Benzodiazepine Withdrawal: Symptoms, Timeline and What to Expect

Benzodiazepine withdrawal occurs when a physically dependent person reduces or stops using the medication. Symptoms range from mild to severe and affect both your physical and psychological health. Because benzodiazepine withdrawal can be extremely uncomfortable and unpredictable It is recommended to seek medical care when going through benzo withdrawal.

This guide offers details on the benzodiazepine withdrawal process: what symptoms to expect, the timeline of recovery and the best next steps for managing discontinuation or treating a substance use disorder, if you have one.

Key Points

• Benzo withdrawal occurs when a physically dependent person reduces or stops the medication
• Symptoms range from anxiety and insomnia to seizures, in severe cases
• Timeline varies by medication half-life, dose and duration of use
• Medical supervision is strongly recommended for all benzo withdrawal
• Tapering (gradual dose reduction) is the safest discontinuation method

What Is Benzodiazepine Withdrawal?

Benzodiazepines are a class of medications used to treat generalized anxiety disorder, insomnia, seizures, social phobia and panic disorder.¹ Benzo withdrawal is the body’s response to a reduction or discontinuation of the drug after someone has developed a physical dependence. Benzos enhance the effects of the neurotransmitter GABA in the brain. It works by binding to GABA receptors and slowing brain activity, causing drowsiness or a calming effect.

This withdrawal process stems from neuroadaptations in the brain. Prolonged benzodiazepine use causes GABA (an inhibitory neurotransmitter) receptors to become less sensitive. When the medication is reduced or stopped, these desensitized receptors cannot adequately inhibit brain activity, leading to relative overactivity of glutamate (an excitatory neurotransmitter). The result is that your nervous system is over-excited.

Withdrawal from benzo use can occur even if you have used the drug as prescribed and at therapeutic doses. 

It is important to remember that withdrawal is not the same as addiction, but the two frequently overlap. Addiction is a chronic condition characterized by continued drug use despite harmful consequences, with a pattern of compulsive behaviors and loss of control.

Alternatively, withdrawal is a set of physical or psychological symptoms that occur when you reduce or stop a substance to which you have developed a dependence. 

Common Benzodiazepine Withdrawal Symptoms

The specific withdrawal symptoms you may experience will depend on several factors, such as which drug you’re using, duration and dosage. You can expect common withdrawal symptoms to have physical, psychological, and cognitive impacts.²

Physical Symptoms

Some of the physical symptoms you can expect include:

• Tremors
• Muscle tension/pain
• Sweating
• Nausea
• Headaches
• Heart palpitations
• Sensory hypersensitivity

Psychological Symptoms

In addition to physical symptoms, some of the psychological side effects include:

• Anxiety
• Panic attacks
• Irritability
• Depression
• Depersonalization
• Insomnia

Cognitive Symptoms

You may also experience some cognitive symptoms, such as:

• Difficulty concentrating
• Memory problems
• Brain fog

Severe Symptoms Requiring Emergency Care

In some cases, you may experience severe symptoms like:

• Seizures
• Hallucinations
• Psychosis
• Delirium

If you experience any of these severe symptoms, seek immediate medical attention.

Benzodiazepine Withdrawal Timeline

Withdrawal generally progresses through three phases, though the timeline varies based on the specific medication, dose and duration of use.

Early Withdrawal

The first stage is called early withdrawal and can last for hours or a few days after stopping the drug. In the early withdrawal stages, you may experience rebound anxiety and insomnia. The onset of early withdrawal varies depending on the half-life of the specific drug you are detoxing from. For example, the onset of withdrawal will be faster for Xanax and slower for Valium.

Acute Withdrawal

The next stage is called acute withdrawal and typically lasts between 5 and 28 days. During this stage, you reach the peak intensity of your symptoms and experience the broadest symptom profile. The highest risk of seizures occurs in the first week to 10 days after stopping benzodiazepines. 

Protracted Withdrawal

Some people may experience protracted withdrawal, also known as post-acute withdrawal syndrome (PAWS). This stage can last from months to years. This is when withdrawal symptoms persist for a prolonged period of time, well beyond the detox period.

PAWS follows a highly non-linear, unpredictable pattern, sometimes referred to as waves and windows. Waves are periods of severe withdrawal symptoms, and windows are periods of relief from symptoms.

