Benzodiazepine Withdrawal | Timeline & Symptoms

Benzodiazepines are a class of prescription central nervous system depressant drugs that act by stimulating gamma-aminobutyric acid (GABA) receptors in the brain with sedative (calming), hypnotic (sleep promoting), anxiolytic (stress reducing), anticonvulsant (seizure reversing), and muscle relaxant effects.

Common examples of benzodiazepine drugs include:

• lorazepam (Ativan)
• diazepam (Valium)
• alprazolam (Xanax)
• clonazepam (Klonopin)
• temazepam (Restoril)
• chlordiazepoxide (Librium)

These medications vary by potency, elimination half-life, and duration of effect, and each will be prescribed for different uses ranging from anesthesia to treatment of anxiety disorders, panic disorders, insomnia and other sleep disorders, muscle spasms, seizures, and more.

Unfortunately, these valuable medications are also prone to misuse and are known for producing severe physical dependence with prolonged use, especially if a person misuses the drug in high doses.

Benzodiazepine Withdrawal

If used properly in a medical context, there is a low risk that a person will experience problems with benzodiazepine withdrawal. Especially if the drug is taken only occasionally as a one-off dose when needed.

However, if these drugs are used regularly over a longer period of time they can quickly promote physical dependence leading to withdrawal symptoms when a person stops or reduces their dose.

As with severe acute alcohol withdrawal, these symptoms can sometimes be hazardous as the brain and body are thrown out of balance in the drug’s absence.

Experts strongly advise that those who are dependent on benzodiazepines participate in a tapering schedule to wean down their dosage gradually, giving the body more time to adjust without producing the same severe withdrawal symptoms that a person would experience when quitting a benzo cold-turkey.

Benzodiazepine Withdrawal Symptoms

The symptoms a person experiences as part of benzodiazepine withdrawal syndrome can vary depending on their health, support, self-care, the specific benzodiazepine and dosage they’ve been taking, and how long they have been taking it.

Commonly reported symptoms of acute benzo withdrawal include:

• abdominal cramping
• rebound anxiety or panic attacks
• depression
• muscle tension
• chest tightness
• elevated heart rate
• sweating
• trembling
• muscle twitching
• blurred vision
• concentration problems
• dizziness
• headaches
• increased sensitivity to light, noise, touch and smell
• loss of appetite and weight loss
• nausea and/or vomiting
• nightmares
• insomnia
• restlessness
• unsteadiness

Other more serious acute withdrawal symptoms are also possible, including:

• severe agitation or confusion
• painful or burning sensations on the skin
• psychosis and delusions, paranoia, and hallucination
• depersonalization or derealization
• seizures

Benzodiazepine Withdrawal Timeline

The timeline for benzodiazepine withdrawal will be different for short-acting benzodiazepines like alprazolam or lorazepam (known for more severe, rapid, and shorter-lasting withdrawal effects) when compared to long-acting drugs like diazepam or clonazepam (known for less severe, longer-onset, and longer-lasting withdrawal effects).

A generalized timeline of benzodiazepine discontinuation and the withdrawal process can be described as:

Early Withdrawal

This first phase usually begins within 6 to 12 hours after the last dose of a short-acting benzodiazepine, or 24 to 48 hours after the last dose of a long-acting benzodiazepine.
Symptoms will begin with a growing sense of anxiety, insomnia, restlessness, irritability, and other rebounding physical and psychological symptoms. This phase may last for a few days to a week.

Acute Withdrawal

This second phase may last from 5 days to two weeks or even longer and can involve intense agitation, depression, headache, nausea, muscle pain, tremors, sweating, heart palpitations, high blood pressure, seizures, and other symptoms.

Those facing acute benzo withdrawal will often be supported with medications, therapy, and peer support groups to address their physical, mental, and emotional needs.

Protracted Withdrawal Syndrome

As many as 1 in 10 individuals who detox from a benzodiazepine may experience certain prolonged withdrawal symptoms known as post-acute withdrawal syndrome, or PAWS.

This phase usually begins at least a month after the last dose of benzodiazepine and gradually subsides over a period of months or, sometimes, years.

PAWS symptoms are sudden and often appear without warning, involving tingling in the extremities, muscle twitches, anxiety, insomnia, depression, sensory sensitivity, mood swings, and cravings.

Treating Benzodiazepine Dependence/Addiction

Improper benzodiazepine use is dangerous not only for its short-term side effects and the potential for physical dependence and eventual withdrawal symptoms. It can also greatly increase a person’s long-term risk of developing mental health disorders, memory problems, sleep problems, and cognitive decline.

Benzodiazepine abuse can also lead to life-threatening effects in cases of drug overdose, especially if taken alongside other commonly abused substances like opioids, alcohol, and stimulants.

Instead of quitting cold turkey or continuing in long-term use, healthcare providers strongly recommend that those who are dependent on these drugs participate in a regimented tapering program followed by medical detoxification and substance abuse treatment.

This may include either inpatient or outpatient treatment that provides counseling, behavioral therapy, dual-diagnosis treatment for co-occurring mental disorders like depression or anxiety, and aftercare support to promote a long-lasting recovery from drug abuse.

For information on our inpatient substance use disorder treatment options, please contact us today.