Withdrawal
As benzodiazepines work directly on the CNS they affect our entire bodily and mental functions and can cause all manner of symptoms from the totally unexpected through to the seemingly bizarre.
Below is a list of some of the more common ones. For a more comprehensive list of withdrawal symptoms, please see the Benzodiazepines Symptoms Index at benzo.org.uk
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People tend to think of withdrawal as occurring upon cessation. However, through my experience and expert opinions, I learnt there are several different stages of withdrawal (as confirmed in The Ashton Manual).
- Withdrawal symptoms during the treatment (once tolerance develops this can occur even while the drugs are still being taken)
- Withdrawal symptoms during the reduction process
- Withdrawal symptoms following complete cessation
- Withdrawal symptoms that can continue for months or even years after stopping (“protracted withdrawal” or long term effects)
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Below are just a few of the very many withdrawal symptoms that have been reported by patients in withdrawal (quoted from The Ashton Manual).
PSYCHOLOGICAL SYMPTOMS
- Excitability (jumpiness, restlessness)
- Insomnia, nightmares, other sleep disturbances
- Increased anxiety, panic attacks
- Agoraphobia, social phobia
- Perceptual distortions
- Depersonalisation, derealisation
- Hallucinations, misperceptions
- Depression
- Obsessions
- Paranoid thoughts
- Rage, aggression, irritability
- Poor memory and concentration
- Intrusive memories
- Craving (rare)
PHYSICAL SYMPTOMS
- Headache
- Pain/stiffness - (limbs, back, neck, teeth, jaw)
- Tingling, numbness, altered sensation - (limbs, face, trunk)
- Weakness ("jelly-legs")
- Fatigue, influenza-like symptoms
- Muscle twitches, jerks, tics, "electric shocks"
- Tremor
- Dizziness, light-headedness, poor balance
- Blurred/double vision, sore or dry eyes
- Tinnitus
- Hypersensitivity - (light, sound, touch, taste, smell)
- Gastrointestinal symptoms - (nausea, vomiting, diarrhoea, constipation, pain, distension, difficulty swallowing)
- Appetite/weight change
- Dry mouth, metallic taste, unusual smell
- Flushing/sweating/palpitations
- Overbreathing
- Urinary difficulties/menstrual difficulties
- Skin rashes, itching
- Fits (rare)
For a more comprehensive list of withdrawal symptoms and side-effects, see the Benzodiazepines Symptoms Index at benzo.org.uk
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Some Protracted Benzodiazepine Withdrawal Symptoms (quoted from The Ashton Manual).
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| Anxiety | - Gradually diminishing over a year |
| Depression | - May last a few months; responds to antidepressant drugs |
| Insomnia | - Gradually diminishing over 6-12 months |
| Sensory symptoms: tinnitus, tingling, numbness, deep or burning pain in limbs, feeling of inner trembling or vibration, strange skin sensations | - Gradually receding but may last at least a year and occasionally several years |
| Motor symptoms: muscle pain, weakness, painful cramps, tremor, jerks, spasms, shaking attacks | - Gradually receding but may last at least a year and occasionally several years |
| Poor memory and cognition | - Gradually receding but may last at least a year and occasionally several years |
| Gastrointestinal symptoms | - Gradually improving but may last a year and occasionally several years |
For a more comprehensive list of withdrawal symptoms and side-effects, see the Benzodiazepines Symptoms Index at benzo.org.uk
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Repeated (incorrect) withdrawals can result in kindling, making each successive attempt more difficult, so a slow appropriate withdrawal from the outset is very important.
Kindling can occur with benzodiazepines as well as with other psychotropic drugs. It is basically a concept that the brain and CNS have “memory” of previous insults / withdrawals, and each event is more severe.
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Wanted
If anyone has access to a professional video clip that shows withdrawal symptoms, especially one with visual examples, please contact. Thank you.
Here is an example of what I’m looking for but in English.
