Benzodiazepine withdrawal syndrome

I know that people on this forum have continually mentioned that benzodiazepines are horribly addictive, which they are. At the moment I'm trying to taper down to nothing the lorazepam I've been taking for years and years. Recently I did wonder whether some of the things I'm feeling (much greater irritability, pins and needles, difficulty sleeping, etc.) were caused by my lowering my lorazepam dose. (I started at 3mg per day and have now worked down to 1mg per day.)

So I did some google searches and found this: http://en.wikipedia.org/wiki/Benzodi...rawal_syndrome
and this:
http://benzo.org.uk/manual/index.htm

Both of these items are excellent and worthwhile. I would strongly urge anyone reading this post who's on a benzodiazepine (for anxiety or sleep) to consider whether it's really doing something for them other than prevent withdrawal symptoms. The sources above do say (as many people here know) that benzos only "work" for about two months.

Both of these websites assert that benzo withdrawal is worse than opiate withdrawal, and that's saying a lot. And it can extend for a long period of time. Of course, how long and how irritating your withdrawal might be depends on you; we all react differently. I myself didn't have a problem
coming down from 3mg to 2mg. But now coming down from 2mg to 1mg does have some mild side-effects. So I'll go to .5mg before I go down to zero. Apparently, for many people it can be worse.

I don't believe I've read anything ever that challenges the assertion that benzos are only effective for a short while. If that's true, then why do P-docs across the country hand out benzo prescriptions year after year to their patients? No doctor or pharmacist ever told me the sad truth concerning benzodiazepines. If anyone reading this post is a P-doc or a T and knows more about this than I do (certainly an easy job), I'd appreciate them posting an answer to that question: If P-docs in fact do know the truth (how can they not?) about benzos, why do they keep their patients on them long after it's obvious the patients are deriving no benefit from them?

Take care!

whhhhooooaaa, your post sure got my attention!!!!
first off, some of us do find benzos help with panic attacks even if we've taken them a longer period of time. the key is to not up the doseage if it's suggested cause one can develop an intolerance and then the circus begins. but benzo's do have a place of use for some of us as long as we're being reponsible.
...well i've got to go and read those studies but it's a known medical fact that some benzos should not be prescribed for more than 6 months...xanex being one. it's written right in the PDR,physician's desk reference, yet docs prescribe xanex like candy to way too many ppl for way too long . it has an incredible half life. so YES many docs of all specialities are over prescribing this family of drugs.
i for one know the dangers of coming off these meds. i was in a medical facility. told them i had been on xanex for one and a half years, it was prescribed to me while i was caretaking my terminally ill mother to help me get back to sleep. i advised them the length of time i was on this drug and the doseage. i had never abused this med. they abruptly took me off-'you don't need this anymore'...3 days later GRAND MAL SEIZURE....should have sued the hospital. it took me one and a half years to be weaned off xanex the correct way and under a responsible physician's care. i do not ever recommend anyone trying to wean themselves off without medical guidance, imho. the ramifications are too dangerous. that's jmho but i lived thank goodness to share this tale. i will always be susceptible to seizures now since i had 2 before they got control if the situation.
so a word of caution, ygrec!!!!!

ps in support of docs not being responsible, i had asked my doc who prescribed the xanex to not put me on a barbiturate, etc. so READ the rx info or ask your pharmacist before filling a new med. i trusted my doc and he was not being responsible. i don't ever ASSUME any more.

ppsssss...many of these drugs are what they call opiate derivatives. so what does that tell you?

Thanks so much for posting this, even though it is scary to read. I agree that doctors and psychiatrists are far too quick to prescribe benzos and they are very often prescribed long-term with very little mention of what will happen when the person tries to come off the drug. I have really bad problems with Generalized Anxiety Disorder and Panic Disorder but so far I've resisted taking benzos (except for a couple of times when a benzo was given to me in the ER) because I am terrified of becoming addicted and ending up in a worse mess. It sucks though because they do provide some relief from the panic, but it seems that the price you end up paying for that short-term relief is just way too high.

