Benzodiazepine Withdrawal

History of Benzodiazepines

Dr. Leo Sternbach, while working for the Chemical Research Department of  Hoffman-Laroche U.S.A. in 1957, developed the first benzodiazepine as a result of his work with a chemical grouping called heptoxdiazines begun in his native Poland in the 1930s. Sternbach’s discovery, found to have hypnotic, sedative, antistrychnine effects, underwent further testing to determine its clinical utility until 1960 when first introduced to the pharmacological market as Librium followed three years later by Valium (Lader). Since the initial introduction of Librium, approximately 30 different types of benzodiazepines have been developed worldwide.

Medical Benefits of Benzodiazepines

Benzodiazepines are prescribed most often to treat anxiety and sleep disorders. Doctors may also prescribe them for use in withdrawal from alcohol, as muscle relaxants, to treat epilepsy, and as a pre-surgery relaxant. Benzodiazepines are often used illegally for those seeking their intoxicating effect.

Increase of Popularity

Benzo Withdrawal

According to a presentation by United Kingdom based expert Dr. C. Heather Ashton for the 3rd Annual Benzodiazepine Conference:  

By the late 1970s benzodiazepines had become the most commonly prescribed of all drugs in the world. It was estimated that one in five of all women and one in ten of all men in Europe took them at some time each year. The drugs were prescribed long-term, often for many years, for complaints such as anxiety, depression, insomnia and ordinary life stresses (History of Benz.).

Risks of Addiction

Considered a replacement for barbiturates when developed, benzodiazepines were widely considered non-addictive until the early 1980s. According to Dr. Ashton’s report to the Benzodiazepine Conference in the 1980s long term users displayed a tolerance and a need for higher dosages and difficulty stopping usage due to withdrawal symptoms. Many complained they had become addicted. The public outcry resulting from this information led to the rise of withdrawal clinics and self-help groups for benzodiazepine addiction worldwide (History of Benz.).

Data published in the Treatment Episode Data Set Report (TEDS) in 2011 shows a substantial increase in treatment admissions for benzodiazepine addiction. The report states that benzodiazepine admissions increased three-fold during the ten year period of 1998-2008; while overall treatment admissions increased just 11% (Substance Abuse).

Benzodiazepine Withdrawal and Treatment

Withdrawal symptoms associated with cessation of benzodiazepine usage include: “…sleep disturbance, irritability, increased tension and anxiety, panic attacks, hand tremor, sweating, difficulty in concentration, dry wretching and nausea, some weight loss, palpitations, headache, muscular pain and stiffness and a host of perceptual changes.” Withdrawal symptoms, depending on dose and length of use, vary and “can result in a number of symptomatic patterns.” The most common pattern typically lasts 1-4 days and is characterized by “rebound” symptoms of anxiety and insomnia. The second pattern is considered “full-blown” withdrawal which can last from 10-14 days and is accompanied by most or all of the above mentioned symptoms (Pétturson).

A similar description of benzodiazepine withdrawal symptoms was published in a 1990 report from the American Psychiatric Association Task Force, in which they categorized a combination of withdrawal symptoms as “uncommon withdrawal reactions [which] included ‘psychosis,’ ‘confusion,’ ‘paranoid delusions,’ and ‘hallucinations” (qtd. Lane).

Dr. Ashton, upon the opening of her withdrawal clinic in the U.K., observed and recorded symptoms of the first 50 patients; individuals on prescribed, therapeutic doses from 1 to 22 year durations and ranging from 20 to 72 years of age. Her observations of patients upon entry to the clinic concluded:

• 20% had taken drug overdoses requiring hospital admission in suicide attempts (illustrating that benzodiazepines cause or exacerbate depression)
• 20% had developed incapacitating agoraphobia (in addition to the majority who had panic attacks)
• 18% had undergone GI investigations (irritable bowel) (a condition closely linked to anxiety)
• 10% had undergone neurological investigations (3 wrongly diagnosed with MS on the basis of muscle weakness and tremor, blurred vision and patches of numbness — signs often associated with anxiety states)
• 62% had been prescribed other psychotropic drugs, mainly antidepressants, since starting benzodiazepines
• 28% were taking a combination of two benzodiazepines, the second added after the first become insufficient (History of Benz.).

