Patients had to have sufficient knowledge of English or French to be able to participate in cognitive testing. Depressive symptoms are common both during long-term benzodiazepine use and in withdrawal. It is not surprising that some patients feel depressed considering the amalgam of other psychological and physical symptoms that may assail them.
Poor memory and cognition
However, as stated above, our results are similar to those of Ogino and colleagues, whose study did include a control group Ogino et al. 2011. Also, in a study exploring the reliability and sensitivity of the BACS in patients and controls, Keefe and colleagues did not observe significant practice effects on the verbal fluency and Tower of London tests when alternate versions were administered. Likewise, no significant practice effects were detected on other measures without alternate versions, except for the symbol-coding task, which showed a significant practice effect (standard deviation of 0.25 in patients with schizophrenia).
- However, they can be challenging to withdraw from, and they can cause permanent movement disorders.
- Investigators are currently trying to find novel compounds to improve cognition in schizophrenia.
- Our study has several limitations, lack of a control group being an obvious one.
- The answer to the first question is that there is no medication which will substitute for a benzodiazepine, unless it is another benzodiazepine, or a drug with benzodiazepine-like properties (such as barbiturates or zolpidem Ambien).
- Unfortunately, flumazenil does not at present offer a practical cure for protracted symptoms.
Long-Term Treatment for Benzodiazepine Withdrawal
Such experiences probably represent a normal defensive reaction evolved as a protection against intolerable suffering. They may involve a primitive brain mechanism similar to the “freezing” of some animals when presented with an inescapable danger. Like other benzodiazepine withdrawal symptoms, these feelings resolve benztropine withdrawal symptoms in time and should not be interpreted as abnormal or crazy. Return of SWS seems to take longer after withdrawal, probably because anxiety levels are high, the brain is overactive and it is hard to relax completely.
Benzodiazepine withdrawal syndrome
These effects are usually more common when starting a medication or after a dose increase. It is also possible to experience a side effect that you feel is serious or long-lasting. If this occurs, speak to your doctor about ways to manage the side effects at your next appointment. On the next page are some of the more common side effects of taking this medicine. Benztropine works by affecting the activity of the brain chemicals acetylcholine and dopamine.
Brooks focused on withdrawal symptoms that were of at least moderate degree, i.e., “marked and distressing”, which he detected in 17 individuals. These “mild reactions” were not specified and also excluded from our analysis. All studies showed a “high” risk of bias according to Cochrane Collaboration’s tool for assessing risk of bias (Table 1) (21). In this systematic review and meta-analysis of five studies, the proportion of individuals with withdrawal symptoms after abrupt oral antipsychotic discontinuation was increased.
- There have been some reports that gabapentin (Neurontin), tiagabine (Gabitril) and possibly pregabalin (yet to be licensed) help with sleep and anxiety in withdrawal.
- The need for sleep is so powerful that normal sleep will eventually reassert itself.
- It is important to note that benzodiazepine withdrawal can be dangerous and should be managed by a healthcare professional.
- Like alcohol, benzodiazepines are fat soluble and are taken up by the fat-containing (lipid) membranes of brain cells.
- Once the hallucinations, which seem real at the time, are recognised as “merely” hallucinations, they quickly become less alarming.
- In both cases the phenomena may herald the beginning of a return in normal memory functions and, although sometimes disturbing, can be welcomed as a sign of a step towards recovery.
In severe cases, benzodiazepine withdrawal can lead to seizures, a medical emergency that requires immediate attention. Individuals may also benefit from cognitive-behavioral therapy approaches, such as stimulus control and sleep restriction. Stimulus control involves changing the sleep environment to promote relaxation and reduce anxiety, while sleep restriction involves limiting the amount of time spent in bed to increase sleep efficiency. Before delving deeper into the signs of benzo withdrawal, it is essential to understand how benzodiazepines work and how withdrawal occurs.
- The symptoms of benzodiazepine withdrawal can vary depending on several factors, including the individual’s history of benzodiazepine use, the dose and duration of use, and the method of discontinuation.
- An important organ in controlling motor stability and maintaining equilibrium is a part of the brain called the cerebellum.
- To cope with physical discomfort during benzodiazepine withdrawal, individuals may benefit from engaging in relaxation exercises, massage therapy, and physical activity such as yoga or swimming.
Generalised anxiety, panics and phobias
As mentioned before, depression can be a real problem in withdrawal and can sometimes be severe amphetamine addiction treatment enough to pose a risk of suicide, though this is unusual with slow tapering. Like any other depression, the depression in withdrawal responds to antidepressant drugs and is probably caused by the same chemical changes in the brain. There is a school of thought, mainly amongst ex-tranquilliser users, that is opposed to the taking of any other drugs during withdrawal. But suicides have occurred in several reported clinical trials of benzodiazepine withdrawal. If depression is severe during benzodiazepine withdrawal as in any other situation, it seems foolhardy to leave it untreated. Benztropine exerts its action in the central nervous system (CNS) and smooth muscles by competing with acetylcholine at muscarinic receptors.
Signs and Symptoms of Benzodiazepine Withdrawal
- Although most studies have not extended beyond a year after withdrawal, the results suggest that improvement continues beyond this time.
- Ratings on the measures, especially the ESRS, may have been influenced by the use of prn doses of anticholinergics.
- The muscle pain and stiffness is actually little different from what is regarded as normal after an unaccustomed bout of exercise, and would be positively expected, even by a well-trained athlete, after running a marathon.
- Chapter I described what benzodiazepines do when they are in the body and how tolerance and dependence develop.
It may take some time for the cerebellar systems to restabilise after benzodiazepine withdrawal and the symptoms can last until this process is complete. Exercises, such as standing on one leg, first with eyes open, then with eyes closed, can speed recovery. The studies in our review (8, 23–26) reported that most withdrawal symptoms started within 4 weeks after abrupt antipsychotic discontinuation and subsided after up to 4 weeks even though certain symptoms such as hyperkinesia may last for months (23). Reported symptoms included nausea and vomiting, abdominal pain, diarrhea, headache, tachycardia, vertigo, increased perspiration, dry mucous membranes, myalgia, restlessness, anxiety, tension, insomnia, and hyperkinesia (Table 2). In addition, Lacoursiere et al. described “isolated reports of numbness, nightmares, rhinorrhea, and bad taste”. Battegay (23) reported a significantly higher rates of withdrawal symptoms in women and the age group above 50 years after discontinuation of different antipsychotics (23).