Xanax, also called alprazolam, is a benzodiazepine used to treat anxiety. When you use Xanax for long periods, both psychological and physical dependence can develop. Physical dependence to a benzodiazepine can develop in days to weeks, even if it's taken as prescribed, according to the U.S. Food and Drug Administration. Quitting Xanax “cold turkey” can also be dangerous, because stopping abruptly may lead to serious withdrawal symptoms. Here is what you need to know about Xanax withdrawal symptoms and what you can do to treat a Xanax addiction.
General Xanax Withdrawal Symptoms
There is no specific time or dose that determines if Xanax addiction signs will be present. But in general, the risk for physical dependence can increase as the dosage and duration of use increases. Even after a few weeks, Xanax withdrawal symptoms can develop if you stop using the drug or reduce your dose. These symptoms can include the following, according to the Merck Manual:
- Troubling dreams
- Awakenings while sleeping
- Feeling tension in the morning
With more chronic use, withdrawal symptoms become more serious. "Perhaps the most dangerous Xanax withdrawal symptom is seizure,” Christian Small, MD, an Addiction Medicine specialist and President at Headlands Addiction Treatment Services, tells WebMD Connect to Care.
Mayo Clinic notes that oher serious Xanax withdrawal symptoms include:
- Auditory hallucinations
- Visual hallucinations
- Feelings of sadness or emptiness
- Loss of interest or pleasure
- Suicidal thoughts
According to American Addiction Centers, tolerance can develop after about 6 months of use, but depending on the dose, it is possible to become dependent sooner. It’s estimated that about 44% of benzodiazepine users will eventually become dependent. It is difficult to stop taking benzodiazepines and you may still experience withdrawal symptoms even if you are taking them at low doses and as prescribed by your doctor. Common Xanax withdrawal symptoms that can be experienced with low dose Xanax or during tapering include:
- Depressed mood
- Inability to sleep
- Feelings of irritation of agitation
- Inability to pay attention
- Poor memory or forgetfulness
- Muscle aches and tension
Withdrawal symptoms often include the symptoms that drove the individual to take the drug in the first place. This is because the brain has adapted to the presence of the drug, and withdrawal is the process of the brain adapting to the absence of the drug. During Xanax withdrawal, individuals may experience rebound anxiety, fatigue, flu-like symptoms, and long-term withdrawal symptoms. Read on to learn more about each, how they can be managed, and more.
Xanax Rebound Anxiety
Stopping Xanax suddenly comes with another risk: rebound anxiety. This occurs when your anxiety symptoms return and are worse than they were initially. Rebound anxiety is mainly experienced as increased physical symptoms of anxiety, but it can come with increased worry and fear too.
Benzodiazepines, like Xanax, bind to gamma aminobutyric acid (GABA) receptors in the brain and boost the activity of GABA. GABA is a neurotransmitter that slows down activity in the brain and central nervous system. When you feel anxious and take Xanax, it boosts GABA, which helps to slow down brain activity and make you feel calm. You may notice that your muscles relax and you feel sleepy as well.
However, the brain quickly learns to tolerate the effects of benzodiazepines, like Xanax, which can result in dependence. And when someone suddenly stops taking these medications, it then becomes difficult for the GABA receptors in the brain to do their job on their own without the help of Xanax. This can subsequently lead to increased anxiety.
A 2018 review article published by the Journal of Addiction Medicine also notes that Xanax withdrawal symptoms tend to be more severe than those associated with other benzodiazepines. This could be due to the medication’s high potency and short half-life, which makes it more likely to cause severe rebound anxiety.
Rebound anxiety can appear quickly, often within 24 hours of stopping your medication. Treatment for rebound anxiety can include:
- Working with your doctor or psychiatrist to follow a tapering schedule
- Switching to a medication like diazepam (Valium), which has a longer half-life than Xanax and is less likely to cause rebound anxiety
- Working with a therapist to learn healthy coping strategies for your anxiety
- Cutting back on caffeine
Benzo Withdrawal Fatigue
According to American Addiction Centers, one common withdrawal symptom is fatigue, which can appear as early as a few hours or days after discontinuing use. Since benzodiazepines are also prescribed to treat insomnia, rebound fatigue can develop in a similar manner to rebound anxiety. Rebound insomnia and anxiety typically peak between 1 and 4 days and then symptoms should begin to improve. Acute withdrawal symptoms generally last about 2-4 weeks. Treatment for withdrawal fatigue can include:
- Getting plenty of rest
- Reducing the amount of commitments and activities you have
- Avoiding caffeine
- Melatonin to help with insomnia
“Body mind practices such as meditation, deep breathing, mindfulness, and yoga can help decrease high heart rate and improve blood circulation, while strengthening emotional resolve and providing a more holistic perspective to help weather withdrawal symptoms.” says Josiah Teng, MHC “Don’t be afraid to ask for help and utilize your social support networks. Friends and family can help you feel unlonely and provide assistance with tasks and other necessary chores.”
