GABA is the most common neurotransmitter in the CNS, and BZDs primarily work on the GABA-A receptor subunit [1]. The GABA-A receptor has various subunits, and the most important in this case is the alpha (A) submit unit. The alpha subunit has various isoforms, which dictate a BZD’s effects on the CNS. The A1 subunit is believed to be responsible for the sedative effects and anterograde amnesia, and some of the anticonvulsive impacts of diazepam [1]. The A2 subunit isoform mediates the anxiolytic and myorelaxant effects [1].
ADVERSE DRUG REACTIONS
People with severe anxiety before starting treatment with BZD typically have more severe withdrawal symptoms, and thus have a harder time fully discontinuing the drug [63]. Psychiatric diagnoses have also been linked to one’s ability to discontinue treatment with BZD. One study showed a high co-occurrence with BZD dependence and all psychiatric disorders in general [64,65]. Specifically, those with cluster B personality disorders have the worst prognosis in regard to discontinuing BZD. In one study, not a single subject diagnosed with a cluster B personality disorder successfully discontinued BZD use [63].
How Long Does Withdrawal From Benzodiazepines Last?
Additionally, these patients are more likely to have comorbid substance use disorders and anxiety disorders so it can be harder to find an efficacious treatment for their withdrawal symptoms [68]. One potential candidate for treatment of withdrawal symptoms in these patients is gabapentin, which works similarly to the neurotransmitter GABA [68]. However, one study showed no significant difference in BZD use in MMT patients between gabapentin and placebo [68]. However, this study was limited by a small severe benzodiazepine withdrawal syndrome sample size, so further randomized clinical trials need to be conducted to assess the efficacy of gabapentin treatment in BZD -dependent MMT patients [68]. Further studies need to be performed on not just gabapentin, but other medications for MMT patients with BZD dependence should be evaluated since treating them is more complicated. Captodiamine is a diphenhydramine-related compound that does not work at histamine receptors as diphenhydramine does and its mechanism of action is unclear [70].
1. Factors Influencing Withdrawal Symptoms
Procedure for administering clonidine for moderate/severe opioid withdrawal. Physical exercise may prolong withdrawal and make withdrawal symptoms worse. Our programs are designed with you in mind, offering a range of options tailored to your needs.
- The best resource in your quest to quit benzodiazepines is your prescribing doctor.
- In the early stage of benzodiazepine withdrawal, which typically begins within a few hours to days after stopping the medication, mild symptoms emerge.
- Experiencing rebound symptoms means the symptoms you had before taking benzodiazepines come back even stronger than before.
- If your reasons for quitting benzodiazepines are that you were misusing them or unable to control your use, then you may require further substance use treatment.
- Although differentiating withdrawal reactions from recrudescent psychiatric symptoms after drug withdrawal is always difficult, a number of factors favored the former interpretation of the newly-appearing symptoms and signs.
Some studies in the past have shown that there is a correlation between chronic BZD use and a decline in cognitive function, including the development of dementia and dementia-like diseases. One study showed a potential for cognitive decline after BZD use in the elderly, but at the same time did not find a link between their use and the development of Alzheimer’s dementia [73]. The researchers in the study cautioned the prescription of BZD in the elderly due to the potential for cognitive decline [73]. One of the main categories of people with BZD prescriptions is those with insomnia. Manconi et al. explored the effects of long-term BZD use on sleep architecture and microstructure in those with insomnia.
Approximately two weeks after birth, the infant experiences withdrawal consisting of continued difficulty feeding, high pitched cries, hyperexcitability, and consequently possible failure to thrive. The ultimate concern is that such fetuses will later be susceptible to autism, learning difficulties, attention deficit disorder, and general hyperactivity [24]. The difference in these characteristics dictates the clinical applicability of the drugs. Oxazepam, temazepam, and chlordiazepoxide which are low potency benzodiazepines are well tolerated with low toxicity levels.
Symptoms generally last 5–28 days, though some may last for several months. 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. These drugs are habit-forming and can easily result in physical dependence. This dependence may lead to a difficult withdrawal if the person chooses to stop taking the drugs.
There were adverse consequences in their personal and professional lives
The risk of falls leading to injuries in elderly BZD users is significantly increased in patients greater than 80 years old, while the increased risk is not significant in patients under 80 [22]. Passaro et al. described an increased risk of falls in elderly hospitalized patients prescribed short-acting BZD [23]. For mothers with BZD use during pregnancy, there is a risk of premature birth and low birth weight. Their relative safety compared to fellow depressants or barbiturates have increased the rate at which they are prescribed [25]. The dependence on BZDs generally leads to withdrawal symptoms, which necessitates careful tapering of the medication when prescribed [26]. Patients with a lower risk of relapse are those taking a daily dose of 10 mg diazepam equivalent or less at the start of tapering, and those who have made a substantial dose reduction themselves before the start of tapering.
The way Ativan works
- Patients with cognitive impairments as a result of alcohol dependence should be provided with ongoing vitamin B1 (thiamine) supplements.
- Withdrawal symptoms may begin after as little as 3–6 weeks of use, even when a person uses the drugs as the doctor directed.
- They quickly diffuse through the blood–brain barrier to affect the inhibitory neurotransmitter GABA and exert sedative effects.
- This patient has developed numerous concerning adverse effects, including tolerance, physiologic dependence, and withdrawal.