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Can You Die from Benzodiazepine Withdrawal?

Which Drugs Are Benzodiazepines?

hospital bed

Benzodiazepines are a type of central nervous system depressant, which slow activity in the brain.1 Doctors may prescribe benzodiazepines to treat anxiety, panic attacks, seizures, and alcohol withdrawal.1,2 They may also sometimes prescribe them for insomnia, though the “Z-drugs” like zolpidem (brand name Ambien) are considered by some to be safer.3

There are several different benzodiazepines on the market, including:4

  • Alprazolam (Xanax).
  • Diazepam (Valium).
  • Lorazepam (Ativan).
  • Clonazepam (Klonopin).
  • Temazepam (Restoril).

Benzodiazepines work by increasing the activity of an inhibitory neurotransmitter, GABA. 2 GABA’s inhibition of brain activity causes effects like drowsiness and relaxation.1

Benzos vary in their half-lives, or how quickly they are eliminated from the body, which impacts how long the effects of the drug are felt by the person.2

Benzodiazepines are typically prescribed only for short periods of time due to the high risk of users becoming tolerant to, dependent on, and/or addicted to them.1

Do They Cause Withdrawal?

Yes, suddenly stopping or greatly decreasing benzodiazepines may cause withdrawal.1 As stated above, they have a high risk for physical dependence, meaning the body comes to rely on the drug to function as expected.1,5 Without the benzodiazepine, they may experience withdrawal symptoms ranging from mild to life-threatening.6

The timeline for when withdrawal will begin and the severity of withdrawal symptoms can be dependent on various factors, including the regular dose as well as the half-life of the benzodiazepine.7

People who abruptly stop taking benzos or decrease the dose may experience physical and psychological withdrawal symptoms in response to the body no longer having the drug.1,8 These symptoms can be both uncomfortable and harmful. 8

Benzodiazepine withdrawal can bring about a wide range of symptoms such as::8,9

  • Headache.
  • Nausea.
  • Heart palpitations.
  • Hyperventilation.
  • Sweating.
  • Anxiety.
  • Panic attacks.
  • Insomnia.
  • Mood changes.
  • Depression.
  • Visual disturbances, such as blurred vision or light sensitivity.
  • Unusual sensations in the body.
  • Sensitivity to loud noise.
  • Derealization, or feeling out of touch with reality.
  • Depersonalization, or feeling like an observer of one’s life.10
  • Muscle spasms, pain, and stiffness.
  • Tremors.
  • Hallucinations.
  • Delirium.
  • Seizures.

Many benzodiazepine users who stop taking the drug experience rebound symptoms, which is a return of original symptoms, like anxiety or insomnia, but in greater severity.2,7

When Do Symptoms Occur?

While long-term benzodiazepine users are at higher risk for developing dependence and withdrawal, stopping benzos after as little as 4 weeks of use can result in withdrawal.2,8

The type of benzodiazepine impacts when withdrawal begins:11

  • Withdrawal from shorter-acting benzos which are absorbed quickly and don’t have an active metabolite, like Halcion, may begin within hours of stopping use and improve significantly by the 4th or 5th day.
  • Withdrawal from benzos with longer-acting metabolites, like Valium, may not start for 1-2 days or more and may last 3 or 4 weeks.

Is Withdrawal from Benzos Deadly?   

Benzodiazepine withdrawal can pose many medical and psychological dangers. Serious symptoms of benzo withdrawal can include sensory distortions, seizures, depression, paranoia, and delirium.8,9 In severe cases, benzodiazepine withdrawal seizures may lead to death.6

Serious psychological symptoms, such as depression, suicidal ideation, self-harming, homicidal ideation, mania, psychosis, and violent behaviors, can also occur and may threaten the life of the individual and/or those around them.2

Benzodiazepine withdrawal can be particularly dangerous for the elderly, people who are also dependent on and/or misusing alcohol or other drugs, individuals with a history of seizures, and people with unstable mental or physical health issues.9,12 Elderly people experiencing benzo withdrawal are at risk for heart attack and falls, as well as for delirium without increases in blood pressure, heart rate, or temperature.12

Withdrawal from benzos carries serious risks that should be considered when deciding how to detox. Fortunately, there are safe ways to detox from benzos for people wanting to quit. The risk of such symptoms may be reduced with medical detox where the benzodiazepine may be tapered slowly or where another medication may be substituted and then tapered.12,13

Can I Detox from Benzos Cold-Turkey?

