The possible perils of Benzodiazepine use

Updated 9/09
This is another post from very early on in the life of my blog (day three to be precise.) I’ve amended it quite a bit as I’ve learned much more and my circumstances have changed significantly, so it’s up to date:

I have suffered ill effects from all the classes of psych drugs; benzos, neuroleptics, anti-depressants, as well as stimulants and mood stabilizers. However because there is such an organized withdrawal community of benzo users on boards and email lists I’ve learned a significant percentage of what I know about psychiatric drug withdrawal in general from the benzo boards. We have yet to have the thousands of people withdrawing from neuroleptics though I certainly hope to see that day too (hey! it’s come…this edit from 2018).

Benzos have been around a lot longer so there are simply more people who have figured out how damaging they are and have networked to get help from one another. Among neuroleptic users it’s much harder to find support and people who know what they are talking about regarding withdrawal.

This post will rely heavily on the work of Dr. Heather Ashton who ran a benzodiazepine withdrawal clinic for 12 years in the UK. She has been involved in the withdrawal of hundreds of addicted consumers. The medical establishment at large has little credible coverage of the ravages of this class of drugs.

I’ve been withdrawing from benzos for close to a year now, following getting off of 5 other psychotropic drugs and I’ve been involved in forums and email lists of benzo users who’s participants run into the thousands. Much of what I will share will be the anecdotal information I have gleaned from these groups, as well as my own experience on benzos, convoluted as that may be with the multiple drugs I’m on. I’ve currently withdrawn from multiple anti-depressants which I now refuse to take ever again. I’ve withdrawn from 50 mg Seroquel, 11 mg of Risperda and 400 mg of Lamictal.  As a side note the ever increasing amounts of all these drugs never relieved my symptoms and instead, I think, exacerbated them.

I’m close to the end of the benzo withdrawal now too, but being that it is the tail end of a 6 years withdrawal process it may take several more months, much to my dismay. I was on 3 mg of Klonopin which I tapered to 1.5 mg and then I did a switch to Valium as it’s supposed to be somewhat easier because of the long half-life. The equivalent dose was 30 mg of Valium. I am now at 6 mg of Valium. It’s an excruciatingly slow process at this point.

I first wrote this post when I’d not even begun my benzo withdrawal because I learned so much, in general about psychotropic drug withdrawal, in the benzo groups. These groups helped me withdraw from all the other class of drugs I’ve withdrawn from.

I’ve basically found out that the symptoms are not all that different. By some accounts benzos are the most difficult drug to withdraw from—this is something Breggin believes, but it seems to be it depends entirely on the individual.

It’s become clear we are all individuals and any psych med is potentially hell to withdraw from, or alternately there is the potential of any withdrawal from any psych drug not being so terrible as well.

There are accounts of people who have come off of benzos relatively easily, but the forums I participated in show a group of people who’s lives have been destroyed by their dependency on benzos. And certainly my disability has been caused by the cocktail of drugs I’ve been on and now the ensuing withdrawals have continued my disability.

The people on the benzo boards are in vast majority “accidental” addicts. Unsuspecting individuals who trusted their doctors. On the bright side, many people go on to recover completely with perhaps only minimal permanent cognitive impairment. On the dark side is the phenomena of protracted withdrawal syndromes for whom a not so small minority can be a permanent condition. The below is taken from this website.

