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From The Ashton Manual:

(Prof Ashton ran a Benzodiazepine Withdrawal Clinic for people wanting to come off benzodiazepines, between 1982 - 1994)
Below she speaks of what happens if people attempt to come off the drugs too fast. Typically a taper will take between 6 months (for someone with a small amount to withdraw from and/or who has been using for a short time - say under 6 months) to 2 years or more for someone who is using a higher dose and/or for longer.
But even with a slow taper - this is a real roller-coaster of a ride - with symptoms waxing and waning in no predictable pattern.

For more information - type in Ashton Manual into google.



"Mechanisms of withdrawal reactions. Drug withdrawal reactions in general tend to consist of a mirror image of the drugs' initial effects. In the case of benzodiazepines, sudden cessation after chronic use may result in dreamless sleep being replaced by insomnia and nightmares; muscle relaxation by increased tension and muscle spasms; tranquillity by anxiety and panic; anticonvulsant effects by epileptic seizures. These reactions are caused by the abrupt exposure of adaptations that have occurred in the nervous system in response to the chronic presence of the drug. Rapid removal of the drug opens the floodgates, resulting in rebound overactivity of all the systems which have been damped down by the benzodiazepine and are now no longer opposed. Nearly all the excitatory mechanisms in the nervous system go into overdrive and, until new adaptations to the drug-free state develop, the brain and peripheral nervous system are in a hyperexcitable state, and extremely vulnerable to stress.

Acute withdrawal symptoms. The most prominent effect of benzodiazepines is an anti-anxiety effect - that is why they were developed as tranquillisers. As a consequence, nearly all the acute symptoms of withdrawal are those of anxiety. They have been described in anxiety states in people who have never touched a benzodiazepine and were recognised as psychological and physical symptoms of anxiety long before benzodiazepines were discovered. However, certain symptom clusters are particularly characteristic of benzodiazepine withdrawal. These include hypersensitivity to sensory stimuli (sound, light, touch, taste and smell) and perceptual distortions (for example sensation of the floor undulating, feeling of motion, impressions of walls or floors tilting, sensation of walking on cotton wool). There also appears to be a higher incidence than usually seen in anxiety states of depersonalisation, feelings of unreality, and tingling and numbness. Visual hallucinations, distortion of the body image ("my head feels like a football/balloon"), feelings of insects crawling on the skin, muscle twitching and weight loss are not uncommon in benzodiazepine withdrawal but unusual in anxiety states.

Table 1 gives a list of symptoms which were spontaneously described by patients in my withdrawal clinic. It is clearly a long list and is probably not inclusive. Of course, not all patients get all the symptoms, and none of the symptoms are inevitable. Withdrawal often seems to seek out the individual's most vulnerable points: if he is prone to headaches, worse headaches may feature in withdrawal; if he is prone to "irritable bowel", digestive symptoms may be aggravated. Such symptoms are nearly always temporary and can be minimised. They are less frightening and seem less important or bizarre if their cause is understood. Furthermore, patients can learn techniques to alleviate or control many of the symptoms: there is a lot they can do to help themselves.

TABLE 1. BENZODIAZEPINE WITHDRAWAL SYMPTOMS

PSYCHOLOGICAL SYMPTOMS
Excitability (jumpiness, restlessness)
Insomnia, nightmares, other sleep disturbances
Increased anxiety, panic attacks
Agoraphobia, social phobia
Perceptual distortions
Depersonalisation, derealisation
Hallucinations, misperceptions
Depression
Obsessions
Paranoid thoughts
Rage, aggression, irritability
Poor memory and concentration
Intrusive memories
Craving (rare)

PHYSICAL SYMPTOMS
Headache
Pain/stiffness - (limbs, back, neck, teeth, jaw)
Tingling, numbness, altered sensation - (limbs, face, trunk)
Weakness ("jelly-legs")
Fatigue, influenza-like symptoms
Muscle twitches, jerks, tics, "electric shocks"
Tremor
Dizziness, light-headedness, poor balance
Blurred/double vision, sore or dry eyes
Tinnitus
Hypersensitivity - (light, sound, touch, taste, smell)
Gastrointestinal symptoms - (nausea, vomiting, diarrhoea,
constipation, pain, distension, difficulty swallowing)
Appetite/weight change
Dry mouth, metallic taste, unusual smell
Flushing/sweating/palpitations
Overbreathing
Urinary difficulties/menstrual difficulties
Skin rashes, itching
Fits (rare)

These symptoms have all been described by patients withdrawing from benzodiazepines; they are not arranged in any particular order, and few if any are specific to benzodiazepine withdrawal. The list is probably not inclusive. Different individuals experience different combinations of symptoms. Do not expect to get all these symptoms!"





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