ARTICLE OVERVIEW: Xanax works like a depressant and affects the nervous system by calming the physical symptoms of anxiety. However, after a while, your body will develop physical dependence to the medication. Here, we review the best way to treat withdrawal when detoxing from Xanax. We’ll take a look at the withdrawal symptoms that can be problematic and their resolution.
TABLE OF CONTENTS
- Effects Of Withdrawal
- Protracted Symptoms
- Cold Turkey Dangers
- Medical Detox
- Home Detox
- Who Use Xanax?
- Tolerance, Dependence, and Addiction
- Your Questions
Effects Of Withdrawal
Xanax is also known by its generic name, alprazolam. Classified as a benzodiazepine drug, Xanax is prescribed to treat anxiety, panic disorders, and in some cases, depression. In fact, benzodiazepines are a class of drugs that produce significant central nervous system. There is the potential for dependence in anyone who uses this medicine for more than a few weeks.
So, what is dependence and why does it cause withdrawal?
Drug dependence is the expected outcome of regular dosing on a psychoactive drug. Basically, the brain must adapt to the chemicals found in a drug like Xanax. In this case, the brain adapts by producing stimulant effects to counter-balance the depressant effects of alprazolam. Take away the drug…and the “sped up” functions take a while to resolve.
Withdrawal symptoms occur when a person stops taking habit-forming drugs because the body becomes used to and adapts to chemicals. So, when the drug is no longer present, the body still acts as if they are until it normalizes again. The time it takes to balance the brain into a non-Xanax state is called “withdrawal”.
Any person who has taken a benzodiazepine for longer than 3–4 weeks is likely to have withdrawal symptoms if the drug is ceased abruptly.
How Long Does Xanax Withdrawal Take?
Xanax withdrawal onset occurs between 2–5 days after stopping, reaching a maximum on days 7–10, and usually abating by the end of the second or third week.
Usually, the greatest effect during withdrawal is the underlying mental health condition that Xanax was treating. This is why a person may feel “rebound” anxiety and/or depression during Xanax withdrawal. Most persons discontinuing Xanax experience a degree of “rebound” anxiety and insomnia. Specific withdrawal symptoms are subjective, with few observable signs.
It is important to note that withdrawal from Xanax does not follow a linear course. Some symptoms may appear, resolve, and then appear again over time. The most common symptoms include:
- Muscle tension
- Poor concentration
- Poor memory
Less common symptoms:
- Agoraphobia, an anxiety disorder characterized by perceiving the environment to be unsafe with no easy way to get away
- Ataxia, or involuntary coordination of muscle movements that includes gait abnormality
- Blurred vision
- Decreased appetite
- Dry retching.
- Feelings of unreality
- Gastrointestinal unrest
- Increased temperature
- Increased sensory perception
- Menstrual changes
- Panic attacks
- Weight loss
- Persistent tinnitus, or hearing sound when no external sound is present
How much and how often a person takes Xanax are the largest factors in determining the severity of withdrawal symptoms. The more Xanax a person took, and the longer they took it for, the more unpleasant their withdrawal experience is likely to be.
The symptoms of withdrawal listed above are sometimes referred to as “benzodiazepine withdrawal syndrome”. There is a progression of symptoms, from anxiety and insomnia to flu-like experiences, to a return of the psychological experience present before treatment with Xanax. The severity of the experience varies greatly in accordance with the amount of the drug a person was taking prior to detoxification.
The effects of Xanax withdrawal do not always end with the acute symptoms listed above. Stopping benzodiazepines, including alprazolam, is sometimes associated with recurrent symptoms called post-acute withdrawal syndrome (PAWS). PAWS refer to symptoms that persist long after the physical impact of the substance has subsided.
NOTE HERE: It is important to know that the resurgence of symptoms is not a sign of PAWS, but may be confused with it.
The symptoms of PAWS can be difficult to identify because they will be inconsistent and irregular. Usually, they will present new and intense anxiety symptoms that can simulate anxiety disorders. Rebound phenomena complicate the recognition of PAWS and the resurgence of symptoms, because it refers to the reappearance of acute withdrawal symptoms during the PAWS period.
The First Hours: The first phase of withdrawal usually begins 6–12 hours of a person’s last dose. As the fast-acting drug leaves the person’s system, symptoms often begin to surface. Insomnia and anxiety are common during this time.
Days 1-4: The second phase of acute withdrawal typically lasts between 1 and 4 days and is characterized by the presence of anxiety and insomnia, sometimes referred to as “rebound” symptoms. The return of the symptoms can be unpleasant, making it important to undergo medically supervised detox. Flu-like symptoms such as nausea, vomiting and diarrhea are common at this phase.
