Benzodiazepine withdrawal is the set of physical and mental symptoms that start when someone lowers or stops a benzo their body has become used to. Symptoms range from anxiety and poor sleep to seizures in severe cases. Because stopping suddenly can be dangerous, benzo withdrawal should be planned and managed with a doctor.
What are benzodiazepines?
Benzodiazepines are prescription sedatives that slow down activity in the brain and nervous system. Doctors prescribe them for anxiety, panic disorder, insomnia, seizures and muscle spasms. Common examples include alprazolam (Xanax), lorazepam (Ativan), clonazepam (Klonopin) and diazepam (Valium).
These medicines boost GABA, a brain chemical that calms nerve activity. With regular use, the brain adjusts to having the drug present. That adjustment is called physical dependence, and it is the reason withdrawal symptoms appear when the dose drops.
Can you go through benzo withdrawal when taking them as prescribed?
Yes. Physical dependence can develop even when a person takes a benzodiazepine exactly as prescribed. Long-term benzodiazepine use raises the chance of withdrawal, but it can happen after shorter use too. The FDA requires a boxed warning on benzodiazepines about the risks of dependence and withdrawal reactions.
Dependence is not the same as addiction. Some people also develop a sedative use disorder, which means they keep using despite harm or take more than prescribed. Either way, the answer is a medical plan rather than stopping alone.
What are benzo withdrawal symptoms?
Withdrawal symptoms vary with the drug, the dose, how long it was taken, and a person's other medical conditions. Many people have a mix of physical symptoms and psychological symptoms.
Common physical symptoms
- Trouble sleeping, or broken, restless sleep
- Tremors, sweating and a racing heart
- Muscle aches, stiffness or twitching
- Headaches, nausea and loss of appetite
- Changes in blood pressure
- Sensitivity to light, sound or touch
Common psychological symptoms
- Anxiety and panic, including panic attacks
- Irritability and trouble concentrating
- Low mood or depression
- Feeling unreal, or feeling detached from your body
Severe withdrawal can include seizures, confusion, hallucinations and psychosis. These are medical emergencies.
How severe are the symptoms of withdrawal?
The severity of benzodiazepine withdrawal ranges from mild discomfort to a life-threatening withdrawal syndrome. Higher doses, longer use and a fast drop in dose all raise the risk of severe withdrawal. A history of seizures, or withdrawal from alcohol at the same time, raises the risk further.
It is hard to predict severity in advance, so a healthcare professional should assess each person before they cut down.
Why is it dangerous to stop benzodiazepines suddenly?
Abrupt withdrawal, often called quitting cold turkey, is the most dangerous way to stop. The brain has adjusted to the drug, and removing it all at once can overwhelm the nervous system. Sudden discontinuation can trigger seizures, which can be fatal.
Can benzodiazepine withdrawal cause seizures if you stop suddenly?
Yes. Seizures are one of the most serious risks of stopping a benzo suddenly, especially after regular use at higher doses. They can happen even in people who have never had a seizure before. This is why withdrawal management needs medical supervision.
How can you stop benzodiazepines safely?
To safely stop taking benzodiazepines, talk with the doctor who prescribes them before you change anything. A doctor usually lowers the dose gradually and adjusts the plan based on how you feel.
Do not change your dose on your own, and do not use alcohol, other sedatives or someone else's pills to manage symptoms. Tell your doctor about every medicine and substance you use, because that changes the plan.
Can I take myself off benzodiazepines?
Stopping on your own is not recommended. Without medical guidance, it is easy to lower the dose too fast and trigger severe withdrawal symptoms. A doctor can also treat withdrawal symptoms such as poor sleep or anxiety as they come up.
What is the typical benzodiazepine withdrawal timeline?
The withdrawal timeline depends mostly on the drug. Short-acting benzodiazepines like Xanax (alprazolam) and lorazepam leave the body quickly, so symptoms tend to start sooner. Long-acting benzodiazepines, such as diazepam and clonazepam, leave the body slowly, so symptoms often start later and build more gradually.
How long do diazepam withdrawal symptoms last?
Because diazepam is long-acting, its withdrawal symptoms may take longer to appear than with Xanax. They can also last longer once they start. How long symptoms last differs from person to person, which is why a doctor tracks progress rather than working from a fixed calendar.
What is protracted benzodiazepine withdrawal?
Protracted withdrawal is when some symptoms continue well after the acute phase has passed. Anxiety, low mood, trouble sleeping and poor concentration are the most common lingering symptoms. They usually ease over time, and ongoing treatment for mental health can help during this stage.
How is rebound anxiety different from benzodiazepine withdrawal symptoms?
Rebound anxiety is the return of the original anxiety or insomnia, often stronger than before, after the medicine is lowered. Withdrawal symptoms include new problems, such as tremors, sensory sensitivity or seizures. Rebound anxiety and withdrawal symptoms can happen together, so a clinician needs to tell them apart and treat the anxiety and panic that led to the prescription.
Why is benzo withdrawal riskier when alcohol or opioids are involved?
Co-occurring alcohol or opioid use makes benzo withdrawal more complicated and more dangerous. Alcohol acts on the same brain system, and alcohol withdrawal can also cause seizures. Mixing benzos with opioids or alcohol raises the risk of slowed breathing and overdose.
If you use more than one substance, tell your care team so they can plan withdrawal from each one safely.
When to seek emergency care
Call 911 or go to the nearest emergency room if you or someone else has any of these during withdrawal:
- A seizure, or shaking that will not stop
- Confusion, hallucinations or not knowing where they are
- Chest pain, a very fast heartbeat or trouble breathing
- Signs of overdose, such as slowed breathing or not waking up
If withdrawal brings thoughts of suicide, call or text 988 right away.
What happens during medically supervised detox?
Medically supervised detox manages withdrawal symptoms under the care of a medical team. Medication can be used to ease withdrawal where needed. Enhance Health Group offers medically supervised detox for people stopping benzodiazepines.
Detox is a first step, not a cure. After detox, most people move into another level of care, such as residential, PHP or IOP. Therapy in those programs supports recovery by treating the anxiety, panic disorder or other mental health concerns that often sit underneath benzodiazepine use.
Getting help with benzodiazepine withdrawal
You can read about benzodiazepine addiction treatment at Enhance to see how care continues after detox. Call admissions at (714) 862-1907 to talk about which level of care fits and to check your insurance. Benefits vary by plan, and a verification is not a promise of coverage.
