10 tips to help patients through benzodiazepine withdrawal
As physicians, we are experts at prescribing medications. However, we often fail miserably when it comes to recognizing adverse reactions and tapering medications. It’s something that is simply lacking in our medical training. I have become a victim of this with benzodiazepines, as I detailed in a prior blog post. Benzodiazepines, in particular, are very difficult drugs to taper. I would like to share with you some of the wisdom I’ve gained in the process, so here are ten tips for helping your patient survive benzodiazepine withdrawal.
Disclaimer: I will be addressing patients physiologically dependent on benzodiazepines who are motivated to come off the drug and do not display signs of abuse or addiction.
1. Believe your patient. Often symptoms of tolerance and/or withdrawal can result in the patient being branded a drug-seeker when this is far from the truth. As physicians, we become jaded, but not everyone is an addict looking for a fix. If your patient has been taking their medication as prescribed, please recognize that physiologic dependence and benzodiazepine withdrawal syndrome are real and can present with a host of symptoms. A little validation of their condition goes a long way towards alleviating the patient’s suffering.
2. Taper, taper, taper. Please don’t “cold turkey” or send your benzodiazepine-dependent patient to detox. Just don’t do it. A certain percentage will be fine, but some will suffer a horrific and debilitating withdrawal syndrome that can last years. I have many friends that have suffered brutal symptoms for five years or more after an abrupt cessation. A sensible taper could have prevented this needless suffering. Please don’t play Russian roulette with your patients.
3. Consider switching to a long half-life benzodiazepine. Short half-life benzodiazepines such as Xanax and Ativan can be difficult to taper due to withdrawal symptoms between scheduled doses. A long-acting benzodiazepine such as Valium alleviates this issue. Valium is also lower potency, meaning it’s easier to make smaller dosage reductions. Of course, if your patient is able to taper directly from their current benzodiazepine, this is the simplest course of action.
4. Patient-controlled, symptom-based tapers are best. The process takes as long as it takes, and the key is for the symptoms to remain tolerable by giving patients control of their taper speed. There is no one “right way” to taper, but there are multiple options available. In the end, each patient will need to find their own way out with your excellent supervision, guidance, and support.
5. Adjunctive medications are not necessary but may be helpful in some cases. Unfortunately, the literature is sparse and often anecdotal at best. Very small studies and case reports have shown that drugs such as gabapentin, carbamazepine, and propranolol may help as aids in withdrawal. Trazodone, mirtazapine, and quetiapine may be helpful in some for insomnia. Some patients have reported relief of withdrawal symptoms with the use of CBD oil or medical marijuana. However, not everyone finds adjunctive medication helpful. Depending on the medication, it must often be tapered as well and carries the potential of its own discontinuation syndrome.
6. Encourage coping skills. These are much needed as the symptoms of withdrawal can be overwhelming. Distraction, meditation/relaxation techniques, taking a hot bath, leaving the house for a short outing and going for a walk can be helpful. Some days are so bad that coping skills provide minimal help. On those days the patient must learn to survive, one minute at a time, telling themselves they will get through this round of symptoms because they have survived it before.
7. Encourage acceptance. Tapering and withdrawal can be a long process. One of my friends who tapered before me shared his doctor’s words of wisdom, to “get comfortable being uncomfortable” and “learn not to fear the symptoms.” Acceptance isn’t easy. It takes a lot of effort and continued practice, but it is key to surviving this process and ultimately having a successful taper.
8. Adequate psychosocial support is extremely helpful during benzodiazepine withdrawal. I know many who are going through this process alone, and I have no idea how they do it. Having family and/or friends who can provide help with daily tasks, understanding of the symptoms and emotional support is very important in this process. Please take time to educate family members about benzodiazepine withdrawal and how they can help their loved one through this difficult season in their life.
9. Do not fear the internet. Yes, we all hate “Dr. Google,” but in the case of benzodiazepines, he saved my life. Just spending a little time on the internet, I was able to figure out why I was so ill when many doctors could not. Benzodiazepine withdrawal syndrome is often under-recognized and poorly understood, so when a patient comes to you with information about it they have obtained online, please don’t be arrogant. Take the time to read and listen. It could potentially save a life. In addition, online support groups such as BenzoBuddies and Facebook groups such as Benzodiazepine Recovery were invaluable resources for me in the beginning of my taper. Through these groups, I made many friends all over the world who understand what I’m going through when nobody else can. With that being said, the forums can be depressing and overwhelming, so patients should use caution in the amount of time they spend on them. Now that I’m further along in my taper, I have developed a core group of friends that I can call or text, and I have less need for the forums.