In her report, Dr. Ashton explains that these symptoms observed in the first 50 patients were not the reasons for originally being prescribed benzodiazepines, but were the result of prolonged “therapeutic” use. Dr. Ashton’s observations illustrate that although originally prescribed benzodiazepines for disorders such as anxiety and depression; long term use actually “exacerbated” these disorders within the patients.

Withdrawal symptoms, particularly following long term use, are so severe – prompting Malcolm Lader, Professor of Psychopharmacology at the University of London, U. K., who, along with Dr. Ashton, is widely considered a leading academic in the field, to declare in a 1999 interview on BBC Radio 4:

It is more difficult to withdraw people from benzodiazepines than it is from heroin. It just seems that the dependency is so ingrained and the withdrawal symptoms you get are so intolerable that people have a great deal of problem coming off. The other aspect is that with heroin, usually the withdrawal is over within a week or so. With benzodiazepines, a proportion of patients go on to long term withdrawal and they have very unpleasant symptoms for month after month, and I get letters from people saying you can go on for two years or more. Some of the tranquilliser groups can document people who still have symptoms ten years after stopping (qtd. Lane).

Treatment for benzodiazepine withdrawal symptoms is typically achieved by a slow “tapering off” schedule, which, according to schedule tables for various benzodiazepines and doses devised by Dr. Ashton, may take up to six months or more. Tapering off of benzodiazepines should not be attempted without the direction of a professional (Benzodiazepines).

Conclusion

Touted as a safe alternative for highly addictive barbiturates in the 60s, benzodiazepines have proven to possess many potential risks. Research shows and experts agree, long term use of benzodiazepines is likely to result in withdrawal symptoms which are difficult to overcome. The growing number of individuals entering treatment for benzodiazepine addiction at such disproportionate levels from those entering treatment for other substance abuse disorders is alarming. A strong word of caution to those seeking to discontinue use of benzodiazepines – do not stop abruptly — consult a professional who can guide you through a safe tapering off schedule.

References:

Callahan, Daniel: Results of Benzodiazepine by Solutions Recovery Center.

Ashton, Heather. “Benzodiazepines: How They Work and How to Withdraw”. benzo.org.uk. Professor C. H. Ashton, 2013. Web. Retrieved from: http://www.benzo.org.uk/manual/bzsched.htm

Ashton, Heather. “History of Benzodiazepines: What the Textbooks May Not Tell You”. Psychiatric Medication Awareness Group. Professor C. H. Ashton, 2012. Web. Retrieved from: http://www.psychmedaware.org/HistoryBenzodiazepines.html

Lader, Malcolm. “History of Benzodiazepine Dependence”. benzo.org.uk. Journal of Substance Abuse Treatment, Vol. 8, pp. 53-59, 1991. Web. Retrieved from: http://www.benzo.org.uk/amisc/lader.pdf

Lane, Christopher. “Side Effects: From Quirky to Serious, Trends in Psychology and Psychiatry”. Psychology Today. Sussex Directories 2013. Web. Retrieved from: http://www.psychologytoday.com/blog/side-effects/201011/brain-damage-benzodiazepines-the-troubling-facts-risks-and-history-minor-tr

Pétturson, H. “The Benzodiazepine Withdrawal Syndrome”. PubMed. PubMed, Nov. 1994. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/7841856

“TEDS Report: Substance Abuse Treatment Admissions for Abuse of Benzodiazepines”. SAMHSA. SAMHSA, 2011. Web. Retrieved from: http://www.samhsa.gov/data/2k11/WEB_TEDS_028/WEB_TEDS-028_BenzoAdmissions_HTML.pdf