What is a major drawback when using benzodiazepines?
Benzodiazepines are commonly prescribed medications used to treat anxiety, insomnia, and other related conditions. However, one of the major drawbacks of benzodiazepines is the potential for dependence and withdrawal symptoms. Benzodiazepines work by enhancing the activity of a neurotransmitter called gamma-aminobutyric acid (GABA), which can lead to physical and psychological dependence over time. When benzodiazepines are abruptly discontinued, withdrawal symptoms can occur, which can be uncomfortable, and in some cases, life-threatening. Therefore, it is crucial to taper benzodiazepines gradually and under medical supervision to prevent withdrawal symptoms.
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Table of Contents
Why do benzodiazepines need to be tapered?
As mentioned earlier, benzodiazepines can cause physical and psychological dependence, which means when you stop them cold turkey, it can cause withdrawal symptoms. Withdrawal symptoms can range from mild to severe and may include anxiety, insomnia, irritability, muscle cramps, nausea, seizures, and in rare cases, delirium tremens. Tapering benzodiazepines gradually allows the body to adjust to lower doses of the medication, minimizing the risk of withdrawal symptoms.
How fast can you taper benzo?
The speed at which benzodiazepines are tapered depends on various factors, such as the type of benzodiazepine, the dosage, the duration of use, and the individual’s overall health status. Generally, a slower taper is recommended to minimize the risk of withdrawal symptoms. A common tapering schedule is to reduce the dose by 10% every two to four weeks. However, this schedule may be adjusted depending on individual circumstances. It is essential to work with a healthcare provider who has experience in benzodiazepine tapering to determine the appropriate tapering schedule.
What are the symptoms of benzo withdrawal?
Categorizing the symptoms.
It is important to note that the severity and duration of withdrawal symptoms can vary depending on several factors, including the type of benzodiazepine, the dose, the duration of use, and the individual’s overall health status.
- Muscle pain
- Heart palpitations
- Sensitivity to light and sound
- Seizures (in severe cases)
- Panic attacks
- Suicidal thoughts
- Hallucinations (in severe cases)
- Cognitive impairment
- Memory problems
- Delirium tremens (in severe cases)
It is important to note that not everyone will experience all of these withdrawal symptoms, and the severity and duration of symptoms can vary depending on the individual’s circumstances. In my experience, I have had clients easily come off of benzodiazepines and others where we had to slow it down to a 5% taper with a liquid. It is essential to work with an experienced healthcare provider to develop a tapering plan and manage withdrawal symptoms effectively.
Short acting benzodiazepines usually have worst withdrawal effects
Short-acting benzodiazepines, such as alprazolam, lorazepam and temazepam have a shorter half-life and are more likely to cause withdrawal symptoms. Longer-acting benzodiazepines, such as diazepam can help minimize withdrawal symptoms. Short-acting benzodiazepines can cause rebound anxiety, which means that anxiety symptoms can become worse than before starting the medication.
In my experience, most people that tried to come off of a benzodiazepine and experienced withdrawal would typically convert over to diazepam to minimize withdrawals. This conversion will require your doctor to be fully onboard. Diazepam is known to be dangerous for anyone with slow kidney function like individuals suffering with chronic illness like diabetes or people older than 60 years of age.
Longer acting benzodiazepines can minimize withdrawal
Longer-acting benzodiazepines, such as diazepam, have a longer half-life and can minimize withdrawal symptoms when tapered gradually. From my clinical experience, diazepam has typically been ideal because of the many dosage types it comes in. Diazepam comes in tablets, liquids, injection, suppositories, and custom compounds.
Most doctors will try to convert your current benzodiazepine dose over to diazepam, and subtract 10 to 25% to avoid potential overdose since the diazepam is more potent. It is so important to work with a doctor that understands you and the process of withdrawing from a strong medication like a benzo.
10 steps yo uneed to do before getting off benzo’s
As a pharmacist with 10 plus years and as a sleep coach, I understand that tapering off medications such as benzodiazepines can be a difficult process.
Your brain has adapted to this chemical we call a benzodiazepine, and created a tight grip or bond with your receptors in your brain. These Gaba receptors have changed and the old Gaba chemicals that your brain produce may not be effective to those receptors anymore. Don’t worry! This is normal and those receptors regenerate over time. We just need to give ourself time and patients.
It is important to take a holistic approach and prepare your body to ensure a successful tapering process. Below are five important steps to consider when preparing to taper off benzodiazepines.
Step 1: Create a plan
Make a plan before beginning the tapering process, it is important to make a plan. This includes running specific tests to see which vitamins and minerals are deficient, evaluating for leaky gut, and assessing liver function. Stressors that could worsen withdrawal symptoms should also be considered. By identifying these factors, you can take steps to address them before beginning the tapering process, which can help reduce the severity of withdrawal symptoms.
Step 2: Get your diet right
Your diet plays a crucial role in your body’s ability to heal and function properly. Eliminating poor quality foods that contain added sugar or that are highly processed is essential. These types of foods can deplete nutrients and cause worsening effects on your health. Also, poor food choices are high in chemicals, preservatives, and processed ingredients that jolt your blood sugar. These types of foods can make it very hard for your gut to produce the missing brain chemicals that will help you when you get off benzodiazepines.
I recommend a whole foods diet, such as the Whole30 or Mediterranean diet. These healthy diets are great because of their abundance of recipes and focus on nutrient-dense foods.
