These include anxiety, insomnia, depression, various sensory and motor symptoms, gastrointestinal disturbances, and poor memory and cognition. Probably many factors are involved, some directly due benzodiazepine withdrawal to the drug and some to indirect or secondary effects (See Table 4). All sorts of strange tinglings, pins and needles, patches of numbness, feelings of electric shocks, sensations of hot and cold, itching, and deep burning pain are not uncommon during benzodiazepine withdrawal. It is difficult to give an exact explanation for these sensations but, like motor nerves, the sensory nerves, along with their connections in the spinal cord and brain, become hyperexcitable during withdrawal.
Compounding pharmacies can be used to obtain very small doses near the end of the taper. As for management of mild alcohol withdrawal, but patients in severe alcohol withdrawal also require diazepam sedation. This may involve very large amounts of diazepam, many times greater than would be prescribed for patients in moderate alcohol withdrawal. If the protocol in Table 11 does not adequately control alcohol withdrawal symptoms, provide additional diazepam (up to 120mg in 24 hours). Patients may have been taking benzodiazepines for an anxiety or other psychological disorder; following withdrawal from benzodiazepines, the patient is likely to experience a recurrence of these psychological symptoms.
It is usually inadvisable to stick to a strict exclusion diet; with a normal balanced diet and sensible general health measures, including regular exercise, gastrointestinal symptoms due to withdrawal gradually abate. Although the above symptoms are often made worse by stress, they are clearly not simply due to anxiety. They suggest a dysfunction in motor and sensory pathways in the spinal cord and/or brain. A possible clue to their mechanism is provided by a trial with flumazenil (Anexate, Romazicon) a benzodiazepine receptor antagonist, published by Lader and Morton (Journal of Psychopharmacology 1992, 6, ). The symptoms were improved by percent and the greatest response occurred in patients with the lowest anxiety ratings.
In larger doses, beta-blockers are used for raised blood pressure and angina, but such doses are not advised in benzodiazepine withdrawal. They should not be taken by anyone who has asthma as they can cause constriction of the bronchial tubes. If beta-blockers have been used regularly for any length of time, they should be withdrawn slowly by tapering the dosage, as they too can cause a withdrawal reaction of increased heart rate and palpitations. Another drawback of antidepressants is that they, too, cause withdrawal reactions if they are stopped suddenly, a fact which has not always been appreciated by doctors. These reactions can be prevented by slow tapering of the antidepressant dosage over about 1-3 months (See Table 2). Most people who have withdrawn from benzodiazepines will be experts at tapering dosages when the time comes to stop the antidepressant and will be able to work out a rate of withdrawal that suits them.
The principles of management of dependence with ‘z-drugs’ such as zolpidem and zopiclone are the same as the management of benzodiazepine dependence. Rather than (or in addition to) expensive therapists, you need someone reliable, who will support you frequently and regularly, long-term, both during withdrawal and for some months afterwards. Voluntary tranquilliser support groups (self-help groups) can be extremely helpful. They are usually run by people who have been through withdrawal and therefore understand the time and patience required, and can provide information about benzodiazepines.
Examples of benzodiazepines include alprazolam (Xanax) and diazepam (Valium). Estimates suggest that 10 to 25% of people who take benzodiazepines for extended periods experience what’s known as protracted withdrawal. Withdrawing from benzodiazepines can be a difficult, even dangerous process. During the first week, you can also expect physical symptoms like headaches and hand tremors.
This diagnosis, and all the symptoms, disappeared soon after the patients stopped their benzodiazepines. The mechanisms of these bizarre symptoms are probably similar to https://ecosoberhouse.com/article/15-benefits-of-the-alcohol-free-lifestyle/ those which cause delirium tremens (hallucinations, classically of pink elephants or rats, in the “DTs” of alcohol withdrawal). Prescribing interventions, substitution, psychotherapies and pharmacotherapies all contribute to the management of benzodiazepine dependence. There is therefore a need to develop a better evidence base and treatment paradigm for these patients. The benzodiazepine-dependent population is heterogeneous and this influences management. A frail 70 year old with falls prescribed flunitrazepam as a sedative hypnotic for 20 years requires a different management approach from a 25-year-old intravenous drug user buying street alprazolam.
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