Withdrawal from Benzodiazepines: Symptoms, Safety, and Treatment - Healthline
Benzodiazepines are a powerful class of medication used to treat anxiety, insomnia, and panic disorder. Examples of benzodiazepines include alprazolam (Xanax) and diazepam (Valium).
While they can quickly relieve symptoms of anxiety and panic, these drugs pose a high risk of dependence. In other words, your body may rely on benzodiazepines to function if you take them frequently and for more than a short period of time. When you stop taking them, you may experience symptoms of withdrawal.
Dependence and withdrawal can happen to anyone, even if you take your medication exactly as instructed.
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.
If you take benzodiazepines infrequently, such as once a week or once every few weeks to treat panic attacks, you can take them for a longer period of time. This is because inconsistent use doesn't pose the same risk of dependence or withdrawal.
If you want to stop taking benzodiazepines after consistent long-term use, your doctor can help you gradually taper off your medication. Tapering can help take the edge off withdrawal symptoms like tremors and nausea, though it may not prevent withdrawal symptoms entirely.
It's incredibly important to follow your doctor's guidance when you stop taking benzodiazepines. If you stop taking them "cold turkey," or all at once, you may experience severe, even life threatening, withdrawal symptoms.
Read on to learn more about benzodiazepine withdrawal, including the signs, how long it lasts, and how to get support with tapering off safely.
Benzodiazepine withdrawal can involve short-term symptoms, rebound symptoms, and long-term symptoms.
Short-term symptoms
Short-term withdrawal symptoms happen shortly after you discontinue your medication.
Short-acting benzodiazepines, like triazolam, pass quickly through the body, so you'll likely experience withdrawal symptoms sooner — sometimes within a matter of hours.
If you take an intermediate-acting benzodiazepine, like alprazolam, or a long-acting benzodiazepine, like diazepam, it may take longer for withdrawal symptoms to appear. For instance, you may not notice symptoms for several days.
The most common symptoms include:
If you're predisposed to seizures, your risk of having a seizure may also increase during the withdrawal period.
These symptoms usually last 2 to 4 weeks, at most. They can range in severity, though for some people, they remain mild and manageable.
Rebound symptoms
Experiencing rebound symptoms means the symptoms you had before taking benzodiazepines come back even stronger than before. The most common rebound symptoms are insomnia and anxiety.
Short-acting benzodiazepines are much more likely to cause rebound symptoms. In fact, if you take your medication every other day, you may notice rebound symptoms on the day between doses.
Once you stop taking benzodiazepines, rebound symptoms may last up to 3 weeks after your last dose.
Long-term symptoms
If you've taken benzodiazepines at high doses for an extended period, you may experience long-term withdrawal symptoms, also called post-acute withdrawal syndrome (PAWS) or protracted withdrawal.
Benzodiazepine-related PAWS can last around 6 to 12 months, although some symptoms can last for years. According to a 2022 internet survey of 1,207 people, the most common long-term symptoms included:
Among respondents whose symptoms lasted months or years, over half said caffeine or alcohol worsened their PAWS symptoms.
Benzodiazepines have a sedative effect because of how they work in your brain. These drugs mimic the effects of a neurotransmitter called gamma aminobutyric acid (GABA). GABA acts as a sort of speed bump that helps all the other chemical messengers travel through your brain at a reasonable pace.
When benzodiazepines attach to your neurons, they invite a bunch of
After a month or so, your brain gets used to sending off more neurotransmitters just so some can get past the benzodiazepine blockade.
But when you start removing benzodiazepines from your system, suddenly your clogged neurons become an open freeway with no traffic lanes. All those extra chemicals flood your brain, and the excess activity causes symptoms like anxiety and sweating.
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.
That's what makes it essential to stop taking benzodiazepines slowly, with support from a medical professional.
Overall effects on everyday life
In addition to the immediate health risk, benzodiazepine withdrawal can seriously affect your quality of life.
The 2022 survey mentioned above also asked respondents to what extent withdrawal symptoms affected their lives. They could rate each problem as nonexistent, mild, moderate, severe, quite severe, or enormous.
People rated withdrawal as having a significant (severe or higher) impact on the following areas of life:
- Fun, recreation, and hobbies: 73.6% reported a significant impact
- Work: 68.4% reported a significant impact
- Ability to take care of home or dependents: 67.6% reported a significant impact
- Social interaction and friendships: 64% reported a significant impact
- Relationships with their spouse or family: 61.7% reported a significant impact
- Ability to drive or walk: 47.3% reported a significant impact
In addition, over half of the survey respondents said benzodiazepines' side effects or withdrawal symptoms caused them to consider suicide.
A therapist or other mental health professional can offer support with navigating these effects and helping improve your overall quality of life during the withdrawal period.
Tapering may not prevent benzodiazepine withdrawal, but it can help minimize the symptoms you experience.
