Benzodiazepines, Tranquilizers, and Sleeping Pills
Here are some of the common tranquilizers and sleeping pills, and their generic names.
- Valium (diazepam)
- Ativan (lorazepam)
- Xanax (alprazolam)
- Klonopin or Rivotril (clonazepam)
- Restoril (temazepam)
- Rohypnol (flunitrazepam)
- Dalmane (flurazepam)
- Imovane (zopiclone)
- Ambien (zoldipem)
- Lunesta (eszopiclone)
A Benzo Story
It's easy to become dependant on tranquilizers. People sometimes become dependent on tranquilizers inadvertently. You can become dependent on them if you take tranquilizers for more than a few months. For example, if you followed your doctor's orders and never abused your prescription, you could still experience significant withdrawal symptoms if you stop them suddenly.
This is a true story about dependence to prescription tranquilizers (sometimes called benzos). Unfortunately it is a story that happens almost every day. Cheryl (not her real name) came to me after ten years of being prescribed Ativan. Although the story is about Ativan, I have heard similar stories about all tranquilizers.
Cheryl was a happy young lady at twenty years old. She rarely took Tylenol for a headache. Life was good, except for her stressful job.
Then one day Cheryl felt a tightness in her chest and had difficulty breathing. Her heart began to race. Her palms were sweaty and her hands were shaking. She was overcome with worry, but didn't know what she was worried about.
Cheryl went to her doctor who listened to her story and told her that she was experiencing an anxiety attack. The visit lasted less than 15 minutes and at the end of the visit he handed her a prescription for Ativan.
The tranquilizer worked exactly as expected initially. Within a few days Cheryl was more relaxed, and she was sleeping better. Sometimes she slept so soundly that she woke up feeling groggy the next morning. But that passed. Even the stress of work was easier to handle. Both Cheryl and her doctor were relieved.
For the next two years Cheryl continued to use Ativan on and off as needed. She never abused it, and never used more than her prescription. For two years her doctor kept on prescribing Ativan with little reassessment. As time went on Cheryl started using it a little more often. Eventually she was taking a tranquilizer almost every day. Sometimes her family doctor would simply renew the prescription over the phone. Cheryl was just happy that the anxiety attacks had gone.
By the end of the third year Cheryl was concerned, and approached her doctor. Was Ativan addictive she wondered? He assured her it was not. But Cheryl had her doubts and she persuaded her doctor to take her off the drug. One week later, Cheryl was hit with series of anxiety attacks. She felt a little guilty that she questioned her doctor, and he immediately restarted her on Ativan.
What Cheryl didn't know was that the anxiety attacks may have been avoided if she had been tapered off the drug correctly. In fact suddenly stopping tranquilizers can be dangerous.
There is a significant risk of seizure, strokes, heart attacks, or hallucinations if you stop tranquilizers suddenly.
Two years later, still not convinced that this was the harmless drug her doctor said it was, Cheryl took herself off the tranquilizers. The withdrawal was rough. Cheryl experienced all kinds of symptoms, including anxiety, mood swings, and poor concentration.
Her husband started to lose patience. But she persisted. Then one day, her boss told her that she had to take on more responsibilities at work. Cheryl tried to explain that she was going through a difficult time and that she wasn't sure she could take on more stress right now. But her boss said that the company was restructuring and Cheryl's job might be on the line.
Despite all that stress, Cheryl managed to remain off the pills and get through the withdrawal. But during that time she didn't dare see her doctor once, because she was afraid that if he made the slightest suggestion she would lose her resolve and go back on Ativan.
Cheryl managed to stay off tranquilizers for a whole year, and was feeling stronger all the time. Given enough time we know she would have done well. It takes about 2 years for patients fully recover from the effects of tranquilizers. But Cheryl's mother fell ill and Cheryl took on the responsibility of her medical care.
One night, Cheryl suddenly woke up with her heart pounding in her chest. She had difficulty breathing, and she thought she was going to die. She went to the emergency room, and after a full examination was told that there was nothing wrong with her. She had experienced another anxiety attack.
The emergency room sent a follow up letter to her family doctor who booked an appointment to see Cheryl. He said he wanted to refer Cheryl to a psychiatrist.
The psychiatrist explained that Cheryl had a chemical imbalance, and that this was the cause of her anxiety. He said that it was not uncommon, and there was an effective treatment for it. He assured her that it was not addictive, and his very words were, "You can take this medication for the rest of your life." Then the psychiatrist did something that set Cheryl back another five years. He wrote her a prescription for Ativan.