Days 5-14: During the third phase of withdrawal, persons are likely to continue feeling the effects of withdrawal for 5–14 days after quitting Xanax. Anxiety and insomnia are still expected symptoms of the withdrawal process at this point.
Week 2 Onward: The last phase means a return to normal functioning of the body. For others persons, it signals the return of anxiety or other psychological conditions that were present before they began taking Xanax. This phase begins 2 weeks after the person has stopped taking the drug.
Because of the adverse effects, lack of efficacy, and socioeconomic costs of continued benzodiazepine use, long-term users have for many years been advised to withdraw if possible or at least to reduce dosage. However, benzodiazepine withdrawal has often been badly managed and has acquired a reputation as a traumatic process. This reputation is largely undeserved if the process is carried out judiciously.
The management of withdrawal has been reviewed by many professionals and agree that the key strategies for successful discontinuation are gradual dosage tapering and psychological support, if necessary.
The degree of psychological support required during withdrawal is variable and may range from a single brief consultation or letter to more formal cognitive, behavioral, or other psychotherapies directed towards anxiety management and stress-coping strategies. Support when needed should be available both during and after withdrawal since persons may remain vulnerable to stress for some months.
Withdrawal from Xanax can be extremely uncomfortable, both physically and mentally. Depending on the clinic you attend, some doctors may prescribe medications to relieve some of the symptoms of Xanax withdrawal, which include:
- Analgesics, such as ibuprofen, acetaminophen, and aspirin (known as Tylenol, Advil, Motrin and others).
- Anti-diarrheal medicines, such as Imodium.
- Anti-nausea medications, such as Dramamine.
The safest way to manage benzodiazepine withdrawal is to take benzodiazepines in gradually decreasing amounts. This is a medical protocol that is called “tapering”. Tapering helps to relieve benzodiazepine withdrawal symptoms and prevent the development of seizures.
The taper may prove more difficult in the case of a short-acting benzodiazepine like Xanax, so depending on the level of use and any previous history with withdrawal, the person may be first switched to a long-acting benzodiazepine before the taper begins. This stabilization phase helps to better manage symptoms by creating more consistent, easier-to-taper levels of benzodiazepines in the body.
For example, the first step in Xanax withdrawal management is usually to stabilize the person on an appropriate dose of diazepam. Your prescribing doctor should calculate how much diazepam is equivalent to the dose of alprazolam you currently use (5mg of diazepam is equivalent to 0,5 mg of alprazolam), to a maximum of 40mg of diazepam. This dose of diazepam is then administered in three divided doses. Even if the equivalent dose of diazepam exceeds 40 mg, no more than 40 mg of diazepam is given daily during this stabilization phase. You are then usually supervised to stabilize with this dose of diazepam for 4-7 days.
More tapering guidelines include:
- Doctors recommended that Xanax taper occur over a period of eight weeks.
- Doses of Xanax should be no more the .5mg every three to four days.
- Tapering may take longer than suddenly stopping Xanax, but minimizes the severity of withdrawal.
- Tapering gives the time to figure out treatment alternatives if the person still needs to treat anxiety symptoms.
For more information on tapering off Xanax, see the Ashton Manual.
Cold Turkey Dangers
Since Xanax is used to treat anxiety, it is important that you do not stop taking it cold turkey. There are just too many variables that can affect this type of withdrawal, including complications such as seizure.
Working with a medical professional is imperative as the person withdraw from Xanax. In fact, the best way to withdraw from Xanax is under medical supervision. A doctor will taper the medication slowly over the course of many weeks. For this reason, any case of Xanax withdrawal should be supervised by a medical professional.
Coming off Xanax is best handled in a specialized detoxification center. What are some of the benefits of a professional detox? Medical staff offer supervision, monitoring, and support in a safe and controlled environment. Additionally, medical and mental health professionals are available round-the-clock to offer the necessary treatment and assistance. Withdrawal can be controlled safely and side effects can be reduced with a gradual and controlled reduction schedule established by a professional.
Benzodiazepine withdrawal should always be medically managed and facilitated through a professional detox clinic in the following cases:
- Other major medical or psychiatric problems co-exist.
- There is polydrug dependence.
- The person takes a high dose (>50mg diazepam equivalent per day) or injects.
- The person requires stabilization of other medication (for example methadone, buprenorphine).
Some situations are agreeable for treating the physical symptoms of quitting Xanax at home. Generally, you still need to be medically supervised during an at home detox with regular check-ins with your doctor. It is important to remember that Clinical Guidelines for Withdrawal Management state:
The most effective treatment for Xanax withdrawal is to decrease the use of the drug in a gradual and controlled manner.
It has been demonstrated that tapering is the most effective way to abandon alprazolam. Additionally, you should be in good general health and have a support network around you.
What might an at-home detox look like?
