Valium withdrawal syndrome—often referred to as benzodiazepine withdrawal—is the cluster of symptoms which appear when a person who has taken Valiums long term and has developed Valium dependence stops taking Valium drug(s) or during dosage reductions. Valium withdrawal is similar to the alcohol withdrawal syndrome and barbiturate withdrawal syndrome and can in severe cases provoke life threatening withdrawal symptoms such as seizures. The most serious side effect of Valium withdrawal is suicide. Severe and life threatening symptoms are mostly limited to abrupt or over-rapid dosage reduction from high doses. A protracted withdrawal syndrome may develop in a proportion of individuals with symptoms such as anxiety, irritability, insomnia and sensory disturbances. In a small number of people it can be severe and resemble serious psychiatric and medical conditions such as schizophrenia and seizure disorders.The protracted withdrawal can be minimised in intensity and severity by a slow gradual reduction in dosage. Withdrawal of Valium is usually beneficial due to the adverse effects associated with the long-term use of Valium. However, it has been recommended that long-term users of Valium are not forced to withdraw against their will.
Chronic exposure to Valium causes physical adaptations in the brain to counteract the drug’s effects. This is known as a tolerance and physical dependence. When the drug is removed or dosage reduced in an individual physically dependent on Valium, numerous withdrawal symptoms both physical and psychological may appear and will remain present until the body reverses the physical dependence by making adaptions to the drug-free environment and thus returning the brain to normal function. Generally the higher the dose and the longer a Valium is used and the more rapidly a Valium is discontinued then the more likely severe withdrawal symptoms will occur. However, severe withdrawal symptoms can still occur during gradual dose reduction or from relatively low doses.
In certain selected patient groups the occurrence of withdrawal symptoms is as high as 100%, whereas in unselected patient groups more than 50% of subjects are able to discontinue Valium with mild or even no withdrawal symptoms at all. Withdrawal symptoms may persist for weeks or months after cessation of Valium. In a smaller subset of patients withdrawal symptoms may continue at a sub acute level for many months or even a year or more. Long term use of Valium may lead to withdrawal like symptoms emerging despite a constant therapeutic dose. Correctly attributing previously misdiagnosed withdrawal symptoms such as anxiety to the withdrawal effects of Valium, individualised taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance and referral to Valium withdrawal support groups increase the success rate of withdrawal.Withdrawal symptoms can resemble psychiatric symptoms which doctors often interpret as evidence for the need of Valium which in turn leads to withdrawal failure and reinstatement of Valium, often to higher doses.
If an individual is using drugs and he or she decides to stop using, they can… right? Not really. Why, you ask. Quite simple. It can be summed up all in one word: withdrawal. Drug use is more than just a bad habit. Drug use is addictive not only because psychologically an individual feels compelled to use, but also because his or her body develops a physical dependence. When this dependence develops and drug use is abruptly discontinued, symptoms of withdrawal can and usually do arise. Basically, the body goes into shock. The exact symptoms of withdrawal will change depending on the drug the individual is dependent upon. Here we will discuss some of the different withdrawal states that can occur.
Valium depresses the nervous system much like alcohol and is abused by all segments of society. Valium is both physically and psychologically addicting and as is considered one of the toughest addictions to break. With chronic use, its abuse potential is high. Withdrawal symptoms can be seen after only 2 or 3 days of repeated use.
Tolerance to Valium builds quickly and is the effect of cellular adaptive changes or enhanced drug metabolism. This tolerance develops over days, weeks, or months is a diminished response associated with chronic use of this drug.
All benzodiazepines, even when used as recommended, may produce emotional and/or physical dependence. Valium has the potential to cause severe emotional and physical dependence in some patients and these individuals may find it exceedingly difficult to stop using. It is important that your physician help you discontinue this medication in a careful and safe manner to avoid severe withdrawal.
To abruptly stop Valium after an extended period of use is extremely dangerous and can cause seizures and sometimes death. Discontinuation of the medication must include a physician supervised gradual taper schedule and/or adjunct medications to minimize acute withdrawal.
