Protracted Benzodiazepine Withdrawal Explained (by Doctor)

Summary

In this insightful video, Dr. Josef delves into the often-overlooked topic of protracted benzodiazepine withdrawal. He explains how this condition, recognized by the FDA in 2020, differs from typical withdrawal syndromes. Unlike regular withdrawal symptoms that resolve in weeks, protracted withdrawal can last for years and is more akin to a neurological injury. Dr. Josef highlights the importance of slow tapering to prevent this condition, emphasizing the unpredictable recovery time but reassuring viewers of the brain's ability to heal over time. Through engaging explanations and practical tips, this video aims to equip viewers with the knowledge to approach benzodiazepine withdrawal cautiously and optimistically.

Highlights

• Protracted withdrawal isn't just a prolonged version of typical withdrawal—it's a distinct neurological condition! 🤯
• The FDA's 2020 mandate to include risks on benzodiazepine labels marks a turning point in recognition. 🚀
• Dr. Josef emphasizes the importance of gradual dose reduction to prevent protracted withdrawal. 🏞️
• Neuroplasticity offers hope: the brain's ability to adapt and heal is a key factor in recovery! 🌱
• Practical advice: keep engaged with support networks and symptom management therapies. 👫

Key Takeaways

• Protracted benzodiazepine withdrawal can last years, unlike other drug withdrawals. 🕰️
• The condition is a neurological injury, not just regular withdrawal. 🧠
• FDA recognized this condition in 2020, mandating label updates. 📅
• Slow tapering off benzodiazepines reduces the risk of protracted withdrawal. 🐢
• Despite severity, most people recover fully over time due to neuroplasticity. 💪

Overview

Dr. Josef takes us on a journey into the world of benzodiazepine withdrawal, specifically focusing on the rare yet debilitating protracted withdrawal. Unlike regular withdrawal syndromes, this condition is more akin to a neurological injury, persisting for years and challenging sufferers both mentally and physically. Dr. Josef stresses that understanding this condition is crucial in providing appropriate treatment and support.

The video underscores the groundbreaking recognition of protracted withdrawal by the FDA in 2020. This step has compelled drug companies to update their labels, highlighting the potential risks. Dr. Josef explains that this condition requires careful management, particularly during the tapering process. A slow, measured reduction in medication dosage is advised to minimize the danger of developing protracted withdrawal symptoms.

In the spirit of hope and resilience, Dr. Josef reassures viewers that recovery, albeit slow, is within reach. He discusses the remarkable ability of the brain to recover through its innate neuroplasticity. Dr. Josef also emphasizes the value of support networks and symptom management practices in aiding recovery. Engaging the support of family and friends, without overwhelming them, is highlighted as a crucial element in the healing journey.

Chapters

• 00:00 - 00:30: Introduction and Overview of Protracted Withdrawal This chapter introduces the concept of protracted benzodiazepine withdrawal, highlighting its significance and the lack of attention it receives. It explains that protracted withdrawal refers to symptoms that persist for months or even years after discontinuing benzodiazepines, differentiating it from the initial withdrawal phase which typically lasts a shorter duration. The chapter aims to raise awareness and provide understanding on how to prevent such prolonged withdrawal effects.
• 00:30 - 01:30: Recognition and Understanding of Protracted Withdrawal The chapter "Recognition and Understanding of Protracted Withdrawal" discusses how the prolonged withdrawal symptoms from benzodiazepines, known as protracted withdrawal, were not initially recognized by the medical community. However, there has been a shift with more articles being published in peer-reviewed journals addressing the condition and its treatments. It highlights the significant acknowledgment by the FDA in 2020, when they required drug companies to include warnings about this risk on benzodiazepine labels.
• 01:30 - 02:30: Mechanism and Occurrence of Protracted Withdrawal This chapter discusses the phenomenon of protracted withdrawal, particularly in the context of benzodiazepines. Unlike typical withdrawal symptoms experienced with substances such as opiates, which usually resolve within a few weeks and can be alleviated by restarting the drug, protracted withdrawal is characterized by prolonged symptoms that may last for years and do not improve by restarting the substance. The chapter emphasizes understanding protracted withdrawal as a neurological injury rather than a standard withdrawal syndrome, highlighting its persistence and distinct nature. The term 'protracted withdrawal' is commonly used to describe this condition, though some prefer different terminologies.
• 02:30 - 04:00: Risk Factors and Symptoms The chapter titled 'Risk Factors and Symptoms' discusses the terminology used for neurological dysfunction caused by benzodiazepine. It emphasizes avoiding the term 'withdrawal' in the illness's name due to potential misconceptions by doctors and families unfamiliar with the condition. The term 'withdrawal' might lead people to believe that the condition is temporary or easily resolved by resuming medication, which is incorrect because protracted benzodiazepine withdrawal is more akin to a brain injury.
• 04:00 - 06:00: Prevention Strategies This chapter discusses the phenomenon of protracted benzodiazepine withdrawal injury, often referred to as BIND. It typically manifests as severe withdrawal symptoms which can sometimes develop gradually even with long-term chronic use of benzodiazepines. The condition is believed to result from cumulative injury due to interdose withdrawal, though the most common occurrence follows severe withdrawal syndromes after either a rapid tapering off the drug or stopping it abruptly.
• 06:00 - 07:30: Tapering Advice This chapter discusses the potential severe withdrawal symptoms associated with benzodiazepines, which can adversely affect the nervous system and increase the risk of developing long-term conditions. It highlights that while most individuals do not experience protracted withdrawal, the exact reasons why some do remain unknown. It suggests that theoretical risk factors for developing long-term withdrawal symptoms may involve factors that contribute to a more severe acute withdrawal phase.
• 07:30 - 09:00: Recovery and Support The chapter 'Recovery and Support' discusses the challenges involved in overcoming drug withdrawal symptoms, particularly in older individuals. It emphasizes that advanced age can complicate the recovery process due to reduced neuroplasticity and diminished biological capacity for the brain to readapt post-drug removal. Additionally, extended use of drugs or consumption of high doses presents further obstacles, as the brain undergoes significant adaptations to these conditions, making the undoing process more complex.
• 09:00 - 10:00: Conclusion and Additional Resources The Conclusion and Additional Resources chapter covers the risks associated with withdrawal from medications, specifically discussing the dangers of taking stimulant medications during withdrawal periods. It emphasizes that these stimulants are usually discontinued prior to withdrawal to avoid harm as the sedative effect is lifted. The chapter also highlights the severity of protracted withdrawal symptoms, which can include a range of neurological and psychiatric issues, such as severe anxiety and intense restlessness or pacing, known as akathisia.