Step 3: Drink water and avoid alcohol
We take water for granted! Our bodies are made up of 60% water and our important organ need water. Our brain needs it. So, make sure to stay hydrated. Your body need about 2.5 to 4 liters of fluids per day. This can come from water, soup, fruits, and other foods. I don’t typically consider coffee a water source since it has a diuretic effect that causes you to pee.
Also, think about your water quality. Avoid drinking from the faucet. Faucets can contain heavy metals, mold toxins, and other things. High quality filter can go a long way and prevent your body from accumulating these toxins. Invest in a good water filter.
Clearly Filtered sells a water pitcher that has a much better filter than a Brita. Clearly Filtered helps to eliminate heavy metals, fluoride, and other contaminants. They can be more expensive than other water filters but they have shown to be effective and have a long lifespan. This is perfect for traveling, staying at hotels, or friends that don’t have the same priorities as you when it comes to clean water. For my home, I use a Berkey Water Filter. The Berkey has 2 column size carbon filters that filter hundreds of things. It’s pricey, but the filters last forever.
Step 4: Exercise
Regular exercise is an important component of preparing your body for a successful tapering process. A majority of these drugs are fat soluble, meaning they live in your fat tissue. Sweating through exercise or moving throughout the day can help force these toxins into your lymph tissue and then into your bloodstream to be eliminated. Exercise also helps to reduce 3stress and improve sleep, which can help manage withdrawal symptoms. Find a way to move throughout the day. Just think. 8 to 10,000 steps every day.
Step 5: Take high-quality supplements
While a healthy diet is important, taking high-quality supplements can help ensure that you are getting the nutrients your body needs to function properly. In the US, manufacturers only have to prove that the ingredient is in their supplement, not that the amount is accurate. Professional grade supplements test to ensure that you are getting ingredients that are ready to work once consumed (called bioactive).
It is important to do your research and choose supplements that are high-quality and appropriate for your individual needs. You can get 10% off your first purchase from a 5 star supplement company like Orthomolecular and for under $1 per day, you would have important nutrients that would cover your deficiencies in your diet. Below is a link to the multivitamin Alpha Base. I take this and recommend this to my family and friends. Also, here is a great article I wrote about why you need to supplement.
Step 6: Work with a trained functional medicine doctor
Along with taking high quality supplements, it is important to know what is deficient in your body. A functional medicine doctor can take a deeper medical history. From there, they can identify basic and more advanced laboratory test to identify root causes of stress, chronic illness or fatigue.
In addition, they can also check things like leaky gut, dysbiosis, and small intestinal bacterial overgrowth. These are gut conditions that can be caused by food sensitivities, gut pathogens, and even medications.
Lastly, a well-trained functional medicine doctor can help you identify any stressors that could worsen the withdrawal symptoms. Whether it’s avoiding certain supplements, alcohol, or other types of medications. A functional medicine doctor or pharmacist can really reduce the frustration.
Step 7: Gather support
Going through the tapering process can be difficult, and it is important to have a support system in place. Notify your family, friends, and neighbors that you will be going through a process that could put a lot of stress on your body, and ask for their help and support.
It can also be helpful to find online support groups that are uplifting and encouraging, and to find a healthcare provider who understands the process and can help guide you through it. Remember, the tapering process can be slow, and it is important to allow your body to adjust and be strong before pulling off completely.
Step 8: Don’t focus on the withdrawal symptoms
At times, you might find it exhausting when tapering off or lowering your dose. Like many of us, you may not get a great night sleep that night. You may have to take extra supplements or drink a more relaxing tea at night.
During the day, it is not a good idea to lie there in agony or focusing on the withdrawal symptoms. I always recommend picking up an activity that will help you distract yourself. Cooking, gardening, cleaning, organizing, knitting, or simply watching television are great ways to take your mind off. If you are feeling fidgety try taking long walks, biking, exercise classes, or walking with a friend.
The key is to not let your brain do what it does best. Focus on the bad stuff. We must do what we can to distract and help paint a brighter picture on the positives.
Step 9: Practice destressing
Even before you are thinking about lowering your dose, either youtube a relaxing meditation that focuses on deep breathing. You’ll want to know how to breath to relax your body when you need that quick hit of relaxing endorphins.
If anything, remember the sequence 4-7-8. Inhale for 4 seconds, hold for 7 seconds, and exhale for 8 seconds. If you can remember that, than just make sure you exhales are slower than your inhales. This allows your “parasympathetic nervous system to kick in which helps to shut off our stress response. Read my blog on stress to learn more about this process.
Step 10: Do Not Rush
Don’t be in a hurry to taper to fast even when everything is going well. Even if you are on the smallest dose and you have been doing great, don’t rush to cut it off cold turkey. There are a few instances where you could have rare withdrawal symptoms even with tiny doses. Just remember if you have been on benzodiazepines longer than 2 weeks and have taken daily, your body has already built an attachment to them.
It’s not that you are addicted, but you may have physical and mental withdrawals from these substances.
Lastly, tapering off benzodiazepines can be a challenging process, but taking a holistic approach to preparing your body can help reduce the severity of withdrawal symptoms and increase your chances of success. By making a plan, eating a healthy diet, exercising regularly, taking high-quality supplements, and gathering support, you can give your body the tools it needs to heal and recover from the effects of these medications. If you need help or guidance with the tapering process, please click the link to contact me and schedule a call. I am here to help you through this process and support you every step of the way.
To Healthy Sleep,
Dr. Zeke Medina