10. Most importantly, provide reassurance. Let your patient know you will support them through this process, no matter how long it takes, and that they will improve with time.
A doctor with a dependency gives her insight.
Cbd oil for benzo withdrawal
I have a dirty little secret, and it’s called a Xanax addiction. For almost a decade, I micro-dosed on the pink oval pill, relying on it – both physically and psychologically – to help me get to the Land of Nod.
During this period of Xanax addiction I felt incredible guilt, because living a natural, holistic lifestyle is my life’s primary focus. Today, I am a functional medicine coach. I’m committed to eating real organic food. I consume micronutrients and superfoods. I spend time in nature. I hike, bike, detox regularly, monitor metabolites and other blood markers, and partake in natural alternative treatments to optimize my vitality. When I got hit by a car in April 2002, while walking across the street, I even refused to take morphine, despite the massive pain. There is really nothing more important than one’s health.
Yet I clung to Xanax like a crutch, a protective shield against the wrath of insomnia. I feared kicking my Xanax addiction would likely trigger “rebound effects,” the emergence or re-emergence of symptoms that had been suppressed or well managed while I was taking the medication. But the truth was – so much time had passed. I didn’t even know what my own sleep cycle looked like anymore. I was ready to quit, but I didn’t know how.
My initial bout with sleeplessness freaked me out. No matter what, I was unable to sleep. I’d finally nod off at 7 a.m., only to have to wake up an hour and a half later to make my call time on the Warner Bros. lot where I was working as the assistant to the director of Catwoman. The sleep deprivation was literally driving me mad before my very eyes. While I leaned toward natural solutions, I was definitely not the health connoisseur I am today. In fact insomnia, and trying to solve it, is one of the many health issues that prompted me to jump down the rabbit hole toward holistic health.
I’d eventually learn that my insomnia was the byproduct of trauma: being hit as a pedestrian by a massive hulk of moving metal doing 30 miles an hour. It was a form of Post-Traumatic Stress Disorder. But no doctor told me this. Instead it was through my own research and my many lab results and visits with alternative medical doctors and practitioners that I began to understand how my body had taken a permanent detour into fight-or-flight response hell.
Unlike an animal, I was not able to shake off the trauma. Instead it had found its way into my nervous system. My cortisol levels flipped, my adrenals fatigued, and my hormones went wacky. My gut malfunctioned, my immune system became compromised, and I developed candida, gut dysbiosis, and food allergies. I was a hot mess. I’ve now seen this type of response in many people who experience trauma, be it childbirth or the death of a loved one. But I didn’t know any of this at the time. I just wanted to sleep.
I was so desperate, I got some Ambien from a young janitor on the Warner Bros. lot. I think he was cleaning our office when I blurted that I was miserable from sleep deprivation. I spent most of my days ruminating on how I could get access to ZZZs. It turned out his sister was a nurse. The next day he handed me the goods in a brown paper bag.
Alas, Ambien left me groggy big time, and I quickly developed a tolerance. Even two didn’t put me to sleep. So that was when he gave me some Ativan.
By the time I realized how addictive that benzo was, it was too late. When I called a doctor for advice (I didn’t yet have insurance as a Canadian back then), he suggested another drug to get me off this one. Kind of like giving methadone to get off heroin. That notion seemed berserk, so I bought a razor blade instead. Every night I shaved down my dose into smaller increments until I weaned myself off.
I couldn’t score sleep drugs from a janitor forever. By that time, I had a doctor who prescribed me the antidepressant Trazadone, which gave me bad vertigo and left me urinating all night.
I needed a “safer” sleep aid. And a more sustainable solution. I used my investigative skills and found a veritable Dr. Feel Good in Beverly Hills. He was a friend of a friend of an ex-boyfriend. Within 22 minutes I had Xanax in my hand. And the keys to Morpheus’s kingdom.
A Star Is Born
Pfizer released Alprazolam aka Xanax in 1981, a year when the average monthly rent was $315, Reagan was our 40th president, and Prince Charles announced his engagement to Lady Diana Spencer.