Woman in bed

Detoxing from benzodiazepines cold turkey, or abruptly stopping them without any medical supervision, can lead to life-threatening complications and is not recommended.12 Rather than stopping benzos cold turkey, detoxing from benzos should be done in a medically supervised manner to reduce the risk of experiencing dangerous complications, such as seizures or delirium.12

Hospital-based detox is recommended for individuals who have been using benzos in high doses for a long period of time. For others, outpatient detox may be an option but is only recommended for patients who have been mainly using benzodiazepines in therapeutic doses, are not dependent on alcohol or other drugs, and are dependable and have dependable loved ones who can help monitor and supervise them.12

In the case of benzodiazepines, detox is safest when performed under close medical supervision. Often, the medical provider will work with a person to taper the drug slowly and carefully to avoid any serious problems during withdrawal. During a taper, a person will gradually take less of the drug over a period of weeks or months, which can help control withdrawal symptoms.12

While it may take longer to detox with a taper rather than cold turkey, it is safer. Alternatives to tapering with the drug the person is already taking include substituting either phenobarbital or a longer-acting benzo, like clonazepam (Klonopin) or chlordiazepoxide (Librium), and then tapering that medication. Treatment with other prescription medications for specific withdrawal symptoms, such anticonvulsants for seizures, may be provided.12

In addition, behavioral and cognitive methods may be helpful during detoxification.12 Some medical providers may provide brief therapy or education on coping skills, and/or they may refer the patient to a therapy provider or support group. More comprehensive medical detox centers or programs may offer group and individual therapy sessions and addiction support groups, like Narcotics Anonymous (NA), to help people cope with withdrawal and begin working on their recovery.

For those who are addicted to benzos, transitioning to either inpatient or outpatient treatment is the next step after detox. Detox alone is not sufficient addiction treatment, as it is not designed to address the long-term problems related to addiction.12 Addiction treatment may involve continued medication management or other interventions for protracted withdrawal symptoms that may persist, such as anxiety and depression.14 Behavioral therapy may help with various elements, such as increasing internal motivation, developing coping skills, and improving relationships, thereby reducing the risk of future relapses. Any co-occurring mental illnesses should also be treated through therapy and/or medication.15

Benzodiazepine withdrawal is a serious condition that poses medical and psychological risks. Benzodiazepine detox should not be done on one’s own; medical detox is the safest way to stop using benzodiazepines. For some individuals, an inpatient detox program is the best option to reduce the likelihood of serious adverse reactions and help prevent fatal outcomes. Medical detox can help you safely achieve abstinence and set you on a path toward a sober life.

References:

  1. National Institute on Drug Abuse. (2018). Misuse of prescription drugs.
  2. Lader, M. (2011). Benzodiazepines revisited—Will we ever learn?. Addiction106(12), 2086-2109.
  3. Agravat, AAsha. (2018). ‘Z’-hypnotics versus benzodiazepines for the treatment of insomnia. Progress in Neurology and Psychiatry, 22(2).
  4. Drug Enforcement Administration. (2013). Benzodiazepines.
  5. National Institute on Drug Abuse. (2007). The Neurobiology of Drug Addiction: 8: Definition of dependence.
  6. Greenberg, M. I. (2001). Benzodiazepine Withdrawal: Potentially Fatal, Commonly Missed: Following benzodiazepine cessation, withdrawal symptoms may begin within 24 hours or take up to two weeks to developEmergency Medicine News23(12), 18.
  7. Pétursson, H. (1994). The benzodiazepine withdrawal syndrome. Addiction, 89(11), 1455-9.
  8. Government of South Australia. (2019). Benzodiazepine withdrawal management.
  9. Brett J, Murnion B. Management of benzodiazepine misuse and dependenceAust Prescr. 2015;38(5):152–155.
  10. Spiegel, D. (2019). Depersonalization/Derealization Disorder.
  11. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association, 2013.
  12. Substance Abuse and Mental Health Services Administration. (2013). Detoxification and substance abuse treatment.
  13. National Institute on Drug Abuse. (2016). Understanding Drug Abuse and Addiction: What Science Says: 8: Medical detoxification.
  14. Semel Institute for Neuroscience and Human Behavior. (n.d.). Post-Acute Withdrawal Syndrome (PAWS).
  15. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Principles of Effective Treatment.

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