Good luck with continuing to wean off the Lorazepam. I really hope it goes well.

Hey, Madisgram!

I've read your post carefully several times. I don't see anything in it that I'd disagree with. Understand now, all I know is what was in the two sources I cited in my post. The lorazepam has been prescribed by my P-doc for three or four years, if not more. And he knows about my desire to get off it. It wasn't his idea, though. It was mine. But he's supervising. So far, the results aren't really bad. Only enough to make me want to taper next month by going to .5mg rather than zero. Unfortunately, I have no idea what my P-doc knows and doesn't know. So I have to lead the way. I haven't undergone anything even close to the seizures you had, so up til now I've been pretty comfortable tapering and reducing the dosage. If you take Ashton at her word, I'm coming down too fast. But so far, so good. If it gets anywhere NEAR serious, I'll go back up to the last step. Do you mean to say, in your last comment, that benzodiazepines, all of them, are opiate derivatives? I haven't run across that information before. Take care!

Hi, Sundog!

It's good to hear that you know what you're dealing with when a P-doc prescribes benzos. I have GAD too, and I know that (if you haven't taken them before), benzos really do help. I'm not in any way against prescribing them, I just think it's not a good idea to use them for more than 2-3 months. Madisgram says six months, but everything I've read says less than that. If you only take them when you're in the ER, obviously nothing bad is going to happen to you. It's just that I think no one should do it for a very long time, and I'm not a doctor. Maybe they know better than me. But if I'm the patient, I'll stick with my own opinion. Take care!

stand corrected re "opiate derivative". in researching the pharmacology i should have said mimic some of the side affects of opiates. i'm not sure tho re xanex but do know it is considered a stronger benzo than the others. i think of benzo's as a synthetic form of more lethal drugs(opiates). sort of like methadone. it is severely addictive yet it is used to get someone withdrawn off heroin. go figure on that logic. so you design something that you can call "legal" that will get someone off of something labeled illegal and the patient becomes addicted to the "legal" substance.

i'm glad you did discuss your withdrawal program with your pdoc. usually they are more in tune with the meds they prescribe than gp-docs. sad but true. however, i usually believe my pharmacist before anyone. now i won't fill anything until i discuss the drug with them.
i find most doctors don't have enough education while getting their M.D. to understand a recovering alcoholic should not be prescribed many drugs unless absolutely necessary due to the drug's properties. have had recovering friends who were prescribed percoset for pain and end up being cross addicted because they trusted their doc to know/understand the potential hazards of doing so while having a recovering alkie for a patient.
that gets us back to the topic of "disease?' and your recent post re alcoholism too. chicken or the egg but in the end the person has a major problem to fix. at least at one time, can't say for sure now, ppl in med school/or pre-med-i was one of them- only had to take a 3 semester hour course on addictions. to me that is scary.
as for you, sounds like you're on top of your game and are being responsible re getting off the benzo. good for you!

crap. I just happened to see this thread from the main menu. I've never had addiction issues, so I don't really come into this section. I've been on xanax for 5 yrs...1mg every night to fall asleep. I also have rx for klonipin, .5mg as needed for panic attacks for 5 yrs. I don't take the klonipin every day, sometimes I go a whole week without it, but I do have major panic attacks and when that happens I take one. So now I read this, and I think my pdoc who I loved for the past 5 yrs is a quack. I don't know what to do now.

I hear you! I've only taken benzos about 3 times in my life (because I'm scared of the addiction potential), but my psychiatrist - who I really like! - is very keen for me to take Klonopin on a daily basis for my Panic Disorder. I have spoken to him about my addiction fears and he assures me that if I take it as prescribed and then taper down correctly I won't have a problem when I try to come off. But I don't believe him! Yet I don't think he is a quack either.....

