Forewarned, forearmed, to be prepared is half the victory. ~ Miguel de Cervantes
For many people, the prospect of facing benzodiazepine withdrawal is terrifying. For others, the actual process of withdrawal itself may be one of the most difficult things they will ever have to endure. This is due in no small part to the mismanagement of taper programs and the mistreatment of those injured by these medications. This happens, more often than not, as a result of the ignorance and false narratives that surround benzodiazepine withdrawal.
Getting educated and making a plan can help you to avoid the pitfalls that might get in the way of a successful taper. For years I’ve worked to educate benzo victims, their loved ones and even their medical providers about this class of drugs and what it takes to successfully and safely withdraw. I can tell you that those who approach benzodiazepine withdrawal prepared have more success, not only in withdrawing but also in reclaiming their lives. Here are three tips to help you plan for the best possible outcome should you choose to taper off a benzodiazepine or sleep aids.
1. Take Charge of Your Taper
The world’s leading authority on benzodiazepine withdrawal, Professor C. Heather Ashton DM FRCP, has this to say when it comes to designing a taper program:
“The rate of tapering should never be rigid but should be flexible and controlled by the patient, not the doctor, according to the patient’s individual needs which are different in every case.The decision to withdraw is also the patient’s decision and should not be forced by the doctor.”
Reading the Ashton Manual is the most important step you can take toward preparing yourself for successful withdrawal. You can read the Ashton manual here and watch my video series on it here.
There are countless factors at play in any given person’s withdrawal. Each experience is unique; this is to be both expected and respected. If you have been on a low dose of benzodiazepine for a relatively short period of time, you may choose to taper fairly rapidly, perhaps over a period of a few months. If you have health complications or need to hold down a full-time job, you may choose to micro taper daily over a year or two, to avoid being overwhelmed by symptoms. Whatever you choose, there is no right or wrong. Learn the basics, develop a plan and approach your doctor with your decision.
Given that most doctors are unfamiliar with both the Ashton Manual and the research surrounding benzodiazepines, you may need to educate your physician about all this. You can print out a copy of the manual for her or send her links to some of the relevant research . It is also a good idea to take a printed copy of your taper plan to your first visit on the subject of withdrawal. It’s not uncommon for medical professionals to be uncomfortable with the idea that what they have learned might be outdated or completely wrong. Be encouraging, polite and confident in your conversation. Let your doctor know that you’ve got this, it’s under control and his part will be that of a supporting role in your withdrawal and recovery.
A word of warning: If you do happen to develop some of the more severe symptoms that can accompany the discontinuation of benzodiazepines, your doctor may want to add in other medications to treat these symptoms. Even the most bizarre and frightening symptoms are very normal during this process. They are only temporary, lessening, and eventually disappearing, as you recover from the injury the medication has created. You may have to decide whether or not to use other drugs to manage these symptoms. Make sure you have an understanding of the risks and benefits of adding in such medications before you start your taper. This way you can make an informed choice and not be pressured into doing anything you might regret.
2. Build a Support Network
This is where it can be crucial to have your support system in place. Online support groups are filled with helpful information and the personal anecdotes of those who have implemented diverse tapering strategies. These support communities are also a wonderful place to find a mentor, something recommended in the Ashton Manual.
While the majority of people in online support groups will already understand what you’re going through, those you regularly encounter in person may not. One important factor in taking control of your taper, is taking charge of your personal narrative. Unfortunately, the words “withdrawal” and “recovery” or the names “xanax” and “valium” have a stigma attached. Using these words, no matter how carefully you may explain things, may lead to friends and loved ones assuming you are dealing with addiction. If you’re not abusing or using your benzodiazepine for recreation, then this is the last thing you want the people in your life to think.
This isn’t just about reputation. The assumption that you have an addiction can lead family and friends to advise you to rapidly withdraw, check into a detox facility or attend 12 step meetings, all if which are inappropriate when dealing with benzodiazepine dependence. There may also be the assumption your are to blame for any hardship you experience. This unfortunately can lead to a lack of empathy at a time in your life when you may be in great need of compassion from others. You’re not required to give anyone any information you’re not comfortable sharing. General statements such as “I was injured by a medication my doctor prescribed” and “I have an iatrogenic illness which I am hopeful will improve with time” are both true and easier for people to sympathize with. I preferred to use the term “benzodiazepine associated illness/injury”, which was far more true to my experience than the term “withdrawal”.
3. Plan for the Worst, Hope for the Best
Remember, not everyone one will experience withdrawal in the same way. People ages 18-80, some of whom have been on benzodiazepines more than 20 years, have been able to successfully taper, some with surprisingly quick recoveries! In my experience, those who do become extremely ill for many months can still alleviate much of that severity by planning for a period of convalescence, along with taking proper care of their minds and bodies.
