Overview

Benzodiazepines

If your receptors permit and you feel like learning about the way in which benzos work, here goes:

They inhibit the activity of neurons in the brain. They work by enhancing the activity of a naturally occurring neurotransmitter or messenger, gamma-aminobutyric acid (GABA).  This causes a calming effect.

Long-term benzodiazepine use affects the GABA receptors. This in turn results in a decrease in GABA function. When this drug which the brain has now become dependent on for enhancing GABA’s calming activity is discontinued, because of the down-regulation of the receptors, the brain is left in a state of GABA-underactivity. These changes which result in the entire nervous system going into overdrive and becoming hyperexcitable, are reported to be the cause of the adverse withdrawal effects that many experience.

Benzodiazepines should be used for no longer than two to four weeks in the treatment of anxiety disorders and should always be tapered off under medical supervision.

Half Life

When a benzodiazepine is taken on a regular basis, there is an ongoing process of drug absorption and elimination. The time it takes for half of the drug to be eliminated or for the blood concentration level to fall by half is known as the half-life. This may vary according to individual, particularly in the elderly.

When someone on a longer acting half-life drug misses several doses or abruptly discontinues the drug, it can take days before withdrawal symptoms surface. This is important to know as some people who stop taking the medication abruptly spend a brief period thinking that they will not have withdrawal symptoms only to be unpleasantly surprised days later.

Tolerance

When the receptors in the brain become habituated to the action of a benzodiazepine, more of the drug is needed in order for the desired therapeutic effect to be achieved. This often develops with regular use and is known as tolerance.

Inter-dose Withdrawal

People who use benzodiazepines sporadically or users who take those with a short half-life can experience ‘inter-dose withdrawal’. When this happens, they begin to feel withdrawal effects between doses.

Paradoxical Reaction

If a patient responds to medication in a contradictory or opposite way to what is expected, it is said to have had a paradoxical effect. An example of this is pain relief medication causing increased pain. Benzodiazepine treatment can sometimes result in paradoxical reactions in susceptible individuals causing an increase in anxiety, agitation, aggressiveness, hyperactivity, insomnia and exacerbation of seizures in epileptics.

Protracted Withdrawal

When symptoms persist for eighteen months or longer, withdrawal is considered to be protracted. Complaints can be as vague as flu-like symptoms or a combination of pathologies mimicking chronic fatigue syndrome, lupus, multiple sclerosis, anxiety disorders, irritable bowel syndrome and other chronic conditions. Common to this phase of withdrawal are periods where the symptoms gradually lessen in intensity or abate totally only to resurface intermittently. These recurrences are often referred to as ‘waves’ and the periods of reprieve, as ‘windows’.

Antidepressants

Antidepressants are drugs designed to relieve the symptoms of depression. Different types of antidepressants are available. The main ones are:

Tricyclics

MAOIs (Monoamine Oxidase Inhibitors)

SSRIs (Selective Serotonin Reuptake Inhibitors)

SNRIs (Serotonin and Noradrenaline Reuptake Inhibitors)

NASSAs (Noradrenaline and Specific Serotoninergic Antidepressants)

How antidepressants work is unknown but it is believed that they increase the activity of certain chemicals in our brains called neurotransmitters which pass signals from one brain cell to another. The chemicals most involved in depression are thought to be serotonin and noradrenaline. The most commonly prescribed antidepressants belong to the SSRI group. They increase the brains level of serotonin by blocking the reuptake of serotonin thereby making more available. MAOIs, inhibit the monoamine oxidase enzyme, thus allowing a greater supply of these chemicals to remain available.

Up to one-third of people who stop antidepressants have withdrawal symptoms, which may include stomach upsets, flu-like symptoms, aches and pains, crying spells, agitation, anxiety, dizziness and electric shocks. Like benzodiazepines, these drugs should never be stopped abruptly. They should be tapered off under the supervision of  your doctor.

Painkillers

Painkillers or analgesics are drugs used to relieve pain. They act on the peripheral and central nervous systems. They include:

Non-steroidal anti-inflammatory drugs (NSAIDs), opioids such as codeine and morphine, tramadol which acts on the opioid receptors, the salicylates and para-acetylaminophenol – paracetamol.

Dependency on painkillers often starts when a patient is treated for an injury, surgery or other medical condition. It can be as simple as a muscle strain during a gym workout or when lifting a heavy item, or something more serious such as a car accident or while recovering from surgery. Taking a painkiller for as little as two weeks can result in dependency.

Like benzodiazepines and antidepressants, painkillers should not be stopped suddenly. They must be tapered off under medical supervision. Typical withdrawal symptoms include sleep difficulty, muscle aches and pains, anxiety, profuse sweating, nausea, vomiting, abdominal cramps and diarrhoea and flu-like symptoms.

Symptoms

The section on symptoms has a comprehensive list of withdrawal symptoms identified specifically in those in benzodiazepine withdrawal. However, many of them are also experienced by those in antidepressant and painkiller withdrawal. It is important to note that not everyone will experience these symptoms.  Please do not scour the internet looking for withdrawal symptoms! : ) If you are yet to taper off your medication, it is best to wait to see how you react before giving attention to symptoms. It is possible that you may not have any or maybe just a few symptoms and may very well not need to read this list.

 

References:

British National Formulary 49, 2005. London: British Medical Association & Royal Pharmaceutical Society of Great Britain.

Rang, H.P., Dale, M.M. & Ritter, J.M., 1999. Pharmacology. 4th ed. Edinburgh: Churchill Livingstone.

Frederick, V. Baylissa, 2009. Benzo-Wise: A Recovery Companion. 1st ed. Iowa: Campanile Publishing

Ashton, C. Heather, 2002. Benzodiazepines: How They Work and How to Withdraw [online] available at www.benzo.org.uk [accessed June 26, 2006].

 

 

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