I don't know what to think. At the same time I have a therapist who is very keen that I forgo benzos and try and get through this on my own steam. It's confusing and I am in a quandry. I do believe that benzos are highly addictive and certainly I've heard from many people that they have a nightmare time trying to come off them. But other people seem to do ok....I guess it's just the luck of the draw?? I don't know. It sucks because I struggle a lot with Generalized Anxiety Disorder and Panic Disorder (as well as some specific phobias). I take an anti-depressant, but it isn't enough. I want to believe my pdoc that I would be ok taking Klonopin regularly, but I just can't believe it and I'm not willing to take the risk. But that leaves me stuck with the unmanaged GAD and PD!!! I don't know why doctors and psychiatrists are so quick to prescribe these medications to people without alerting them to the potential dangers.

I hope you're able to talk to your pdoc about your concerns and I'm wishing you all the best!

Although I think it is good to be concerned about the addictive potential of any drug, I don't think you should assume your pdoc is a quack. Why don't you talk about your concerns with him? Some people do not become addicted to benzos. Your pdoc should be monitoring you for signs of addiction and probably does this with you in conversation at your appointments (you may not even realize it). It could be he hasn't seen any signs so isn't worried. If you have any signs of addiction, you should definitely report them to him. If you are worried about the Xanax, there are other medications you could take at night to help you sleep.

I don't take benzos, but I do take another drug that people can become addicted to--amphetamines (for ADHD). I am ALWAYS paranoid I will become addicted to them and am often asking my PNP about this when I see her for medication management. She gets a little exasperated with me sometimes, I think! You are not addicted! she says. She sometimes will whip out the little mini-assessment of addiction and go through the questions with me. I always get an extremely low score. Then she will say, if you were addicted, you would answer such and such a way to this question and to this one. It makes me feel reassured when she does the questionnaire. She also prescribes carefully and in such a way that does not promote addiction in her patients. (And I am sure she would not prescribe benzos to someone who has had other addictions, such as to alcohol, in the past.)

Yes, it's partly what genes you were dealt at birth and also how the drugs are prescribed to you (dose, formulation, duration, for what purpose, etc.). I am glad you are seeing a therapist too. Are you working on Panic with behavioral therapy? Could you take benzos at low dose while you learn to manage your panic and anxiety with behavioral techniques with your therapist (or with whatever approach he uses)? Then when you can manage, you can taper off the meds?

Thank you! ((((sunrise))) What you suggest definitely makes a lot of sense (about taking a low dose for a short time). I am just so conflicted over this.......I need to do something though because so far I've made very little progress. I have only recently started working with this particular therapist (though I've been in therapy before) and we've only had two sessions. I'm seeing her again next week and I'm definitely going to talk to her some more about how best to move forward.

Thanks so much again! And thanks also for pointing out that some people do just fine on benzos and that not all doctors who prescribe them are quacks!!

They work just fine for me. I look upon GAD as a condition and would never stop taking a medicine that actually helps me.

eileen talking with your pdoc is the best way to decide what to do. i'm a recovering alcoholic among other things. my pdoc put me on klonopin for my panic attacks and i balked. we talked about it and i continue to use it as prescribed. it does keep the panic attacks away and it also assists with my bipolar disorder...many pdocs use this because it does other stuff good too for bipolar. so speak with your pdoc. he may have a solid reasoning re your xanex altho there are less powerful benzo's out there that you could use for getting to sleep tho. hope this eases your concerns.

Hi, Eileen,

I'm sorry if this thread got you upset. I think p-docs know what they're doing when they prescribe benzos, in other words, they're weighing the pros and cons. They are not quacks. It's up to us, the patients, to tell the p-docs if and when we feel the benzos are not doing their job anymore. At that point, we can decide whether to taper off slowly and not take them. I don't think anyone feels that benzos are positive after they've lost their effect. If they're still working for you, well and good. We all have different responses. Personally, I just don't want to take drugs that have outlived their usefulness for me. What we're talking about here should in no way endanger your trust in your own p-doc. My situation hasn't affected my trust in my p-doc. He was waiting for me to say something. Now I've said it, we're cooperating in my tapering down. Take care!

