Stopping Benzodiazepines & Z Drugs

What are benzodiazepines and Z drugs?

Benzodiazepines are a group of drugs that are sometimes used to treat anxiety. Examples include: diazepam (Valium), lorazepam (Ativan), chlordiazepoxide (Librium, Tropium), alprazolam, clobazam, clonazepam, clorazepate, and oxazepam. Some are also used as sleeping tablets. These include: temazepam, flunitrazepam, flurazepam, loprazolam, lormetazepam, nitrazepam.

Zaleplon, zolpidem, and zopiclone are other sleeping tablets but, strictly speaking, are not benzodiazepines. They are known as the Z drugs. However, they act in a similar way (they have a similar effect on the brain cells as benzodiazepines).

When you first start taking a benzodiazepine or Z drug, it usually works well to ease the symptoms of anxiety, or to cause sleep. You can usually stop a benzodiazepine or Z drug without any problems if you take it for just a short time (less than 2-4 weeks).

Tolerance
After a few weeks of taking a benzodiazepine or Z drug each day, the body and brain often becomes used to the drug. In many people it gradually loses its effect. The initial dose then has little effect and so a higher dose is needed for it to work. In time, the higher dose does not work, and so an even higher dose is needed, and so on. This effect is called tolerance.

Dependence (addiction)
There is a good chance that you will become dependent on a benzodiazepine or Z drug if you take it for more than four weeks. This means that withdrawal symptoms occur if the tablets are stopped suddenly. In effect, you need the drug to feel 'normal'. Possible withdrawal symptoms include:

• Psychological symptoms - such as anxiety, depression, panic attacks, odd sensations, nightmares, feeling as if you are outside your body, feelings of unreality, or just feeling awful. Rarely, a serious mental breakdown can occur (psychosis).
• Physical symptoms such as sweating, unable to sleep, headache, tremor, feeling sick, feeling unsteady, palpitations, muscle spasms, and being oversensitive to light, sound and touch. Rarely, convulsions (seizures) occur.
• In some cases the withdrawal symptoms seem like the original anxiety symptoms.

The duration of withdrawal symptoms varies, but often lasts up to six weeks and sometimes longer. Some people who have taken these drugs for a long time may continue to have minor withdrawal symptoms for several months after stopping. Withdrawal symptoms may not start for two days after stopping the tablets, and tend to be worst in the first week or so before gradually easing. You may end up continuing to take the drug to prevent withdrawal symptoms but, because of tolerance, it is no longer helping the original anxiety or sleeping problem.

Some people who take a benzodiazepine or Z drug long-term believe that the drug is still helping to ease anxiety or sleeping problems. However, in fact, in many people the drug is just preventing withdrawal symptoms.

Why should I stop taking a benzodiazepine or Z drug?

Studies have shown that coming off benzodiazepines and Z drugs can have many benefits. For example, the benefits of stopping long-term benzodiazepines in elderly people were investigated in a trial of 139 people over the age of 65 years. This study found that stopping treatment:

• Had no long-term adverse effects on sleeping or anxiety symptoms.
• Improved memory and reaction times, while people who continued taking benzodiazepines declined in both these areas.
• Increased levels of alertness.
• Improved quality of life measures for physical and social functioning, and vitality.

Studies have shown that in people who continue to take benzodiazepines long term, there is:

• An increased risk of fractured hips in older people (due to the increased risk of falls). One study of 125,203 people aged 65 years or more found that the risk of hip fracture was increased by 24% in people taking benzodiazepines compared with those not taking benzodiazepines.
• Impairment of mental function and memory in older people. This has sometimes been wrongly diagnosed as dementia.
• An increased risk of injury in car crashes (due to the affect on alertness).

So, in summary, coming off a long-term benzodiazepine or Z drug:

• Is likely to improve your memory, reaction time, alertness, and quality of life.
• Reduces your risk of falls, accidents, fractured bones, and other injuries.

How should I stop taking a long-term benzodiazepine or Z drug?

