Tolerance & Withdrawal Explained
People can experience benzodiazepine withdrawal even if they’re not decreasing their dose. This is known as “tolerance.”
Tolerance
Put simply, tolerance may develop for most in as little as 2-4 weeks after a person has taken benzodiazepine as the body and brain attempt to overcome or work around the drug’s effects (also known as neuroadaptations). The tolerance or “tolerance withdrawal” phenomenon is often how patients initially discover that their benzodiazepine is no working as well as it did the first time they used it and feel they need to up-dose their medication. Beyond anxiety, tolerance also develops to the anticonvulsant effects of benzodiazepines making them generally unsuitable for long-term control of epilepsy.
The original dose of the drug will be progressively less effective and a higher dose is required to obtain the original effect. This has often led doctors to increase the dosage in their prescriptions or to add another benzodiazepine so that some patients end up taking two benzodiazepines at once.
Tolerance to the hypnotic effects develops rapidly and sleep recordings have shown that sleep patterns, including deep sleep (slow wave sleep) and dreaming (which are initially suppressed by benzodiazepines), return to pre-treatment levels after a few weeks of regular benzodiazepine use. Similarly, daytime users of the drugs for anxiety no longer feel sleepy after a few days.
Tolerance to the anxiolytic effects develops more slowly but there is little evidence that benzodiazepines retain their effectiveness after a few months. In fact, long-term benzodiazepine use may even aggravate anxiety disorders. Many people find that anxiety symptoms gradually increase over the years despite continuous benzodiazepine use and panic attacks and agoraphobia may appear for the first time after year/s of chronic use. Such worsening of symptoms during long-term benzodiazepine use is probably due to the development of tolerance to the anxiolytic effects so that “withdrawal” symptoms emerge even in the continued presence of the drugs.
Tolerance develops with many regularly used drugs including alcohol, heroin, morphine and cannabis. The body responds to the continued presence of the drug with a series of adjustments that tend to overcome the drug effects. In the case of benzodiazepines, compensatory changes occur in the GABA and benzodiazepine receptors which become less responsive so that the inhibitory actions of GABA and benzodiazepines are decreased. At the same time there are changes in the secondary systems controlled by GABA so that the activity of excitatory neurotransmitters tends to be restored. Tolerance to different effects of benzodiazepines may vary between individuals – probably because of differences in underlying neurological and chemical make-up which are reflected in personality characteristics and susceptibility to stress. The development of tolerance is one of the reasons people become dependent on benzodiazepines and sets the scene for the withdrawal syndrome.
Why tolerance occurs
There are a few theories on why tolerance develops – receptor down-regulation from repeated and long-term exposure to benzodiazepines. Many people are surprised to learn that short-term use of benzodiazepines is only 2 to 4 weeks. Another is receptor uncoupling, also known as decoupling, which is the process of receptor-binding sites or domains becoming separated, moving alignments and/or becoming internalized, resulting in medication tolerance from prolonged exposure to benzodiazepines. Compensatory changes occur in the GABA and benzodiazepine receptors which become less responsive so that the inhibitory actions of GABA and benzodiazepines are decreased. At the same time, there are changes in the secondary systems controlled by GABA so that the activity of excitatory neurotransmitters tends to be restored.
Tolerance is the reason why many medical prescribers often increase a patient’s prescribed dose over time. Sometimes they even add another benzodiazepine and some patients have ended up taking two (or more) benzodiazepines at once. Of course, inevitably the body then becomes tolerant on the new higher dose and the cycle repeats.
Withdrawal
Benzodiazepines are not intended to be taken long-term because continued use or abuse can cause the brain to become both physically and psychologically dependent on them. Some people may only have a few withdrawal symptoms that may not impact their life while others may have more symptoms. PostScript360 helps to reduce withdrawal symptoms with a personalised taper schedule, health eating plan, lifestyle changes, and well-being exercises.
If you have been taking benzodiazepines for longer than 3 weeks please do not abruptly stop taking benzodiazepines. This can cause serious withdrawal symptoms.
Withdrawal symptoms range from a return of uncomfortable psychological symptoms to physical symptoms such as:
Family history of drug dependency or previous issues with substance abuse and/or dependency can increase the likelihood of developing a dependency to benzodiazepine and may potentially add to the withdrawal timeline duration. People taking benzodiazepine for a long time and higher doses are likely to experience more withdrawal symptoms that last longer than those taking smaller doses for a shorter length of time.