According to these guidelines on benzodiazepine withdrawal, some people with low risk of addiction be managed in general practice and may benefit most from attempting withdrawal. High-risk, addicted patients are best managed with initial stabilisation and maintenance therapy in specialist residential or outpatient addiction services. There are general principles that apply to both groups.
There are few typical variants on outpatient programs that might work. Usually, at home detox for Xanax requires attendance in a drug rehab program. This is because you may need to address psychological issues underlying drug use. A daily check-in program requires that the person go to check in with a counselor every day, while more intensive outpatient, day treatment, and partial hospitalization programs can require that you are at the center for a set number of hours each day.
Also, as withdrawal occurs, you need to get enough fluids and replenish the electrolytes lost as you withdraw. You may also want to consult with your local pharmacist and look into over-the-counter medications at the local pharmacy to treat flu-like symptoms and treat bodily discomfort. Teas such as chamomile or hardening have an adhesive effect on the nervous system. The help of a nutritionist for recommendations on changes in diet or supplements can also help during detoxification.
If you have decided to stop taking Xanax, it is essential that you follow the advice of your prescribing doctor to make the process as comfortable as possible, both for you and your family and the loved ones around you. In addition, you want to minimize all possible risks. The most common safety considerations include:
- Possibility of seizure.
- Possibility of hallucination, paranoia, or delusion.
- Possibility of perceptual distortions.
Additionally it is very important to always have in mind that any concurrent abuse with alcohol or other substances could make a withdrawal situation even more dangerous, putting your life at risk, so it is essential to be honest with yourself and with health professionals that will help you in your treatment for Xanax withdrawal before embarking on recovery efforts.
Who Use Xanax?
If you’re confronting a Xanax problem, just know that you are not alone.
From 2006, there has been a rapid increase in the number of people admitted to drug treatment centers in the United State for tranquilizer use in general, as well as for Xanax, in particular.
According with the National Survey on Drug Use and Health (NSDUH), an estimated 2.0 million people aged 12 or older in 2016 were current misusers of tranquilizers, which represents 0.7 percent; in addition, there were 536,000 young adults aged 18 to 25, were current misusers of tranquilizers, which represents 0.5 percent of adolescents, more than the other age groups.
And some people suffer from overdose and death.
The American Association of Poison Control Centers reports 81,427 case mentions, 31,255 single exposures, and 11 deaths associated with benzodiazepines in 2010. There were an estimated 345,691 emergency department visits attributed to benzodiazepines in 2010, a statistically significant increase from 271,698 visits in 2008. Of the 345,691, 124,902 were alprazolam.
Thankfully, the 2016 Monitoring the Future Study found that Xanax and tranquilizer use is on the decline in younger populations. Perceptions on availability are lower, as is use overall. So while youth are taking Xanax outside of prescription use, it is not trending in popularity as a drug-of-choice.
Tolerance, Addiction, And Dependence
According to the U.S. National Library of Medicine, Xanax use can result in tolerance, addiction, and dependence if taken in large quantities or used for a prolonged period. Unfortunately, people often misuse these terms, leading to the mistaken belief that tolerance, dependence, and addiction are just different names for the same thing. However, knowing the distinction between these terms can lead to a better understanding of the dangers of drug abuse.
The most important difference between these terms is that tolerance and dependence refer to the physical consequences of drug use. In contrast, addiction is a descriptive term that refers to a need to engage in harmful behavior such as drug use. Here’s a definition of each:
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.
Physical dependence is a state of adaptation that is manifested by a drug class specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.
Tolerance is a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.
The bottom line is this: if you think you have a problem with Xanax, you probably do. However, the condition is medical. As such, drug problems are treated medically…and successfully!
Don’t be freaked out by Xanax. Doctors and medical staff are trained in protocols for tapering and withdrawal. Seek help. You need it!
And you don’t need to go through withdrawal on your own.
Can you stop taking Xanax? The answer is… it is not easy, but with medical help, you can do it! Do you still have questions about treating Xanax withdrawal? Please ask your questions in the comments section below. We will get to you ASAP. And if we don’t know the answer to your question, we’ll refer you to someone who can help.
Reference Sources: DEA: Benzodiazepines
DRUGABUSE: Understanding Tolerance, Dependence, and Addiction
NCBI: The benzodiazepine withdrawal syndrome.
NCBI: Clinical Guidelines for Withdrawal Management and Treatment of Drug Dependence in Closed Settings.
NCBI: Cognitive effects of long-term benzodiazepine use: a meta-analysis.
NSDUH: Results from the 2016 National Survey on Drug Use and Health
NSW HEALTH: Drug and Alcohol Withdrawal Clinical Practice Guidelines
SA HEALTH: Benzodiazepine withdrawal management
All of the information on this page has been reviewed and verified by a licensed medical professional.