For some chronic benzodiazepine users, withdrawal can be a long, drawn-out process. A sizeable minority, perhaps 10 to 15%(3) develop a “post-withdrawal syndrome”(4), which may linger for months or even years. This syndrome is clearly not a disease entity; it probably represents an amalgam of pharmacological and psychological factors directly and indirectly related to benzodiazepine use. The syndrome includes (1) pharmacological withdrawal symptoms involving the slow reversal of receptor changes directly induced in the brain by benzodiazepines(1,5-7), and (2) psychological symptoms resulting indirectly from long-term benzodiazepine use, including exposure of poor stress-coping abilities and other personal difficulties. These symptoms merge into a complex clinical picture that may be further complicated by (3) the reappearance of underlying anxiety or depression and (4) possibly also by ill-understood long-term neurological effects of benzodiazepines(1).Thus, the totality of the benzodiazepine withdrawal syndrome is as difficult to define or demarcate as a bout of influenza, which may include overlapping pathologies of acute viral toxaemia, secondary bacterial infection, prolonged post-viral depression and somatic damage such as cardiomyopathy. Nevertheless, an awareness that symptoms may be protracted is important for clinicians supervising benzodiazepine withdrawal; proper management of the initial withdrawal can decrease the incidence, severity and duration of protracted symptoms and improve the prospects for eventual recovery.

After being on benzos for sometime most people end up in a state of “tolerance withdrawal.” I stopped adding to my dose of benzo when I reached 3 mg of Klonopin. My doctor was encouraging me to double my dose, but I refused.

I started out as a Xanax user, which I quickly gained tolerance to, as it has the shortest half-life among the benzos and one can reach the ugly state of “tolerance withdrawal” rather quickly. I woke up in the middle of the night with panic attacks once reaching tolerance. Psychiatrists don’t really understand this phenomena and in general simply change the benzo being used and increase doses. After increasing my Xanax dose several times, I was switched to the longer acting Klonopin. I ended up hooked on a much   higher dose of Klonopin, making the problem worse.

….the evidence suggests that benzodiazepines are no longer effective after a few weeks or months of regular use. They lose much of their efficacy because of the development of tolerance. When tolerance develops, “withdrawal ” symptoms can appear even though the user continues to take the drug. Thus the symptoms suffered by many long-term users are a mixture of adverse effects of the drugs and “withdrawal” effects due to tolerance. The Committee on Safety of Medicines and the Royal College of Psychiatrists in the UK concluded in various statements (1988 and 1992) that benzodiazepines are unsuitable for long-term use and that they should in general be prescribed for periods of 2-4 weeks only.

What exactly is “tolerance withdrawal?” As I understand it and experienced it, it is the result of, having developed tolerance, the body craves more. In between doses the body goes into “withdrawal.” This is experienced by break-through anxiety and or physical and mental discomforts of various natures. The discomfort goes away once the scheduled dose is administered. What is of importance here, in my case, is that I was not prescribed benzos for anxiety. I was prescribed them for insomnia. I have since developed what might be commonly called general anxiety disorder or GAD. I’m convinced that this in part is the result of benzo tolerance and damage as I’ve seen it referred to by scores of accidental addicts, most notably by people who were not initially prescribed the benzo for anxiety.

Before deciding “my drugs were my problem,” (to borrow a phrase–modified for my purposes–from Peter Breggin) I was taking 3 mg Klonopin each evening and then up to 3 mg a day PRN (ie: as needed.) Yes, up to 6 mg a day. Evidence of  tolerance withdrawal was exemplified by a daily anxiety attack or some other kind of discomfort in the evening before I took my regular scheduled dose of meds. I stopped taking more to alleviate the symptoms a very long time ago. I’ve learned a lot about coping with discomfort since starting my withdrawals. If I’d been willing to live with a little discomfort years ago I wouldn’t be in this position today. Behavioral coping mechanisms are really a much more effective long term treatment and infinitely safer.

The other lovely result of my benzo use is the cognitive impairment I’ve developed. This, in my case, is exacerbated by the use of neuroleptics, another class of drugs that cause severe cognitive problems. As far as benzos go there is a description of the cognitive issues involved after long term use:

