Benzodiazepine Withdrawal

Benzodiazepine Withdrawal General Information

As not all individuals are familiar with the phrase “Benzodiazepine Withdrawal”, we will try to define it in the beginning of our presentation; this clinical syndrome (which is commonly abbreviated as benzo withdrawal) refers to the clinical manifestations which develop in the case of an individual who has been treated with a certain benzodiazepine medication for a prolonged period of time and who then ceases his or her therapy course with that product. This medical syndrome can also appear in the case of patients who have reduced their daily intake of this medication at an abnormally rapid rate.

This medical syndrome is known to be similar to other conditions such as barbiturate withdrawal syndrome, alcohol withdrawal syndrome, and so on. The cause of Benzodiazepine Withdrawal is known to be the presence of a physical adaptation (dependence and tolerance) of the patient’s brain that aims to fight against the adverse manifestations that can be associated with the use of benzodiazepines. The symptoms of this medical syndrome will remain present until the patient’s organism is able to reverse the developed physical dependence – this is achieved as the brain adapts to the environment that is free of any benzodiazepine-ingredients (as the patient’s brain returns to its natural function).

Studies have shown that the regular intake of a well determined dose of a benzodiazepine-based medical product for a month and a half proved to produce a great risk of dependence. In other words, after approximately 6 weeks of therapy with a benzodiazepine (such as Diazepam) patients who have abruptly ceased their therapy course with this product developed the unpleasant clinical manifestations of this withdrawal syndrome. This type of syndrome is a common medical complication, especially in the case of patients whose therapy span with a benzodiazepine product exceeded a month.

Benzodiazepine Withdrawal Symptoms

Some of the clinical manifestations that are commonly associated with the presence of this medical condition (Benzodiazepine Withdrawal) are very similar (in some cases, even identical) to the symptoms that the patient initially presented (and that were dealt with through the intake of benzodiazepines). For this reason, it is very important for the patient and the doctor to see the difference between rebound and relapse (especially during the withdrawal phase, as numerous misdiagnoses are placed in such circumstances). This is one of the main reasons for which numerous specialists choose to wait at least seven months after the patient ceases a long-term therapy course with a certain benzodiazepine before re-evaluating the diagnosis.

The common clinical manifestations that indicate the presence of Benzodiazepine Withdrawal include headache, insomnia, electric shock, anxiety, nightmares, panic attacks, high blood pressure, postural hypotension, depression (in some cases, suicidal ideation was developed by some patients), perspiration, tremor, appetite changes (the most frequent is appetite loss), dysphoria, metallic taste, hyperosmia, photophobia, paranoia, etc. The severity of the symptoms that accompany the presence of this medical syndrome (benzodiazepine Withdrawal) also depends on the severity of the individual’s addiction to benzodiazepine remedies. In the most severe clinical cases, certain individuals developed a very severe form of withdrawal syndrome due to their prior intake of benzodiazepines; their symptoms included: convulsions, catatonia, confusion, coma, self harm, psychosis, mania, violence, delusions, post traumatic stress disorder, and so on.

Benzodiazepine Withdrawal Treatment

Recent clinical studies that focused on the effects of Flumazenil (a common benzodiazepine receptor clinical antagonist) on the clinical manifestations that were present in the case of some patients who had been diagnosed with the presence of Benzodiazepine Withdrawal decided that this medication can be employed as a successful remedy in the case of patients with the protracted form of this medical syndrome (such individuals were administered between 0.2 and 2 mg of Flumazenil; the administration was IV and it was able to decrease / ease the symptoms associated with this syndrome). However, further medical investigations will be required until a universal medical decision is taken.

Another way in which the patient can deal with his or her diagnosed Benzodiazepine withdrawal is undergoing cognitive behavioral treatment. This is a more effective alternative to another therapy option in which the patient is prescribed the use of special hypnotic remedies. Some of the most common drugs that fit this medical category include: Zopiclone, Temazepam and Nitrazepam. However, studies have shown that these medicines are not of great value in the effective management of chronic insomnia. The consumption of such clinical remedies has shown to effectively reduce the patient’s performance at work, increase his or her absenteeism or increase the incidence of road traffic accidents and that of willing self-harm. Studies performed in the case of elderly individuals who were being treated with hypnotic remedies in order to deal with their Benzodiazepine Withdrawal symptoms also reported an increase in the number falls and fractures. For this reason, it has been accepted worldwide that the use of such remedies for more than a month is not recommended for any age group.

Luckily, undergoing cognitive behavioral therapy has proven to be more effective in the long term medical management of symptoms associated with Benzodiazepine Withdrawal (such as insomnia). In certain cases, an inpatient clinical facility (for example a “Detox”) will take the individual off a benzodiazepine therapy course, putting him or her under therapy with a short taper of a clinical barbiturate (Phenobarbital) – the purpose of this action is the effective prevention of seizures. However, this way of avoiding (or dealing with) Benzodiazepine Withdrawal is considered by some specialists a barbaric one, and is, therefore, very controversial.

Hope remains in further analysis and testing of the positive effects of Flumazenil in the management of this medical condition. This type of therapy option is a promising one; so far, this medical product has proven to effectively stimulate the reversal of tolerance (one of the main causes of Benzodiazepine Withdrawal symptoms) and also to enhance the normalization of the patient’s healthy receptor functions. Besides the fact that such a therapy is expected to induce a reduction of the clinical manifestations associated with this syndrome, it is also thought to be able to diminish the rates of relapse.