscience, Newcastle University. Retrieved 29 April 2013. “Benzodiazepines : How they work and how to withdraw”
5. Professor Heather Ashton (2002). "Benzodiazepines: How They Work and How to Withdraw". Archived from the original on 15 September 2011.
6. O'Connor, RD (1993). "Benzodiazepine dependence--a treatment perspective and an advocacy for control". NIDA Research Monograph. 131: 266–9. PMID 8105385.
7. Voshaar, R. C. O.; Couvée, JE; Van Balkom, AJ; Mulder, PG; Zitman, FG (2006). "Strategies for discontinuing long-term benzodiazepine use: Meta-analysis". British Journal of Psychiatry. 189 (3): 213–20. :10.1192/bjp.189.3.213. PMID, 16946355.
8. Nutt, David (1986). "Benzodiazepine dependence in the clinic: Reason for anxiety?". Trends in Pharmacological Sciences. 7: 457–60. doi: 10.1016/0165-6147(86)90420-7.
9. De Gier, N.; Gorgels, W.; Lucassen, P.; Oude Voshaar, R.; Mulder, J.; Zitman, F. (2010). "Discontinuation of long-term benzodiazepine use: 10-year follow-up". Family Practice. 28 (3): 253–9. d:10.1093/fampra/cmq113. 21193495.
10. Authier, Nicolas; Boucher, Alexandra; Lamaison, Dominique; Llorca, Pierre-Michel; Descotes, Jacques; Eschalier, Alain (2009). "Second Meeting of the French CEIP (Centres d'Évaluation et d'Information sur la Pharmacodépendance). Part II: Benzodiazepine Withdrawal". Thérapie. 64 (6): 365–70. doi:10.2515/therapie/2009051. PMID 20025839.
11. Heberlein, A.; Bleich, S.; Kornhuber, J.; Hillemacher, T. (2008). "Benzodiazepin-Abhängigkeit: Ursachen und Behandlungsmöglichkeiten" [Benzodiazepine Dependence: Causalities and Treatment Options]. Fortschritte der Neurologie · Psychiatrie (in German). 77 (1): 7–15. doi:10.1055/s-0028-1100831. PMID 19101875
12. Lee-chiong, Teofilo (24 April 2008). Sleep Medicine: Essentials and Review. Oxford University Press, USA. p. 468. ISBN 978-0-19-530659-0.
13. Evans, Katie; Sullivan, Michael J. (2001). "Withdrawal and Medical Issues". Dual Diagnosis: Counseling the Mentally Ill Substance Abuser (2nd ed.). Guilford Press. pp. 52–3. ISBN 978-1-57230-446-8. Archived from the original on 3 May 2018.
14. Lader, M (1987). "Long-term anxiolytic therapy: The issue of drug withdrawal". The Journal of Clinical Psychiatry. 48 Suppl: 12–6. PMID 2891684.
15. Boisse, NR; Periana, RM; Guarino, JJ; Kruger, HS; Samoriski, GM (1986). "Pharmacologic characterization of acute chlordiazepoxide dependence in the rat". Journal of Pharmacology and Experimental Therapeutics. 239 (3): 775–83. PMID 3098961.
16. Boisse, NR; Periana, RM; Guarino, JJ; Kruger, HS (1986). "Acute chlordiazepoxide dependence in the rat: Comparisons to chronic". NIDA Research Monograph. 67: 197–201. PMID 3092067.
17. Professor Heather Ashton (2004). "Protracted Withdrawal Symptoms From Benzodiazepines". Comprehensive Handbook of Drug & Alcohol Addiction.
18. Allison, C; Pratt, J.A (2003). "Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence". Pharmacology & Therapeutics. 98 (2): 171–95. doi:10.1016/S0163-7258(03)00029-9. PMID 12725868.
19. Herman, JB; Brotman, AW; Rosenbaum, JF (1987). "Rebound anxiety in panic disorder patients treated with shorter-acting benzodiazepines". The Journal of Clinical Psychiatry. 48 Suppl: 22–8. PMID 2889722.
20. Allgulander, C; Bandelow, B; Hollander, E; Montgomery, SA; Nutt, DJ; Okasha, A; Pollack, MH; Stein, DJ; Swinson, RP; World Council Of, Anxiety (2003). "WCA recommendations for the long-term treatment of generalized anxiety disorder". CNS Spectrums. 8 (8 Suppl 1): 53–61. doi:10.1017/S1092852900006945. PMID 14767398.
21. Salzman, Carl (1993). "Benzodiazepine treatment of panic and agoraphobic symptoms: Use, dependence, toxicity, abuse". Journal of Psychiatric Research. 27: 97–110. doi:10.1016/0022-3956(93)90021-S. PMID 7908335.
22. Gabbard, Glen O. (15 May 2007). Gabbard's Treatments of Psychiatric Disorders, Fourth Edition (Treatments of Psychiatric Disorders). American Psychiatric Publishing. pp. 209–211. ISBN 978-1-58562-216-0
23. Onyett, SR (1989). "The benzodiazepine withdrawal syndrome and its management". The Journal of the Royal College of General Practitioners. 39 (321): 160–3. PMC 1711840. PMID 2576073.
24. Ashton, Heather (1991). "Protracted withdrawal syndromes from benzodiazepines". Journal of Substance Abuse Treatment. 8 (1–2): 19–28. doi:10.1016/0740-5472(91)90023-4. PMID 1675688.