Benzodiazepines are a class of depressant drug that can be used to treat a variety of conditions, including insomnia, anxiety and seizures. They can be very useful when used as prescribed but can also be addictive and can be particularly dangerous when misused.

But how do benzodiazepines work, what are the risks and what is benzodiazepine withdrawal syndrome?

Understanding Benzodiazepine Withdrawal Syndrome

Benzodiazepines are a useful class of drugs for certain conditions. They are depressants, which means they slow down certain functions in the body and brain. As well as insomnia, anxiety and seizures they can be used to treat Tourette syndrome, delirium, delirium tremens, sleep disorders and abnormal movements such as tics and tremors associated with other medications.¹

There are many drugs in the group but diazepam (sold under the brand name Valium) is the most widely used one in the UK. Others, such as alprazolam (Xanax) and etizolam, are not generally prescribed in the UK but may be found on the black market as they can be prescribed in other countries. A number of benzodiazepine-type new psychoactive substances (NPS) have also emerged recently. These are sometimes known as ‘street benzos’.²

Long-term use of these drugs can cause physiological dependence. There is less risk if you are monitored and using the drugs as prescribed, but there is still a risk if you use them continuously. The risks can be worse if you misuse the drugs, including taking higher doses than prescribed or taking them recreationally.

Benzodiazepine withdrawal syndrome refers to a set of physical and psychological withdrawal symptoms that may be experienced when a dependency has developed and the drug is suddenly removed or even reduced.

What Causes Benzodiazepine Withdrawal Syndrome?

Benzodiazepines work by affecting receptors in the central nervous system that deal with a chemical known as gamma aminobutyric acid (GABA). GABA reduces activity in areas of the brain responsible for a number of functions including reasoning, memory, emotions and some essential functions like breathing. Benzodiazepines increase the effects of GABA, leading to physical and mental sedation.^3,4

Over time, the brain and central nervous system become used to this situation and your brain chemistry changes to compensate. When the drugs are removed, it takes time for the system to adjust back to normal function and this can lead to a range of withdrawal symptoms.

There are a number of risk factors that can increase the chance of developing benzodiazepine withdrawal syndrome including pre-existing or co-occurring mental health conditions such as anxiety disorders and depression, and alcohol and substance misuse.⁵

Symptoms of Benzodiazepine Withdrawal Syndrome

There are a number of potential benzodiazepine withdrawal symptoms. The most common form of benzodiazepine withdrawal is a short-lived ‘rebound’ of anxiety and insomnia, which usually comes on within 1-4 days of last taking the drug. Some people may experience the full-blown withdrawal syndrome, however, especially if they have been taking heavy doses of benzodiazepine or using it for a long time.

Physical symptoms of benzodiazepine withdrawal syndrome can include:

Headache
Muscle pain
Nausea
Sweating
Sensitivity to light and sound

Psychological symptoms of benzodiazepine withdrawal syndrome can include:

Anxiety
Irritability
Insomnia
Depression
Panic attacks

In some cases, particularly following higher doses of benzodiazepines, there may be more severe withdrawal symptoms including seizures and psychotic episodes.⁶

Stages and Timeline of Benzodiazepine Withdrawal

Both the severity and the timeline for benzodiazepine withdrawal can vary quite widely, depending on the heaviness and duration of use and other factors including any underlying mental health conditions and concurrent misuse of alcohol and other depressant drugs.

In general though, the withdrawal process can be divided into three different categories:

Early Withdrawal

This is what is sometimes known as ‘rebound’ and can see the symptoms of conditions the drug may be used to treat – such as anxiety and insomnia – start to come back. Symptoms can start to show within hours but will usually be a few days after the last dose of benzodiazepines taken.

Acute Withdrawal

This occurs within the first few weeks, where symptoms are often at their peak and can include intense physical and psychological discomfort. It can typically last from 5-28 days, although some cases will be longer.

Protracted Withdrawal

This may also be known as Post-Acute Withdrawal Syndrome or PAWS. It will not be experienced by everyone but some individuals may experience lingering symptoms for months or even years. These could include mood instability, anxiety, and insomnia. An estimated 10–25% of people who use benzodiazepines for extended periods experience withdrawal symptoms that last for 12 months or longer.^7,8

Coping Strategies and Support for Benzodiazepine Withdrawal

There are a number of things you can do to lessen the risks of experiencing benzodiazepine withdrawal or manage the symptoms if you do experience it. These can include:

Working with a healthcare provider for a customised tapering schedule. Sudden discontinuation of benzodiazepines can be dangerous. A gradual tapering approach under medical supervision, which sees you reduce the dosage gradually before stopping, can help minimise withdrawal effects and make the transition safer.
Considering supportive therapies like cognitive behavioural therapy (CBT) to manage anxiety.
Practising mindfulness, relaxation techniques, and engaging in gentle physical activity to reduce stress.
Avoiding caffeine and other stimulants, which can worsen anxiety symptoms.

When to Seek Professional Help for Benzodiazepine Withdrawal

Professional help and advice should be sought before beginning any reduction in benzodiazepine use. It’s worth remembering that some people may experience withdrawal symptoms even when they have used the drug as prescribed and directed. Outpatient support and monitoring can be very valuable but serious cases of benzodiazepine withdrawal syndrome may benefit from a dedicated detox programme and a safe environment like an inpatient rehabilitation centre.

Get help today

Benzodiazepine dependency and withdrawal is a serious and potentially dangerous issue that is difficult to deal with alone. If you are concerned about your own benzo use or that of a loved one, get in touch today for confidential help and advice and to find out how we can help you to come off benzodiazepines safely and comfortably.