Referred to in the Urban Dictionary as “God’s gift,” Xanax quickly became a bestseller. The wonder drug du jour was a massive technological improvement over its cousin Valium and other members of the benzodiazepine family. For one, it did not linger in the system for a hundred hours, leaving you hung over and zombified. Xanax is quick acting and has a much shorter half-life, vanishing hours after it takes effect.
I started off at 1 mg before bedtime, well below the average dose of 5 mg. (I can’t even imagine how someone can function on that amount.) I slept at night and didn’t feel hungover the next day. And so began my Xanax addiction. Xanax became my saving grace. I was as calm as a lake on a windless day.
More than 49 million prescriptions for alprazolam were written in 2012, making Xanax the second-most prescribed psychoactive drug that year after the narcotic painkiller hydrocodone.
In its generic form, writes New York Magazine, Xanax is prescribed more often than the sleeping pill Ambien, and more often than the antidepressant Zoloft. Only drugs for chronic conditions like high blood pressure and high cholesterol do better. Today, the 12th most prescribed drug in America has reached iconic proportions as part of the cultural fabric of our times. For instance, the pill was esteemed in U2’s song Xanax and Wine and was the subject of a Miley Cyrus alleged butt tweet. References to “zannies” have become casual and comical. Even military dogs who have detected one too many bombs in their day are being treated with Xanax. Meanwhile everyone knows that friends who love friends don’t let them fly without.
Xanax gained a foothold in the anti-anxiety market as a spot treatment. It was indicated for “panic disorder,” which had just been established as a legitimate pathology, according to New York Magazine.
It’s no surprise that Xanax addiction is so common. Today you can easily argue that our current, increasingly crazy reality necessitates self-soothing meds. It doesn’t help that many of us do not get the nutrients we need to function properly. A deficiency in magnesium alone, which is involved in over 300 intracellular functions, can spur an anxious episode. Eighty percent of Americans are not getting enough of the mineral. But given our fast food world, it’s much easier to reach for some drug that’s been touted as “alcohol in a pill.” But there’s one little downside: Xanax is highly addictive.
“Dependence ensues quickly even at therapeutic doses, resulting in what is considered to be one of the worst withdrawal syndromes by the medical community when abruptly discontinued,” attests one person on Urban Dictionary.
Many who have weaned themselves off of a Xanax addiction report grizzly experiences, which is why you need a slow, individualized taper. Fatigue, disorientation, malaise, severe panic, startle reactions, nerve pain, muscle aches, and short-term memory loss are some of the side effects of saying bye-bye to benzo. Xanax withdrawal is a beast. The anxiety and panic from stopping benzos is usually much worse than the anxiety and panic that initially led to the abuse.
“I fought for eight hard months and failed,” writes another person in Urban Dictionary, “and now I am coming up on the time to jump off my tapered dose and am scared shitless … I know the pain and debilitating mental issues that await.”
In a Huffington Post article Is It Bedtime For Benzos, Dr. Peter Madill, an integrative medicine physician, says that following “a sudden withdrawal or even too-rapid taper, the brain thinks it’s being injured, so it marshals all these other mechanisms to try and mitigate these reactions.”
Not exactly reassuring information that will make you get up and quit your Xanax addiction.
According to Stat News, between 1996 and 2013, the death rate from benzo overdoses exploded by more than 500 percent, from 0.58 per 100,000 people to 3 per 100,000. Benzos are now involved in more than 30 percent of all overdose deaths, usually in combination with opioids or alcohol.
While most people develop tolerance and increase their dosage, I luckily weaned myself to 0.25 mg and steadily cruised at that measure for years, while simultaneously working on my overall health, adding nootropics at night, such as theanine and tryptophan.
While my daily Xanax intake did not seemingly affect my immediate performance, I wondered about the long-term effects.
“Benzodiazepines impair the formation of new memories,” says Dr. Jason Eric Schiffman, director of UCLA’s Dual Diagnosis Program, which offers treatment for addiction and co-occurring mental health conditions. “So they interfere with psychotherapy, which actually heals the cause of anxiety rather than just attenuating symptoms.”
A 2002 study found former use of benzodiazepines was associated with a significantly increased risk of dementia.
Meanwhile I discovered that Xanax contains fillers and additives. Although these ingredients are listed as “inactive,” they can actually pose significant health risks. Xanax contains cornstarch, which is very much likely genetically modified and treated with systemic pesticides and glyphosate, along with sodium benzoate, a known carcinogen that prevents cells from taking in oxygen, a necessary element for cellular metabolism and other functions. In addition to its link to cancer, sodium benzoate has been associated with an increased risk of Parkinson’s disease, neurodegenerative disorders, and premature aging.