Studies have shown that benzodiazepines directly impact insulin. Many severe symptoms people experience during withdrawal are directly related to blood sugar imbalances. For such, implementing a diet that is high in healthy fats and protein while eliminating processed sugars and other high impact carbohydrates, makes a huge difference.
It’s also worth noting that if you’re very sensitive to benzodiazepine reductions, you’re probably not going to be able to tolerate substances such as caffeine, msg or other stimulating chemicals during withdrawal and recovery. Learning how to cook healthy, natural meals will benefit you greatly throughout your taper and long after.
If you haven’t already learned techniques for managing anxiety and panic attacks, how to do mindfulness, meditation etc. it’s best to learn these beforehand. You’ll be glad you did. Getting in the habit of regular light exercise can also really help to work out some of the adrenaline surges you might experience as your body adjusts to having less and less medication in your system.
At the end of the day, you won’t be able to control every aspect of your healing. Unfortunately, some people will be unwell for much longer than expected. Here are some other questions to consider as you plan for possible future events:
- Can your doctor help you request accommodations for your level of disability at work?
- Can you arrange for child care?
- Do you know what it would take to apply for disability?
- Is there someone who can help you manage necessary tasks that might become too difficult to do on your own such as running errands, paying bills, or even driving you to appointments?
These are worst case scenarios. While they’re not easy to think about now, they will be much more difficult to address if you become too ill to even drive to the store for groceries. Preparedness helps remove a lot of the fear from these situations. It will also help you achieve an acceptance of your limitations which will aid in the overall process of healing, both physically and emotionally.
In fact, the biggest piece of advice I can give anyone throughout all of this is “accept, accept, accept”. Accept that things turn out differently than expected. Accept your decision to both start this medication and to stop it. Accept help from others. Accept healing when it comes and setbacks when they inevitably happen. Accept the symptoms you experience as your body’s wisdom in healing you bit by bit. This is all part of the process and it all leads to you getting better. One day, you will look back and be so grateful that you have you back. You’ll realize how much you missed the old you. You’ll wonder how you ever managed to live life so emotionally stunted as you were on the benzodiazepine. You’ll take pleasure in the vibrant hues and beautiful subtleties of the world around you. Accept that life will never be the same, and that this isn’t necessarily a bad thing.
I would love to read about Lexapro tapering, and how long do symptoms last,,,,,,any help?
Thank you! This is so helpful. I successfully completed a benzodiazepine taper. I actually found the antidepressant tapers more difficult (which is saying something!). Lavender pills were very helpful to me to manage symptoms.
Thank you for the article. I am trying to taper off the smallest does of klonopin. It is so hard. I have Hashimotos Thyroiditis and it has been very debilitating for years.
I am on the last .125 mg of Xanax. I used to take .25 2-3 times a day. March 2017, I decided 33 years was too long to be on it. What has it done to my brain? Nobody seems to know. Actually, a psych doctor told me I might always need it, as I had a “sensitive nervous system.” I had just completed a program to learn about and get over anxiety attacks but felt nauseated some after a move etc. The past 2+ years I have learned my husband of 47.5 years is a Narcissist. I realize the Xanax was a way to not feel quite as much. To cushion the anxiety. He is determined xanax is the reason I’m changing and doesn’t like it. But I have learned other ways to deal with N, and that’s what he doesn’t like. I was determined to deal with the tapering, but am taking more time to get off the last little bit. And I’m not opposed to taking another .125 mg now and then as I work through these issues. I’ve taken this course and do notice the good fats do help w blood sugar. I didn’t notice the correlation before and a bit of nervous feeling might be the need for some Xanax. Last night I felt that as I hadn’t had a snack and ate half an avocado and felt fine.
I have tapered off benzos, and yes it was tough… but nothing compared to coming off Seroquel. Please consider writing an article like this for anti-psychotics.
Attempting to detox from Lorazepam was futile. After much research, I have been using the Ashton method. I plan on doing this as slowly as I need to. Thank goodness I have a doctor who is willing to allow this. In the past, I was sent to a so called expert who put me on Klonopin and detox’d me so quickly that I had a seizure. I was a detox failure and went right back on benzo’s. This was several years ago. Lorazepam stopped working for me so, it was time to ditch it. I had already successfully got off of Lexapro which didn’t do anything other than put fifty Lbs on me and gave me all sorts of symptoms. It is important to find a doctor who is willing to work with you because, some are old school ignorant and will either tell you to stay on them forever or will detox you way too quickly. I am so glad for this article. It confirms what many of us already knew. It also serves to educate providers. Thanks much!
Thanks Kelly, for creating such a comprehensive and supportive action plan for achieving Benzodiazepine withdrawal.
i can say that in my own process of coming off all the psych meds i had been taking for 17 years, re-achieving a natural balance after the Klonopin (called Clonazepam in Canada) was the most arduous and gruelling.
