As with any drug, once you take your last Xanax or Valium — whether you intend to quit for good or you’ve just run out — the clock starts ticking. If you’re abusing it, or even if you’re just physically dependent on it, then you need to know: What is the timeline for benzo withdrawal symptoms?
If you’re taking them, you know what they are, but for those who don’t, WebMD has a good primer on what benzos do: “Benzodiazepines are a type of medication known as tranquilizers. Familiar names include Valium and Xanax. They are some of the most commonly prescribed medications in the United States.
“Doctors may prescribe a benzodiazepine for the following legitimate medical conditions, the website adds: “Anxiety, insomnia, alcohol withdrawal, seizure control; muscle relaxation, inducing amnesia for uncomfortable procedures (and) given before an anesthetic (such as before surgery). Benzodiazepines act on the central nervous system, produce sedation and muscle relaxation, and lower anxiety levels.”
However, and this is the most important reason to understand what is the timeline for benzo withdrawal symptoms: “When people without prescriptions obtain and take these drugs for their sedating effects, use turns into abuse. Sometimes people who have prescriptions misuse their medications, as well. Taking too much and running out of the prescription, being overly focused on when you can take the next one and feeling you can’t live without it might also be signs of a problem.”
What Is the Timeline for Benzo Withdrawal Symptoms: Rebound
According to Medical News Today, stopping the use of benzos brings on early withdrawal symptoms, which are also known as rebound symptoms: “A person’s withdrawal symptoms often depend on the half-life of the drug. Withdrawal symptoms from short-acting drugs, such as Xanax, may come on faster than withdrawal symptoms from long-acting drugs, such as Valium. During the early stages of withdrawal, the person may notice the symptoms of the condition that the drug was treating start to return, or rebound. For example, symptoms of anxiety or insomnia may come back or get worse without the drugs.”
According to a 1994 paper in the journal Addiction, those rebound symptoms can occur as much as 24 hours after stopping benzos, but for long-acting drugs, it can be as long as four days before they begin to manifest. It’s known as a rebound effect because the brain, which the problems for which benzos are designed — primarily insomnia and anxiety — return with a vengeance when the sedating effects of the drugs are no longer present in sufficient amounts to calm them.
And for some individuals, immediate withdrawal can be much worse: Colin Moran, speaking with ABC News, tried to taper himself over the course of a month and still went through a tough time the day after he stopped completely: “I woke up and I thought I had a stroke," he said. "My scalp, down the middle of my body — everywhere on the left was numb, and I could barely move on that side of the body. Even though I thought I had a stroke, I was in such a confused state that I didn't even feel inclined to do anything about it.”
Acute Withdrawal Symptoms
The 1994 paper reports that “the second pattern is the full-blown withdrawal syndrome, usually lasting 10-14 days.” According to Medical News Today, this is the acute withdrawal period: “Symptoms generally last 5–28 days, though some may last for several months. Most of the withdrawal symptoms will occur in this phase. People who have been through acute withdrawal often say that this phase is the most difficult.”
According to a paper on benzodiazepine dependence published in the Journal of the American Board of Family Practice, “The benzodiazepine sedative-hypnotic-type withdrawal is the normal cluster of anxiety-related symptoms that occur following cessation of alcohol, benzodiazepines, and other sedative-hypnotics. Acute benzodiazepine withdrawal signs include anxiety, insomnia, tremors, agitation, nightmares, anorexia, and seizures; less frequently, nausea and vomiting, hallucinations, depersonalized feelings, delirium, and hypersensitivity to visual and auditory stimuli can occur. With abrupt cessation of high doses, patients can experience a psychotic episode or grand mal seizures and death.”
While death is extremely rare for those asking “what is the timeline for benzo withdrawal symptoms?,” it’s important to note, writes Zak Fallows for the Massachusetts Institute of Technology, that “benzodiazepine withdrawal is unusually dangerous for former alcoholics. Alcohol withdrawal causes delirium tremens, a condition that is often fatal. Delirium tremens gets progressively worse each time you experience it. An alcoholic who has suffered delirium tremens five times in the past is more likely to get delirium tremens again, the symptoms will start more quickly after they stop drinking alcohol, and the symptoms will be more severe. If that alcoholic is taking a benzodiazepine on a daily basis, then abruptly stopping the benzodiazepine may trigger delirium tremens.”
What Is the Timeline for Benzo Withdrawal Symptoms: Protracted Withdrawal
Perhaps the most alarming phase of the benzo withdrawal symptom timeline is what’s known as protracted withdrawal, according to Medical News Today: “Although many symptoms subside after the acute withdrawal phase, lingering side effects are possible … protracted withdrawals may cause their own set of symptoms, often called post-acute withdrawal symptoms, or PAWS. These include: insomnia, anxiety, poor concentration, loss of sex drive, depression (and) mood swings.”
In fact, adds Dr. Harris Stratyner, vice chairman of the National Council on Alcoholism and Drug Dependence, “10 percent of people who quit abruptly may experience a "syndrome" of withdrawal symptoms that extend long after the drugs leave their bodies. This change can reverse, but for a small proportion of people, it can take months or years to recover.”
The Food and Drug Administration (FDA) took steps to make those dangers more transparent last year by adding a boxed warning to benzos. After reviewing databases, reported incidents and published literature, the FDA found that benzos “are also widely abused and misused, often together with alcohol, prescription opioids, and illicit drugs, which worsen the risks of serious problems. We also found that some patients have had serious withdrawal reactions after benzodiazepines were stopped suddenly or the dose was reduced too quickly. Some patients experienced withdrawal symptoms lasting many months.”
Some of those protracted symptoms are troubling: Lily Lynch, writing for the British website The Guardian, detailed her own experiences tapering off of benzos for a full month. On the other side of acute withdrawal symptoms, she writes, “My symptoms now include deafening tinnitus, 72-hour migraines and panic, all of which come and go. This tendency of symptoms to come and go, increasing and decreasing in severity, is known as windows and waves. The only constant I experience are cognitive problems, especially related to my memory of the better part of the past decade.”
So What Should You Do?
So what is the timeline for benzo withdrawal symptoms? It varies. And it sounds excruciating. If you’re physically dependent on a legitimate prescription, or if your abusing illegally obtained benzos, the aforementioned details may seem like a good reason not to ever stop.
However, these drugs have a way of affecting quality of life, even if you’re taking them under a doctor’s orders. Your physician can help you safely withdraw, but that’s not always an option for individuals who obtain these pills illicitly and find themselves addicted to benzos. For those persons, the best course of action is to seek professional help in order to detox from benzodiazepine addiction under a supervised medical setting.
In addiction treatment parlance, that’s known as medical detox, and it’s a situation that will help you slowly, safely and comfortably wean yourself off of benzos. But more than that, it will help those individuals navigate a life without benzos: As the article in Addiction points out, “such support should include the provision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non-pharmacological ways of coping with stress.”
Those things are provided in an addiction treatment setting, so rather than asking “what is the timeline for benzo withdrawal symptoms?” and attempting to navigate or deal with them yourself, consider finding an addiction treatment facility that can keep you both safe, sane and healthy.