Xanax Addiction: The Givings Of GABA
GABA receptors are a class of receptors that respond to the neurotransmitter gamma-aminobutyric acid (GABA), the chief inhibitory compound in the mature vertebrate central nervous system. GABA receptors influence cognition by coordinating with glutamatergic processes. Millions of neurons all over the brain respond to GABA. The effects include reducing anxiety, calming the nervous system, helping with sleep, and relaxing the muscles.
Like many other anxiolytic and sedative drugs, alprazolam works by binding γ-aminobutyric acid A (GABAA) receptors in the brain, which decreases the overall level of brain activity. By activating GABAA receptors, Xanax reduces feelings of anxiety and panic in patients. This in turn activates the gratification hormone, dopamine, explains Dr. Junella Chin, an integrative medical cannabis practice in California.
However, long-term use can cause the body to stop producing GABA naturally. Symptoms of withdrawal are mostly caused by these GABA deficiencies, explains cannabis researcher Brandon Seymour of BioTrackTHC.
The Calming Effects Of Full Spectrum Hemp Extract
My discovery of a Xanax addiction replacement happened by accident. It was July, and I was in Greece. The founder of MediQi Energetics had just sent me a Companion Set consisting of capsule and oil for me to vet and test. I took five capsules and a dropper of oil, and an hour later I was sleepy. It was as though my body was ready to catch up on a multitude of lost hours. That night I’d forgotten to take my Xanax, and my sleep was deep and sound. And just like that, I kicked Big Pharma out of my life.
Sleep Better And Feel More Energetic With All Natural Theanine!
Benzo bashers will tell you that we desperately need more research into agents that can alleviate the withdrawal process. Could that benevolent plant compound CBD, with its host of benefits, be the solution?
Chin, who has been specializing in integrative cannabis medicine for more than 15 years with her physician husband, has seen patients successfully use CBD oil to kick a Xanax addiction.
“A lot of patients do not want to consume THC, with reasons having to do with their occupation. Or they just simply tried it and do not like the way it makes them feel,” says Chin who recently discussed the pharmacokinetics of Xanax versus CBD oils (no THC) during a lecture to the Department of Psychiatry and Internal Medicine at Touro University.
Interestingly, CBD reduces anxiety through its mediation of the neurotransmitter GABA.
“CBD is a GABA-uptake inhibitor, meaning that it creates a surplus of GABA in the brain, which results in a quieting and calming effect,” she says. “With CBD oil supplementation, patients don’t have the racing thoughts that paralyze them at work or keep them lying awake in bed at night.”
The beauty of CBD is that it interacts with our endocannabinoid system, which modulates neurotransmitter release in a manner that maintains homeostasis, and prevents the development of excessive neuronal activity in the central nervous system.
While CBD hasn’t been on the market for very long, making studies limited, experts do believe it’s a much safer alternative to benzos – especially long term – adds Seymour.
Andrew Serafini, Director of Business Relations at Evrcbd also used a hemp-based CBD at night and as needed during the day to get off 0.25 mg of Xanax.
“I deal with anxiety every day still. With CBD, it’s manageable. CBD not only softened the withdrawal symptoms, but it laid a solid foundation for complete abstinence from Xanax,” says the 39-year-old who has been Xanax-free for more than seven months. (When determining serving amounts, Serafini suggests considering weight and severity of anxiety. Diet also plays a significant role.)
Despite what many describe as severe withdrawal, I suffered none, likely because my dose was very low. For those who are on a higher dose of Xanax, consider adding THC to help ease the transition and consulting with a doctor.
Xanax Addiction: The Irony Of Regulations
The sad irony is that the DEA recently categorized CBD, extracted from the marijuana plant, as a Schedule 1 drug alongside heroin, despite its many health benefits and the lack of any psychoactive properties, while Xanax, which is highly addictive, is classified as a Schedule IV controlled substance, a category for drugs considered to have a relatively low incidence of abuse.
What makes more sense, swallowing a pill with a host of side effects or a natural plant compound with a host of benefits?
I have a dirty little secret, and it’s called Xanax. For about 10 years I micro-dosed on the pink oval pill and developed a Xanax addiction. Read my story.