Essentially, withdrawal symptoms from Valium are like the mirror of its therapeutic effects. Valium withdrawal can produce especially severe withdrawal symptoms similar to those in alcohol and barbiturate withdrawal, including jittery, shaky feelings and any of the following: rapid heartbeat, tremor, insomnia, sweating, irritability, anxiety, blurred vision, decreased concentration, decreased mental clarity, diarrhea, heightened awareness of noise or bright lights, impaired sense of smell, loss of appetite, loss of weight, muscle cramps, seizures, tingling sensation, and agitation. In more extreme cases, typically associated with sudden cessation of the drug, users may experience convulsions, tremor, abdominal and muscle cramps, vomiting and sweating. After extended abuse, abrupt discontinuation should be avoided and a gradual dosage tapering schedule carefully followed.
Obviously, the severity of withdrawal symptoms is directly related to the amount of the drug taken and the length of time over which it has been taken.
Some of the withdrawal symptoms are identical to the symptoms for which the medication was originally prescribed. The ability to determine the difference between relapse and rebound is very important during the withdrawal phase and can often lead to a misdiagnosis. Withdrawal symptoms from low dose dependence typically last 6–12 months and gradually improve over that time period. Symptoms may lack a psychological cause and can fluctuate in intensity with periods of good and bad days until eventual recovery. For this reason, many experts agree that after withdrawal from long term or even fairly short term use of benzodiazepine drugs, at least six months should have elapsed prior to re-evaluating the symptoms and updating a diagnosis.
The following symptoms may emerge during gradual dosage reduction but can usually be reduced in intensity or eliminated altogether by reducing the rate of reduction:
* Anxiety, possible terror and panic attacks
* Agitation and restlessness
* Hypochondriasis
* Dilated pupils
* Impaired concentration
* Nightmares
* Insomnia
* Muscular spasms, cramps or fasciculations
* Electric shock sensations
* Blurred vision
* Dizziness
* Dry mouth
* Aches and pains
* Hearing impairment
* Taste and smell disturbances
* Chest pain
* Flu like symptoms
* Impaired memory and concentration[37]
* Increased sensitivity to sound
* Increased urinary frequency
* Numbness and tingling
* Hot and cold flushes
* Headache
* Rebound REM sleep
* Stiffness
* Fatigue and weakness
* Hyperosmia
* Restless legs syndrome
* Metallic taste
* Photophobia
* Paranoia
* Hypnagogia-hallucinations
* Nausea and vomiting
* Elevation in blood pressure
* Tachycardia
* Hypertension
* Postural hypotension
* Depression (can be severe), possible suicidal ideation
* Tremor
* Perspiration
* Loss of appetite and weight loss
* Dysphoria
* Depersonalization
* Derealisation (Feelings of unreality)
* Obsessive compulsive disorder
* Tinnitus
* Paraesthesia
* Visual disturbances
* Mood swings
* Indecision
* Gastrointestinal problems (Irritable bowel syndrome)
An abrupt or over-rapid discontinuation of benzodiazepines may result in a more serious and very unpleasant withdrawal syndrome that may additionally result in:
* Convulsions, which may result in death
* Catatonia, which may result in death
* Coma (rare)
* Suicide
* Attempted suicide
* Suicidal ideation
* Self harm
* Hyperthermia
* Delusions
* Homicidal ideation
* Urges to shout, throw, break things or to harm someone
* Violence
* Post Traumatic Stress Disorder
* Organic brain syndrome
* Psychosis
* Confusion
* Mania
* Neuroleptic malignant syndrome like event (rare)
* Delirium tremens
Some people experience little or no withdrawal when stopping long term benzodiazepine usage. It is not known for sure why there is such a variation between patients but recent research in animals suggests that withdrawal from sedative hypnotic drugs may be influenced by a genetic component. As withdrawal progresses patients often find that their physical and mental health improves with improved mood and improved cognition.