| Some benzodiazepines are widely and successfully | | | | The conflicting reports regarding the duration of |
| used as short-term treatment in certain settings such | | | | withdrawal and whether or not protracted withdrawal |
| as in hospitals as pre-medication before operations, | | | | exists poses one of the biggest problems for |
| for nervous patients before a dental procedure, and | | | | patients. Withdrawal can last as short as between 5 |
| in the treatment of some forms of epilepsy and | | | | and 28 days for those with mild dependencies. |
| movement disorders. They are also used in the | | | | However, there are many cases where symptoms |
| management of alcohol withdrawal as they work to | | | | persist for longer and these patients are told the |
| alleviate delirium tremens. While many doctors are | | | | withdrawal period has ended and the problems are "all |
| aware of the dependency and withdrawal issues | | | | in the head". Furthermore, as alternative diagnoses |
| related to their long-term use, others are still limited in | | | | are queried additional emotional energy is expended |
| their knowledge and may consequently give | | | | awaiting diagnostic tests results which are usually |
| substandard care, often putting their patients' safety | | | | negative. When every test is exhausted, the |
| at risk. | | | | suggestion that the problems are psychogenic in |
| The following are useful points to be considered | | | | origin and nothing to do with withdrawal is inevitably |
| when withdrawing a patient from a benzodiazepine: | | | | made. This misinformation does not augur well for |
| Symptoms | | | | the unfortunate patients who then become |
| When taken long-term (more than four weeks), the | | | | concerned about the implied possibility of |
| patient can become dependent on the drug and may | | | | psychological disorders only to find that the |
| experience withdrawal symptoms when it is | | | | symptoms disappear once the protracted period |
| discontinued. This withdrawal experience is unique and | | | | ends. |
| symptoms vary according to individual. Common | | | | Benzo-wise doctors will agree that while many people |
| physical symptoms include: profuse sweating, | | | | recover within a six to eighteen-month period, it is |
| headaches, nausea, dizziness, gastric disturbances, | | | | not uncommon for a percentage of patients to |
| palpitations, chills, muscle pain, twitches, spasms and | | | | experience symptoms (often interspersed with |
| tremors. Psychological symptoms such as feelings of | | | | windows of normality) for two to three years or |
| depersonalisation, derealisation, anxiety, panic attacks, | | | | longer in rare cases. |
| nightmares and distorted perception are also | | | | Pre-existing Anxiety Myth |
| common. | | | | Because many patients are prescribed |
| There are doctors who are very aware of this and | | | | benzodiazepines for anxiety-related issues, the |
| are able to reassure their patients that the | | | | consensus is usually that the post-withdrawal |
| symptoms are indeed withdrawal-related and will | | | | syndrome or any protracted symptoms are in fact |
| disappear once withdrawal is over. Sadly, this is not | | | | due to a resurgence of the pre-existing anxiety. I |
| always the case and many patients with no | | | | was prescribed a benzodiazepine for a neuromuscular |
| pre-existing psychological problems end up being | | | | condition and had no history of anxiety, depression or |
| misdiagnosed and treated for schizophrenia, bipolar | | | | any other psychological problem. The anxiety I |
| and other mental health disorders. | | | | experienced especially during acute withdrawal was |
| Cold-Turkey | | | | inconceivable. I have also communicated with others |
| A patient should never be advised to discontinue | | | | who were prescribed benzos for medical problems |
| taking a benzodiazepine abruptly. "Then stop taking it" | | | | and experienced intense organic fear and numerous |
| was the reply of a well-intentioned doctor when I | | | | anxiety-related symptoms. Pre-existing anxiety or |
| expressed my concern that the drug had lost its | | | | not, a nervous system in a hyper-excitable state due |
| efficacy. Fortunately, I found information online which | | | | to the down-regulation of GABA receptors can |
| recommended a slow taper using diazepam (because | | | | reduce the most grounded and stable person to |
| of its longer elimination half-life) and was able to | | | | literally a 'quivering wreck'. |
| successfully wean off. It is surprising that many | | | | It is the responsibility of every doctor who prescribes |
| doctors still give this advice and our Helpline often | | | | a benzodiazepine to give the patient information on |
| receives frantic emails from people experiencing | | | | which the decision to take or not take the drug can |
| extremely distressing symptoms as a result. Quitting | | | | be based. When treating patients for anxiety, |
| cold-turkey is dangerous and can cause serious | | | | insomnia or other related conditions, a doctor might |
| problems including seizures and psychosis. | | | | understandably be hesitant and conclude that |
| Tapering | | | | imparting too much information will only make |
| The decision to withdraw should be the patient's and | | | | matters worse. However, keeping patients ignorant |
| she or he must be allowed to taper off the drug at a | | | | of the addictive properties of a drug is not in their |
| comfortable pace using the most appropriate | | | | best interest and this is the reason for the |
| weaning process. The more common methods are: | | | | 'unpleasant surprise factor' that presents in the form |
| substituting with diazepam, titration by crushing the | | | | of withdrawal. |
| tablet into a powder and mixing it with water, and | | | | These are only the basics from an ex-patient's |
| the direct method where the dosage is very slowly | | | | perspective. The most comprehensive guide is the |
| reduced. Factors to be considered include personal | | | | Ashton Manual - Benzodiazepines: How They Work |
| circumstances, overall general health, the stressors in | | | | & How To Withdraw which should be |
| the patient's life, stamina, support available and | | | | compulsory reading for every healthcare professional. |
| previous experience with drugs. It is most important | | | | It has additional information on symptoms, tapering |
| that the patient feels in control of the process. Apart | | | | schedules, Z drugs which are similar to benzos, |
| from the usual withdrawal challenges, being pressured | | | | effects of other medication such as quinolones, and |
| into tapering too quickly can cause additional anxiety | | | | everything required to ensure that a patient |
| and hinder recovery. | | | | withdrawing from a benzodiazepine is given the best |
| Duration | | | | possible care. |