If you have been taking a benzodiazepine or Z drug for over four weeks and want to stop it, it is best to discuss the problem with a doctor. Some people can stop taking benzodiazepines and Z drugs without any difficulty as they have only minor withdrawal effects which soon ease off. However, for a lot of people the withdrawal effects are too severe to cope with if the drug is stopped suddenly. Therefore, it is often best to reduce the dose gradually over several months before finally stopping it. Your doctor can advise on dosages, time scale, etc.

Diazepam withdrawal plan
A common plan is to switch from whatever benzodiazepine tablet or Z drug that you are taking to diazepam. Diazepam is a 'long-acting' benzodiazepine that is commonly used. With diazepam, the dose can be altered very gradually and with greater ease compared to other benzodiazepines.

Your doctor will be able to prescribe the dose of diazepam equivalent to the dose of your particular type of benzodiazepine or Z drug. After this, you can decide with your doctor a plan of how to gradually reduce the dose. A common plan is to reduce the dose by a small amount every 1-2 weeks. The amount the dose is reduced each step may vary, depending on how large a dose you are taking to start with. Also, the last few dose reductions before finally stopping completely may be less than the original dose reductions, and done more gradually.

The gradual reduction of dose keeps any withdrawal symptoms to a minimum.

Some tips that may help

• Before coming off a benzodiazepine or Z drug it may be best to wait until any life crisis has past, and your level of stress is as low as can be.
• Consider starting whilst on holiday, when you have less pressure from work, less family commitments, less stress, etc.
• Consider telling family or friends that you are coming off a benzodiazepine or Z drug. They may give you encouragement and support.
• Consider joining a local self-help group. Advice and support from other people in similar circumstances, or who have come off a benzodiazepine or Z drug, can be very encouraging.
• If you are taking other addictive drugs in addition to benzodiazepines, then you may need specialist help at coming off the various drugs. Your doctor will be able to advise or refer you on to local services which can help.

Other ways of tackling anxiety and sleeping problems

Benzodiazepines and Z drugs are not the long term answer to anxiety or sleep problems.

If you have anxiety symptoms, there are other ways of tackling your symptoms. For example, learning to relax, or joining an anxiety management group. If anxiety symptoms persist or are severe, your doctor may advise on other treatments such as cognitive behaviour therapy (CBT). There are separate leaflets that may help called 'Anxiety - A Self Help Guide', 'Generalised Anxiety Disorder', 'Anxiety Disorders', 'Cognitive Behaviour Therapy', and 'Stress - Tips on How to Avoid It'.

Another leaflet called 'Insomnia (Poor Sleep)' gives tips on how to improve sleep.

A final note

Most people who have taken a benzodiazepine or Z drug can successfully come off it. After switching to diazepam (described above), the pace and speed of withdrawal varies greatly from person to person. Go at a pace that is comfortable for you after discussion with your doctor. For many people, the gradual withdrawal and eventual stopping of diazepam takes several months. However, some people take up to a year to gradually reduce the dose before finally stopping it.

Further sources of help and advice

Your local doctor or practice nurse
Will usually be able to advise on local self-help groups, anxiety management groups, etc.

CITA (Council for Information on Tranquillisers and Antidepressants)
The JDI Centre, 3–11 Mersey View, Waterloo, Liverpool, L22 6QA
Helpline: 0151 932 0102    Web: www.citawithdrawal.org.uk
Helps people to cope with addiction to benzodiazapines and withdrawal from them. The helpline is staffed by ex-benzodiazepine users, nurses and counsellors. Has a list of self-help groups.

BAT (Battle Against Tranquillisers)
PO Box 658, Bristol, BS99 1XP
Tel: 0117 9663629    Web: www.bataid.org
Helps people on benzodiazepines (and similar) who wish to withdraw from them, to do so as comfortably as possible, and to help them make the necessary changes in life after withdrawal. For further information and details of groups in your area, contact the above address.

Benzodiazepines Co-operation Not Confrontation (BCNC)
Web: www.bcnc.org.uk
A support group primarily aimed at people who are affected by prescription supplied benzodiazepines.

© EMIS and PIP 2006   Updated: June 2006   PRODIGY Validated