Studies of cognitive function: Several studies have shown that chronic benzodiazepine use is associated with specific cognitive impairments which are different from those seen on acute administration (Hendler et al.1980; Petursson et al. 1983; Lucki et al. 1986; Brosan et al. 1986; Golombok et al. 1988; Lader 1987; Tata et al. 1994). For example, Golombok et al. 1988 tested the performance in a battery of psychomotor tests of 50 patients who had been taking benzodiazepines (up to 30mg diazepam equivalent daily) for at least once year and by control subjects who had not taken benzodiazepines regularly. The cognitive performance of the chronic benzodiazepine users was specifically impaired in two main areas: (a) visuospatial ability and (b) ability to sustain attention in a repetitive task under time pressure. The pattern of impairment was consistent with deficits in posterior cortical (parietal, posterior temporal and occipital) rather than frontal lobe function.More recently Tata et al. (1994) found a wider range of cognitive impairments in 21 patients who had taken larger doses (10-100mg diazepam equivalent, daily) for a mean of 13.2 years compared with 21 normal control subjects matched for sex, age and I.Q. The benzodiazepine users showed significant impairments in verbal learning and memory, and in psychomotor, visuomotor and visuo-conceptual abilities. The main adverse effects of benzodiazepines on memory and psychomotor performance in this study appeared to implicate functions of the hippocampus and diencephalon/recticular formation. In neither of the studies (Golombok et al. 1988 and Tata et al. 1994) were differences in anxiety levels between benzodiazepine users and controls considered likely to account for the rather specific differences in performance.

Another common “side effect” of chronic benzo use is depression as well as a host of other problems including “querrulousness” and agression. Scores of people prescribed benzos end up on anti-depressants. For me depression predated benzo use. But I don’t doubt that my benzo use increased and protracted my depression.

Long-term Side Effects: All the psychological changes mentioned above may occur as long-term side effects when the use (or abuse) has become chronic i.e. has been going on for many months or even years. The frequency of such side effects is significantly higher than the frequency of “paradoxical” side effects. The long-term effects include depression, querulousness or aggression, and subtle personality changes. Further, fatigue, passivity and symptoms of memory and cognitive impairment may ensue.

“Querulousness,” perhaps another way to say irritable? My irritability since beginning treatment with psychiatric drugs has sky-rocketed. This has led to greater and greater doses of neuroleptics of all things! Yes, my psychiatrist got me up to 11 mg of Risperdal, paired with 50 mg of Seroquel for irritability. Granted it’s now become clear to me that the anti-psychotics were also contributing to the irritability. But my god, ANTI-PSYCHOTICS in massive doses for irritability! The irritability never improved, yet I stayed on these drugs for years. As I’ve come off of them my irritability has neither gotten worse nor has it improved. I can only hope that the withdrawal of benzos will give me some relief.

Many people withdrawing from benzos report problems with rage that tends to remit once the withdrawal is over.

I will end this post with a positive message from Dr. Heather Ashton. While being on benzodiazepines, and then the process of withdrawal can be an ugly proposition, Ashton comforts people with the following words:

Contrary to public impression, you definitely do NOT have to “go through hell” to come off benzodiazepine hypnotics or tranquillisers.Most symptoms are due to too rapid withdrawal or to fear. But do not be afraid. With individually tailored, gradual , dosage tapering, adjusted to your own lifestyle and personality, and with support, encouragement, and advice from appropriate mentors, it is possible to become benzodiazepine-free without suffering or with only minimal discomfort. I have personally seen hundreds of people withdraw after taking benzodiazepines for 1 to over 20 years. Many of them actually started to feel better during withdrawal: their minds became clearer as dosage was tapered and their self-confidence increased with each reduction. Over 90% withdrew successfully and after withdrawal (as many other studies have also shown) their physical and mental health improved, they slept better, felt stronger, and were able to take control of their lives without medication. Almost anyone with the right motivation, the right withdrawal schedule, and the right advice can become benzodiazepine-free without intolerable symptoms.

Perhaps, my experience on the benzo boards illustrate the experience of the 10% who have a hell of a time withdrawing.

Certainly with all the classes of drugs there are those who have it easy and those who have it rough, but it pays to know that one never knows where they will fall when they choose to take that first pill and thus we need informed consent.