When tapering off benzodiazepines, you'll always want to work with a trained healthcare professional who can monitor you for side effects and adjust your pace accordingly.
Your tapering regimen will depend on several factors, including:
- the amount and frequency of your original dose
- whether you took a short-acting or long-acting benzodiazepine
- how long you took the medication
- any pre-existing health concerns
- how well your body tolerates withdrawal symptoms
Medical experts continue to debate the best way to taper these medications, so there's no single agreed-upon approach.
In most cases, your doctor will reduce your dosage by 5% to 25% in the first week. Every 1 to 4 weeks after that, they'll reduce your dose by another 5% to 25% of the original dose.
People tapering off the same original dosage of medication can have drastically different tapering experiences.
For example, say you're tapering off a dose of 20 milligrams (mg) of diazepam (Valium). A very quick taper would involve reducing the dose by 5 mg (25%) each week. It would take 4 weeks to finish this taper.
A slow taper would involve reducing your dose by 1 mg (5%) every 4 weeks. It would take at least a year and a half to finish this taper.
Most tapering schedules fall somewhere in between these two extremes. That said, extended tapering regimens aren't uncommon: In the 2022 survey, at least 1 in 10 people who discontinued benzodiazepines took at least a year to complete their taper.
Difficult tapers
Of course, tapering isn't always simple and linear. You may have to pause, slow down, or speed up depending on how your body reacts to withdrawal.
Research shows you're more likely to have a challenging taper if you:
- previously attempted to taper off
- have a history of substance use disorder (SUD)
- have co-occurring mental health issues, especially a personality disorder
- have chronic health concerns
- are over the age of 65
- lack social support
- have an unsympathetic primary care physician
These factors don't guarantee you'll have severe withdrawal symptoms, but they can increase your vulnerability. So, your doctor may recommend a slower taper schedule as a safety precaution.
Tapering off supratherapeutic doses
Tapering can also involve some complications if you're tapering off supratherapeutic doses of benzodiazepines. A supratherapeutic dosage means you've been taking more than what experts consider the maximum "safe" dose, which can vary by medication:
- Alprazolam (Xanax): over 4 mg per day
- Clonazepam (Klonopin): over 4 mg per day
- Lorazepam (Ativan): over 8 mg per day
- Diazepam (Valium): over 30 mg per day
- Chlordiazepoxide (Librium): over 40 mg per day
People with benzodiazepine tolerance may take supratherapeutic doses because the recommended range no longer provides relief for their symptoms. The higher dose may help ease your symptoms, but it can also increase your risk of overdose and severe withdrawal symptoms.
In the first week of tapering off, your doctor may reduce your dose as much as 30% to get you to a safe amount. After that first leap, the steps become smaller, usually 5% to 10% of the original dose. Depending on your situation, your doctor may reduce your dose on a monthly, weekly, or even daily basis.
If you experience unpleasant withdrawal symptoms during your taper, your care team can help you explore options to address those symptoms and get relief.
Tapering changes
Sometimes altering your tapering schedule can reduce withdrawal symptoms. Some expert-recommended strategies include:
- switching to a long-acting benzodiazepine
- stopping for a few months at the 50% mark so your body can stabilize
- slowing down the pace at the very end of the taper
Medication
Some medications may also help treat your withdrawal symptoms. While experts have yet to find a gold standard medication for treating benzodiazepine withdrawal, your doctor may prescribe one or more of the following medications off-label:
Some supplements, such as valerian and melatonin, might also help you get some relief from your symptoms, but research has found mixed results. Your care team can offer more guidance on safely trying these supplements.
Other interventions
Though therapy generally can't address withdrawal symptoms specifically, it can help improve some symptoms, like anxiety and insomnia.
According to the National Center for PTSD, the most beneficial kind of therapy for benzodiazepine withdrawal is cognitive behavioral therapy (CBT). This type of therapy can help you challenge and reframe unhelpful beliefs and behaviors and replace them with more productive ones.
Your therapist can also teach you sleep hygiene and relaxation techniques.
Emerging research also suggests acceptance and commitment therapy (ACT) could also have benefits during benzodiazepine withdrawal. This approach helps you learn to tolerate discomfort and distress, instead of avoiding it, and choose to live according to your values.
Benzodiazepines are only intended for short-term use: usually a few weeks, at most. Long-term use raises your risk of experiencing withdrawal symptoms when you stop taking the medication.
Stopping benzodiazepines all at once can be dangerous, so your doctor will likely guide you through a tapering regimen that involves gradually reducing your dose over time. If you experience severe withdrawal symptoms during tapering, tell your doctor so they can adjust your care plan as needed.
Emily Swaim is a freelance health writer and editor who specializes in psychology. She has a BA in English from Kenyon College and an MFA in writing from California College of the Arts. In 2021, she received her Board of Editors in Life Sciences (BELS) certification. You can find more of her work on GoodTherapy, Verywell, Investopedia, Vox, and Insider. Find her on Twitter and LinkedIn.
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