For two years i was sleeping only one or two hours a night. In my case my process was initiated through what you might call a spiritually informing event while i was on all the pharmaceuticals, whereby i unequivocally knew at a soul level that i would soon die unless i chose a different life path, than one following the mental health system. So i wasn’t dealing with anxiety brought on by fear and doubt anymore, because my determination was clear and intense.
However, my sleep regulating system was still whacked and i became completely focussed on never taking any sleep aid again even though my Naturopath suggested botanical remedies. And i also realized that private clinics running sleep studies for profit under Canada’s publicly funded health care, were really only out to find ways to sell you on sleep apnea machines.
i had this spiritually informing event nine years ago after which i started the sudden med withdrawal, and have now been doing well after i subsequently went through a healing process.
In your approach to drug taper and elimination, i especially value the patient-centred focus, as well as your deep understanding and inclusion of the spiritual dimension.
i would also like to comment that for those in countries with public health care, like Canada, how easy it is to fall into a bottomless pit with a continual drip-feed of pharmaceuticals at public expense, and a system which is only able to offer support, if you remain in this pit.
Thank you Kelly so much for addressing this. I have been trying to get off my Klonopin for some time. I’m having a hard time dropping below a certain amount. It is a small amount. It is half of what is prescribed for me. Your article is so helpful. I love the work that you are doing. Many Blessings! Judy
How long does withdraw last?
I wish your advice had been available when I tapered benzos several years back. It was very difficult and I was so alone. I am tapering from Lamictal, the last nightmare rx I was put on back in 2003. Do you have advice for coming off that one? I am now at 4.8 mg and tapering 13% at a time. Very slow cuz I am very fearful of a backlash reaction from my nervous system which can have a mind of it’s own. Would CBD oil be useful in speeding up the taper for instance?
I hope to be able to share your wise words doc with anyone who has problems and is looking to get it back to reality
My biggest problem going off klonopin is that I take it for sleep and can’t sleep without it. I have tappered it way down to very little and then use supplements like theanine, magnesium, and CBD oil. Is it better to use the supplements? I struggle with C-PTSD, which has caused me to have insomnia for the past 30 years.
Excellent information and recommendations. Thank you, Jocelyn!
Do you have recommendations for getting off Seroquel, Lithium and Lexapro and in what order?
I got off Ativan (with agony) by myself, and have halved Lexapro in 1month.
Thank you so much. You are a lifegiver.
LindaJennings
Dr. Brogan discusses tapering in her book, A Mind of Your Own. You can also email our office at office@kellybroganmd.om and we can send you some tapering resources.
Dr. Brogan, thank you for writing this very important article, with all the sage advice. Just today, a colleague of mine told me about the “headache” that her elderly mother is now forced to deal with after her psychiatrist began to fumble the ball here with getting her mother off lorazepam.
Kind regards,
David Shannahoff-Khalsa
Thank you so….. much for the article on coming off benzodiazepines – I am trying to come off an anti-depressant that I have been taking for the last 10 years – & have tried before – hopefully, I will as you say accept some of the days that you are more quiet & not feeling yourself!
I’m Jennifer and with the knowledge and guidance of Kelly Brogan’s online program, I too successfully tapered off of clonazapam, Abilify, and Viibryd last year. I had been on these types of psychotropic drugs as prescribed by doctors for over 25 years. As noted in earlier comments, I knew these substances were no longer serving me and indeed felt they were poisoning me at this point. By putting my mindset in order, eating very clean (including eating lots of good fats and protein and ceasing sugar, dairy, caffeine, alcohol, gluten, etc.) and arming myself with Kelly’s protocol, I approached my doc who was game to support me in this endeavor. I believe it took about nine months for me, but we took it slow and steady. There were some adjustments needed along the way to facilitate symptoms and situations… indeed, the process is very personal and individual.
While I still experience depression and anxiety (and some insomnia), these symptoms are much less extreme now and I’m managing them through EMDR with a wonderful psychologist, stress-management mindfulness, clean eating and acceptance. I found that the most important factors for me during this time was self-love and gentle kindness. Continued blessings and thanks to Kelly for her program and to all my cohorts in the on-line community. I feel I’m experiencing my second chance at life!
Dr. Brogan, Thank you for all the wonderful, helpful information you have provided thus far re: tapering off different medications. Living in the U.S. and with our current ‘opiate epidemic’, I was curious if you were looking into this at all? Especially how to taper off opiates, and the ever so difficult ‘replacement management meds such as Suboxone or Buprenorphine”. I find this to be one of the most import topics that, unfortunately Physician’s and Patients, are extremely unaware of the damage of long term use of these medications cause and the extreme (worse than heroin and Vicodin or opiate pills) debilitating process of tapering and getting off these medications. If you have any insight or resources to direct me toward, I’d greatly appreciate it. I have your book and will try to apply the protocols for this as well. Thanks again.
Does this advice also apply to tapering off anti-psychotics (ie: neuroleptics) ? If not, how does the tapering differ?