Thanks for posting this ygrec I need reminding constantly that its gonna take a while for me to get better from benzos. I was taking clonazepam and zopiclone among others for years and used the Prof Ashton info to convince my doc to prescribe me valium so I could slowly taper off it all. That took a year and now over a year off I'm slowly waking up from years of sedation and having to go through all the problems these drugs masked, my doc now says it was a big mistake that the shrinks prescribed me benzos. Keep the faith with the lorazepam its the hardest thing Ive ever done but its an amazing feeling not to be a slave to that stuff

For me, it is worth the possibility of being dependent on benzos (xanax) and being able to function. I do not abuse this but have been on it (same dose) for 6 years. I have withdrawn from both Valium (in the late '70's) and atavan. The atavan withdrawal was sheer hell. I was inpatient at the time, and I was watched carefully but that didn't help the insomnia, tactile hallucinations, panic, shaking etc.... Back in the 70's my p doc gave me valium. He said it was perfectly safe and continued to prescribe it when my maintenance dose was 100 mg a day. I was fully functioning , held a full time job and felt it wasn't an issue because the doctor said it wasn't. In my defense, I was young, didn't question doctors, and thought they knew best. Only after taking an overdose of over 1000mg of valium with wine, ending up in ICU, then a state hospital, did someone catch on that I had a serious addiction to it. Never touched valium again...never will but the xanax in moderation keeps me functional.
I guess it's a toss up whether one wants relief with dependence, or fullbolown symptoms and being benzo free.

Hi, Calista!

More power to you! If xanax is working for you, great! Drug reaction is a very personal thing. All of us have to figure out on our own, with our p-docs, whether a particular med is good for us at a particular time or has outlived its usefulness. I've been on and off benzos for forty years, including some really hairy tapers. For me, I'd be happy just to use them when I have an acute problem. I've tapered off xanax, valium, ativan and others, and doing it again would really, for me, be a significant nuisance. So if I can, I'd just prefer not to take them in the first place, or to keep it short if I do have to take them. Yes, I have no question about their being effective anxiety treatments. They do work as promised. I just could do without the months of tapering needed by me to get off them. It's a personal choice that everyone is free to make in their own way for their own situation. Take care!

Good luck with your benzo taper. I hope the side effects aren't too severe for you. You have the courage to do this and should feel proud for doing what is right for you.

I have been reminded this week how very useful these drugs can be. My TMJ disorder has been flaring up and one thing I can do to head it off at the pass is take a valium to relax my jaw muscles. I do this when I go to bed at night and the next day the incipient pain is gone or much lessened. Valium is a great muscle relaxant and sometimes just what I need to avoid having my TMJ escalate and cause awful pain and require much stronger drugs. Calista, when I saw how much valium you were taking, my jaw dropped. Thank goodness you are off of that. For my TMJ this last week, over the course of 5 days I took valium on 3 of those, each time 2.5 mg (half a pill) at bedtime. Sometimes I'll take a full pill, but didn't need it at this time. With luck, I won't need to take anymore for a couple of months (at the time of another flare-up). I am really glad I have a doctor who is willing to prescribe the valium for me, as it is a life saver. I hate when doctors say take Ibuprofen for something like this--just does not help but yet so many will say it. Ibuprofen does not relax muscles, docs, it helps with inflammation! I think doctors may hesitate to prescribe what the patient needs because of the addiction worry.

Interestingly, my TMJ doctor said another thing that might me is occasional physical therapy treatments on my jaw and face muscles. Will my insurance pay for this? No. Will my insurance pay for a valium prescription? Yes.

It was only a few months ago that I learned from a doctor that the effective, pain-relieving dose of Ibuprofen is 800-1000mg!!! He instructed me to ignore the instructions on the bottle and said 200-400mg of Ibuprofen wouldn't do anything for anybody! If you want to check this yourself, google "clinical dose Ibuprofen" or "prescription dose Ibuprofen."

You might try that the next time your TMJ is acting up, just to find out how it works. That means four or five of the usual 200mg pills or tablets. I used to feel the way you do now, but a thousand milligrams of Ibuprofen works pretty well for me. Take care!