Short-Acting vs. Long-Acting Benzo Withdrawal

Different benzodiazepines may produce different withdrawal symptoms, making a personalized tapering schedule especially important during detox. 

Short-acting benzos, such as Xanax and Ativan, tend to produce earlier-onset and more intense withdrawal symptoms. Whereas long-acting benzos, such as Valium and Klonopin, produce later-onset and more gradual withdrawal symptoms.

Short-acting drugs often require frequent dosing during tapering to avoid severe, abrupt withdrawal. This is less of a concern when quitting long-acting benzos. 

The same withdrawal symptoms exist for both types of benzos; however, you may experience them differently and in varying intensities.

Factors That Affect Withdrawal Severity

Several variables can influence how difficult withdrawal will be for you, including:

• Duration of use
• The dose you were taking
• The type of benzo you use
• The speed of discontinuation

If you have been taking the drug for a longer period of time or at a high dose, then you may experience more severe withdrawal symptoms. As well, you are more likely to have intense withdrawals if you stop using the drug abruptly as opposed to a slow taper.

History of Previous withdrawals

A history of previous withdrawal episodes is an important consideration, as it can influence both the severity and progression of your symptoms. This is due to the kindling effect, where, for some people, repeated cycles of addiction and detox lead to progressively more severe withdrawal symptoms. For some people, each time they repeat the withdrawal process, it is more intense and dangerous than the previous episodes.

Co-occurring Mental Health Conditions

Co-occurring mental health conditions can also impact what your withdrawal may look like. Because several of the withdrawal symptoms for benzos include anxiety-related symptoms, these can be worse if you already have an underlying anxiety condition. If you were taking benzos to help treat your anxiety, the detox stage can make those original anxiety symptoms much worse until withdrawal is complete.

Polysubstance Use

If you are using multiple substances while also taking benzos, it could complicate your withdrawal process. Especially, alcohol or opioid use, which can make withdrawal symptoms more severe and even life-threatening. Alcohol use can increase your likelihood of seizures during withdrawal, while opioids increase the risk of respiratory depression.

Age and Overall Health

Another factor that will impact your detox experience is your age and overall health. The older you are, the more at risk you are for developing complications during detox. Also, if you have underlying medical conditions or health issues, they may worsen due to the stress of withdrawal.

Why Medical Supervision Is Essential

Addiction professionals recommended that you detox from benzodiazepines under medical supervision because of the potential for serious medical complications.

Benzo withdrawal carries real medical risks including:³

• Seizures
• Hallucinations
• Panic attacks
• Suicidal thoughts
• Confusion
• Memory loss

To ensure your safety while detoxing from these drugs, supervised tapering is considered the standard of care. You can read the ASAM guidelines for medical recommendations on safely detoxing.

The level of medical supervision you need during detox will depend on the substances you have been using and the severity of your withdrawal symptoms. In most cases, the treatment team will begin with a thorough assessment and create a plan to help you safely taper off the substance when appropriate. 

Throughout detox, medical staff will closely monitor for symptoms and provide medications or other interventions to help keep you as comfortable as possible. 

Doctors and nurses will also monitor your physical and emotional health around-the-clock to ensure you remain safe and supported throughout the detox process. 

There are several levels of care available in detox, depending on the severity of your symptoms and the support you need. Both inpatient and outpatient programs offer medical supervision for withdrawal management.

Inpatient care provides 24/7 support and requires you to stay at the facility. This type of care is more appropriate for:

• Severe addictions
• High risk of severe symptoms such as seizures or hallucinations
• Co-occurring mental health conditions
• Polysubstance use
• Those with a lack of a stable support system

Outpatient allows you to stay at home in between appointments with medical staff and may be appropriate for those with:

• Mild addiction
• Strong support systems at home
• Generally good mental and physical health

Benzodiazepine Withdrawal FAQs

Sources

1. U.S. Food and Drug Administration. (2020). FDA requiring Boxed Warning updated to improve safe use of the benzodiazepine drug class.
2. Benzodiazepine Information Coalition. n.d. Ashton Manual.
3. The New England Journal of Medicine Review. (2017). Treatment of Benzodiazepine Dependence.