Now events started to happen a little more quickly. The Ativan wasn't as effective as it had been in the past, and there were days when Cheryl needed more than her usual dose. The psychiatrist agreed that on bad days Cheryl could take 1 or 2 more pills to deal with her anxiety. By the end, Cheryl was being prescribed 4 times her initial dose. But at each visit her psychiatrist reassured her that she was doing well. Gradually, he spent less and less time with her since the Ativan was working. Some visits consisted of him just writing a prescription.
Cheryl had become dependent on tranquilizers. The more she took them, the more her brain adapted to them, and the more she needed. Whenever she tried to slow down, her withdrawal symptoms forced her to start up again.
The irony of tranquilizers is that they're prescribed for anxiety and sleep. But the longer you take them the more they increase your anxiety and disturb your sleep.
The doctors had said that Cheryl could take these pills for the rest of her life. And sure enough it was coming true. Tranquilizers are the perfect addictive drug. The longer you take them — the more you need them.
After a while Cheryl began to experience new symptoms. She started feeling depressed. Initially she had a hard time describing it. She was less interested in things. She didn't have as much energy as she normally did, and she wasn't as happy. She complained to her psychiatrist who eventually decided to start Cheryl on an antidepressant. But he continued to prescribe the tranquilizer.
Most addictive drugs if taken long enough can cause depression. It is quite common with tranquilizers. Cheryl had been given a tranquilizer that caused depression, and now she was taking an antidepressant to counteract the tranquilizer.
Ten years had passed in one person's life. What started out as anxiety, probably brought on by work stress, had gradually escalated into dependence and depression.
Finally, it was Cheryl herself who took the initiative and sought help to come off her drugs. She was gradually tapered off her Ativan, and counseled on post-acute withdrawal. Her withdrawal was uncomfortable, but with support she managed to get through it.
Cheryl completed her taper, went through withdrawal, and is now living a better life. Her symptoms disappeared after about two years. She will now happily tell you that she feels better than she's felt in years, and that it's good to no longer be dependent on tranquilizers.
Why are benzodiazepines still prescribed? If they're that awful why do doctors still use them? Because they can be helpful if taken for a short time. Some people need them to deal with unusually stressful situations. But if you take them for longer than a few weeks or months, your body will adapt to them, your anxiety level will rise, and you will need more of them over time. (Reference: www.AddictionsAndRecovery.org)
Potential Symptoms of Long-term Use
The longer you use tranquilizers and sleeping pills the more anxious you become. In the beginning the help you relax and fall asleep. But after a few months they have the opposite effect.(1)
One of the most disturbing symptoms of long-term benzodiazepine use is depersonalization. It means not feeling quite real. It's impossible to describe unless you've experienced it, but tranquilizer patients often say things like "I don't feel quite real," or "my arms don't feel connected to my body," or "when I'm in a group of people I somehow feel outside of myself." All bizarre descriptions that mean the person is experiencing depersonalization.
Depersonalization is usually worse during post-acute withdrawal. I have known patients who thought they were going crazy because they had depersonalization, when in fact they were experiencing typical tranquilizer withdrawal. The depersonalization will go away eventually, but it can take many months. Of course, you should always see a doctor if you have any unusual symptoms – preferably one who is familiar with addictions.
There is an excellent website on tranquilizers and tapering off tranquilizers. It is Benzodiazepine Addiction, Withdrawal&Recovery (benzo.org.uk). This site contains taper schedules from the "Ashton Manual", written by Professor Heather Ashton, a world authority on benzodiazepine post-acute withdrawal.
Post-Acute Withdrawal Symptoms
Some of the symptoms of tranquilizer post-acute withdrawal are:
- Mood swings
- Poor concentration
- Social isolation
- Low energy
- Disturbed sleep
Post-acute withdrawal gradually gets better over two years. Your symptoms should show gradual improvement. Measure your progress month to month. If you measure your progress day to day, or week to week, you'll often have one week that will be worse than the week before. But if you measure your progress month to month you should see steady improvement. If you take care of yourself, and you're patient, you can get through this.
Look at the post-acute withdrawal page to learn more about those symptoms and how to deal with them.
Recovery and Relapse Prevention Strategies
If you have decided that you are addicted, this is your opportunity to change your life. Learn more about recovery skills and relapse prevention strategies in the following pages. You can recover from addiction and be happier.
1) Poyares, D., Guilleminault, C., Ohayon, M. M., & Tufik, S., Chronic benzodiazepine usage and withdrawal in insomnia patients. J Psychiatr Res, 2004. 38(3): p. 327-34.