“For most individuals, peak withdrawal symptoms, including flu-like symptoms that are referred to as benzo flu, generally last from 1-5 days. Generally withdrawal symptoms will subside within 14 to 28 days, although less severe post-acute withdrawal symptoms can last for months. Acute withdrawal symptoms can come in waves, and do not always have a continuous downtrend from peak of withdrawal symptoms..” Aaron Sternlicht, LMHC tells WebMD Care to Connect. “These symptoms can include headache, body ache, sweating, insomnia, fatigue, weakness, tremors, nausea, vomiting, muscle pain, and diarrhea among many other flu-like symptoms.”
Because benzodiazepine withdrawal can be dangerous, it’s important to discuss discontinuing your medication with your doctor before trying to go “cold turkey” or reduce your dosage on your own. Dr. Murtaza Ali, Chief Medical Officer for FHE Health, tells WebMD Connect to Care that managing symptoms of benzo flu can include:
- Getting sufficient rest
- Drinking lots of fluids
- Eating a mild diet that includes fresh fruits and vegetables
- Avoiding caffeine
- Relaxation techniques, such as deep breathing exercises, acupuncture, meditation and mindfulness
- Other therapies, conducted with a therapist or in a group, maybe be helpful
Are Benzo Withdrawal Symptoms Permanent?
Benzodiazepine withdrawal symptoms are not permanent, but for some individuals they can be long-term. This is called protracted withdrawal syndrome, or post-acute withdrawal syndrome (PAWS), and can last several months or longer, according to American Addiction Centers. Common symptoms of protracted withdrawal from benzodiazepines are chronic anxiety, depression, and difficulty sleeping. More common symptoms of PAWS include:
- Anxiety or panic attacks
- Impaired concentration
- Mood swings
- Poor memory and brain fog
- Increased sensitivity to stress
A 2019 article published in the Journal of Osteopathic Medicine describes how long-term use of benzodiazepines can cause withdrawal to become complicated. Long term use of benzodiazepines leads to tolerance and can impact the availability of GABA receptors in the brain. The brain will downregulate GABA receptors, making it more difficult for benzodiazepines and GABA to bind to these receptors and promote a calming effect. This downregulation effect takes time to be reversed after stopping benzos and will result in protracted withdrawal symptoms as the brain works to reverse this adaptation.
Ultimately, withdrawal ranges in intensity and duration and is dependent on a few factors including the original dose that was taken and the rate at which the medication was tapered down. Tapering with the help of your doctor or psychiatrist can help to prevent protracted withdrawal.
Is it Possible to Withdraw from Xanax Without Feeling Any Symptoms?
According to American Addiction Centers, there is no quick fix for benzodiazepine withdrawal. They recommend about 8 weeks to safely withdraw from Xanax by following a tapering schedule. Tapering is the best way to avoid negative outcomes from withdrawal, like hallucinations and seizures.
While there are no medications specifically for treating benzodiazepine withdrawal, some individuals are prescribed medication to help ease detox symptoms as they taper. These include:
- Busprione, which can ease the emotional effects of withdrawal like rebound anxiety. This medication takes 2-3 weeks before it begins to take effect and can be beneficial for patients in detox who are tapering down their benzo doses.
- Flumazenil, which is primarily used to treat benzo overdoses because it blocks the effects of benzos and forces the drug out of the body. It has also shown some success in reducing withdrawal symptoms during detox.
Many people wonder–is magnesium good for benzodiazepine withdrawal? “While magnesium may have a calming effect for some individuals, it will not treat the brain overactivity that is found in patients with benzodiazepine withdrawal. In many cases of benzodiazepine withdrawal, careful reintroduction and slow tapering of benzodiazepine medications is required to combat the unwanted signs and symptoms of withdrawal.” says Dr. Kelly Johnson-Arbor, Medical Toxicologist, and Co-Medical Director of the National Capital Poison Center.
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