"It is more difficult to withdraw people
from benzodiazepines than it is from heroin"
Professor Malcolm Lader: Emeritus Professor of Clinical Psychopharmacology, Institute of Psychiatry, University of London, England, Adviser to the World Health Organisation on drugs used in psychiatry (Ran a Benzodiazepine Withdrawal Clinic in London and has published more than 100 papers on the subject of benzodiazepines).
Experts say, compared to other addictive drugs, benzodiazepines are some of the most difficult to withdrawal from.
“It's more difficult to withdraw people from benzodiazepines than it is from heroin – it just seems that the dependence is so ingrained and the withdrawal symptoms you get are so intolerable that people have a great deal of problem coming off. The other aspect is that with heroin usually the withdrawal is over within a week or so. With benzodiazepines a proportion of patients go on to long-term withdrawal and they have very unpleasant symptoms for month after month and I get letters from people saying that it can go on for 2 years or more. Some of the tranquilliser groups can document people who still have symptoms 10 years after stopping.” (Source: Professor Malcolm Lader, BBC Radio 4, Face the Facts, broadcast on March 16, 1999)
In 1978, Prof. Lader called these drugs "the opium of the masses" because of the very high prescribing rates. In 1981 he warned that in the context of tranquilliser addiction "there is an epidemic in the making" and in 1988 he stated that this was the biggest medically-induced problem of the late 20th Century (Source: http://www.benzo.org.uk/lader2.htm).
And guess what? Nothing's changed...See "Who's Responsible?"
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The Ashton Manual is available here
See The Ashton Manual for expert information on withdrawal.
Or visit: benzo.org.uk which houses extensive information and literature from experts and people in the know.
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WARNING
- Any information given on this site should not be substituted for the advice of a physician who is well-informed about benzodiazepine dependency and withdrawal.
- All information given here is therefore to be followed at your own risk (See Disclaimer).
- Abrupt cessation of benzodiazepines may be very dangerous. Always consult your prescriber if you are considering making any changes.
Don’t think benzos are dependence forming on prescription doses?
Think again!
“Tolerance and dependence can develop if benzodiazepines are used regularly for longer than 2-4 weeks. There is no minimum dose, for example tolerance and dependence have been observed after the regular use of 2.5-5mg of diazepam.”
Professor Heather Ashton: Emeritus Professor of Clinical Psychopharmacology, University of Newcastle upon Tyne, England
Did You Know?
Tolerance doesn’t always develop across all symptoms.
For example, someone might develop tolerance to the hypnotic (promotion of sleep) effects but not to the anxiolytic (anxiety relief) effects, or they might develop tolerance to some symptoms of anxiety and not others. Tolerance to the various actions of benzodiazepines develops at variable rates and to different degrees (See The Ashton Manual).
The Ashton Manual contains expert advice on benzodiazepines and how to withdrawal written by world renowned expert Prof. Heather Ashton.
The withdrawal schedules provided in the manual are only intended as "general guides". Each person's experience of withdrawal is unique and the course of withdrawal depends on many factors.
“It is more difficult to withdraw people from benzodiazepines than it is from heroin.”
Professor Malcolm H Lader
Institute of Psychiatry London
BBC Radio 4, Face The Facts
March 16, 1999
“Withdrawal symptoms can last months or years in 15% of long-term users. In some people, chronic use has resulted in long-term, possibly permanent disability.”
Professor C Heather Ashton
DM, FRCP,
Good Housekeeping, 2003
Each one of us has a different experience of withdrawal.
The duration and degree of intensity can vary depending on the individual and there are many reasons for this.
Ever wonder why the diazepam conversion rates differ from source to source?
Addictive Medicine Specialist, Dr. Graeme Judson explains as follows:
“The rate used for converting Diazepam equivalents tends to differ from source to source. This is because individual variation in clinical responses to “equivalent” doses can vary so close monitoring of patient response to substitution is necessary when converting from one Benzodiazepine to another.”