Ygrec (and others), beware such high doses of Ibuprofen for any length of time. For a couple of days it is probably OK, but do this with caution. Kidneys are damaged by NSAIDs such as Ibuprofen at high dose or for extended periods. Just ask my Dad--complete kidney failure and on dialysis. The reason the recommended amount of over the counter Ibuprofen is so low is because the manufacturers could be sued out the wazoo if they prescribed more due to the kidney problem.

Yes, Ibuprofen can help with pain caused by inflammation, and I have indeed taken prescription strength Ibuprofen in other situations when it was called for, but my TMJ pain is caused by muscle tightness and has nothing to do with inflammation. Therefore, Ibuprofen is inappropriate (and ineffective). I can understand that you would not know this, Ygrec (unless you're a healthcare provider!), but I don't get when physicians play dumb. It must be the addiction risk. Valium is a muscle relaxant. Ibuprofen is not.

Thanks a lot, Sunrise, I knew nothing about that. Since my doctor told me to do so it didn't occur to me that problems could arise. Luckily, I've only taken that kind of dose very now and then, not for some continuing problem. Take care!

Since we are talking benzos, I thought I would share a few thoughts on "addiction" vs. "dependency". Addiction would imply several things including, but not limited to, taking more than prescribed, "doctor shopping" to get an additional source of prescriptions, and many other possible "addict" behaviors to get more meds.

Dependency on the other hand, simply means that a person is dependent on taking his or her prescribed dose or risks going through withdrawals. There are no signs of addiction (see above paragraph) or other drug-seeking behaviors. The body "needs" that particular dose and may have withdrawal symptoms if the medication is not taken.

I have been taking the same dose (as prescribed) of clonazepam since 2000. My dose has never escalated, BUT, on the one time that I had forgotten to take my one dose of clonazepam, I paid for it dearly (sweating profusely, extreme anxiety, feeling like bugs crawling on my skin). I am dependent on my dose of clonazepam. Do I like the fact that I am dependent on benzos? Not really, but my pdoc and I have mutually agreed that the current benefits outweigh the fact that I am dependent. When the time comes, my pdoc indicated that he will give me a tapering schedule.

As for clonazepam losing its efficacy over the long haul, I can only say that for me, this has not proven to be an issue.

Lastly, the decision to start on any medication, including benzodiazepines, should be prefaced by the patient having a thorough understanding of the risks, benefits, and possible side effects. Laurie

Dear Laurie,

I agree with you entirely on the distinction between addiction and dependency. I was/am dependent on lorazepam. But unlike yourself and clonazepam, I'm convinced that I get no further anxiolytic benefit from lorazepam. And the most important conclusion to draw from that fact is that if I continue to have anxiety problems, which I do, the only way to deal with them is, first, to get off of all the lorazepam, go through a period without benzos, and then start again at a lower dose when it will give me something beneficial. All I get from lorazepam now is a putting off of withdrawal symptoms. It does nothing for anxiety any more. After two or three months off lorazepam, I'll talk with my P-doc about either re-starting lorazepam or trying xanax. I don't know anything else to do. Take care.

I am in severe, severe withdrawl syndrome from 6 mg klonopin. Two psychiatrists did this. They took the total Klonopin away and had GP withdraw using Librium. It should never have been removed totally nor Librium introduced in its place. They just kept reducing it monthly until I refused to take anything because I had become unable to barely speak, body spasms, never slept, hot, than cold, difficulty breathing, no life. Anxiety out of control. Nobody knows what to do. I am going to die.

BENZOS. Are absolutely the most addictive drug on earth. Do not take them lightly. I have detoxed from numerous narcotics for pain including the horrid Oxycontin for 2 years. I went through detox which was hell. BENZOS are different. No one knows the absolute addictive quality these have. Under two continuous psychiatrists as well as a team of GPs I have been tapered too fast and now cannot find help. I am desperate.24/7 I am in agony.