Approaches to managing benzodiazepines

Gold, Jeffrey A.

doi:10.1016/j.ptdy.2020.02.020

Cited by 2 publications

(7 citation statements)

References 50 publications

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“…However, across psychotropics, subsequent post-acute withdrawal symptoms (PAWS, also known as protracted withdrawal syndrome or PWS,), differing qualitatively from acute withdrawal, may last much longer, even years, 35 , 36 , 55 , 67 – 70 indicating that further neurobiological re-adaptation occurs at individual rates, sometimes very slowly. 24 , 57 , 62 , 71 – 73 PWS can be as debilitating and disabling as acute withdrawal symptoms.…”

Section: The Significance Of Withdrawal Symptomsmentioning

confidence: 99%

“…56 , 73 , 93 Years ago, inundated by people with severe withdrawal symptoms from the “half, and half, and then off” reductions recommended by their prescribers, patient peer support groups propounded reductions of 10% per step, 94 as suggested by many sources. 57 , 68 , 93 , 95 – 98 Since 2011, SurvivingAntidepressants.org has advocated a conservative 10% reduction per month of the most recent dose – an exponential taper, the size of each reduction becoming progressively smaller, approximating the hyperbolic method endorsed by recent research. 40 , 72 , 73 , 98 These gradual tapers to minimize withdrawal symptoms typically require the creation of customized dosages ( Box 1 ) and take many months to several years, depending on individual tolerance for dosage reduction.…”

Section: Harm Reduction Taperingmentioning

confidence: 99%

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What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

Framer¹

2021

Therapeutic Advances in Psychopharmacology

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Although psychiatric drug withdrawal syndromes have been recognized since the 1950s – recent studies confirm antidepressant withdrawal syndrome incidence upwards of 40% – medical information about how to safely go off the drugs has been lacking. To fill this gap, over the last 25 years, patients have developed a robust Internet-based subculture of peer support for tapering off psychiatric drugs and recovering from withdrawal syndrome. This account from the founder of such an online community covers lessons learned from thousands of patients regarding common experiences with medical providers, identification of adverse drug reactions, risk factors for withdrawal, tapering techniques, withdrawal symptoms, protracted withdrawal syndrome, and strategies to cope with symptoms, in the context of the existing scientific literature.

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Section: The Significance Of Withdrawal Symptomsmentioning

confidence: 99%

Section: Harm Reduction Taperingmentioning

confidence: 99%

What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

Framer¹

2021

Therapeutic Advances in Psychopharmacology

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“…Many practitioners follow the general recommendation of switching from a short‐ to long‐acting agent to decrease risk of withdrawal when tapering 47 ; however, reports of success with these strategies are lacking. In general, people with chronic benzodiazepine use disorder may be treated on an outpatient basis to control symptoms of withdrawal using a dose reduction of 25% once a week 48 . In those who are on higher doses, have consistently used over years, or have failed tapers in the past, a slower reduction can be employed, such as a reduction of 10% to 25% every 2 to 4 weeks over 6 months 48 …”

Section: Gamma‐aminobutyric Acid Gaba Receptor Types and Drug Actionsmentioning

confidence: 99%

“…In general, people with chronic benzodiazepine use disorder may be treated on an outpatient basis to control symptoms of withdrawal using a dose reduction of 25% once a week 48 . In those who are on higher doses, have consistently used over years, or have failed tapers in the past, a slower reduction can be employed, such as a reduction of 10% to 25% every 2 to 4 weeks over 6 months 48 …”

Section: Gamma‐aminobutyric Acid Gaba Receptor Types and Drug Actionsmentioning

confidence: 99%

“…People with co‐occurring substance use disorder that is active, a rapid withdrawal can be considered but is often recommended to occur during an inpatient admission to reduce the risk of possible overdose with concomitant substances with additive sedative effects. Inpatient treatment provides the ability of rapid withdrawal over 2 to 3 weeks with extensive monitoring and use of supportive care measures for withdrawal symptom management 48 …”

Section: Gamma‐aminobutyric Acid Gaba Receptor Types and Drug Actionsmentioning

confidence: 99%

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Sedative‐Hypnotic Agents That Impact Gamma‐Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma‐Hydroxybutyric Acid, Phenibut, and Selank

Doyno

White

2021

The Journal of Clinical Pharma

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There are many nonopioid central nervous system depressant substances that share a gamma‐aminobutyric acid (GABA) receptor–related mechanism of action. These sedatives‐hypnotics can be indicated to treat anxiety, seizures, depression, and insomnia but are also used as substances of abuse and used to facilitate sexual assault. Barbiturates, methaqualone, and glutethimide were among the first type A GABA receptor–mediated sedative‐hypnotics. Their clinical use was limited for most indications by serious adverse events and strong abuse potential but continue to be used illicitly around the world. The benzodiazepines supplanted barbiturates for most indications because they were less likely to cause severe adverse events in monotherapy. Flunitrazepam is a newer benzodiazepine that is preferentially used recreationally and to facilitate sexual assault. Flunitrazepam has greater potency and higher affinity for the type A GABA receptor than most benzodiazepines. Gamma‐hydroxybutyric acid is sought illicitly for its hypnotic, euphoric and anabolic effects as well as to facilitate sexual assault. When any of these GABAergic drugs are used in high doses or with other sedative hypnotic agents, respiratory depression, coma, and death have occurred. Chronic use of these GABAergic drugs can lead to significant withdrawal syndromes. Phenibut and selank are poorly studied Russian drugs with GABAergic mechanisms that are inexplicably sold to US consumers as dietary supplements. Poison control center calls regarding phenibut have increased substantially over the past 5 years. Desired euphoriant effects account for the recreational and illicit use of many GABA‐modulating agents. However, illicit use can lead to significant toxicities related to abuse, dependence, and subsequent withdrawal syndromes. Significant evaluation of developing agents with GABA properties should be conducted to determine abuse potential before public access ensues.

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Approaches to managing benzodiazepines

Cited by 2 publications

References 50 publications

What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

What I have learnt from helping thousands of people taper off antidepressants and other psychotropic medications

Sedative‐Hypnotic Agents That Impact Gamma‐Aminobutyric Acid Receptors: Focus on Flunitrazepam, Gamma‐Hydroxybutyric Acid, Phenibut, and Selank

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