Protracted Benzodiazepine Withdrawal Explained (by Doctor) Transcription

• 00:00 - 00:30 welcome back to our Channel where we explore the side effects of psychiatric medication today we're addressing a topic that doesn't receive enough attention protracted benidipine withdrawal so what is it and more importantly how can you prevent it let's dive in protracted withdrawal is a term used to describe a set of symptoms that can persist for months sometimes even years after stopping benzo diip Pines it differs from the initial withdrawal phase which typically only lasts a few
• 00:30 - 01:00 weeks for a long time protracted withdrawal from Benz Anda Pines was not recognized by the professional Community however recently more articles on this condition and its treatment have been published in the peer review literature perhaps the most authoritative recognition of this condition was by the FDA in 2020 when they mandated that all drug companies making benzo diazines finally include a description of the risk in the labels so what is protracted
• 01:00 - 01:30 benid as a pain withdrawal it's best understood as a neurological injury and not a normal withdrawal syndrome in a typical withdrawal syndrome from other drugs like opiates the symptoms resolve in about 2 to 6 weeks and they go away if you restart the drug however once protracted withdrawal develops it can take years to resolve and does not go away even if you restart the drug although the condition is best known as protracted withdrawal many AC prefer to
• 01:30 - 02:00 use the title bind benzo dipine induced neurological dysfunction since using the word withdrawal in the illness name can be confusing for doctors and families unfamiliar with the condition many people when they hear the word withdraw assume the condition will resolve quickly or that the symptoms will simply disappear if you get back on the drug but this is not the case because protracted benzodiazapine withdrawal is more like a brain injury so why does
• 02:00 - 02:30 protracted benzo aspine withdrawal injury or bind occur well it typically occurs in response to severe withdrawal symptoms although some cases have gradually occurred in the setting of long-term chronic use in these instances it is hypothesized that the injury develops due to cumulative injury from interdose withdrawal however the most common development of this condition follows severe withdrawal syndromes after a rapid taper or a cold turkey
• 02:30 - 03:00 detox this suggests that severe withdrawal symptoms can be damaging to the nervous system and place people at risk of developing this condition it is important to note that the majority of people who experience severe withdrawal symptoms from benzodiazapines do not develop protracted withdrawal but it is currently unknown why it only happens to some some theoretical risk factors for developing this condition would include any risk factors that might place someone at risk of a more severe acute
• 03:00 - 03:30 withdrawal symptoms these can be things like older age due to the reduced neuroplasticity and less biological capacity for the brain to quickly readapt to the removal of the drug other risk factors may include being on the drug for decades or being on a very high dose because these would suggest additional adaptations in the brain to accommodate the long use or also the high doses and that would be more difficult to undo when the drug was
• 03:30 - 04:00 removed other risks can be things like taking stimulant medications during the time of withdrawal which are typically removed before withdrawing people as the additional stimulation that's there can be damaging once you remove the sedative break that is the benidipine symptoms of protracted withdrawal can be severe and disabling and they can include a wide range of neurological and psychiatric symptoms such as severe anxiety intense pacing or restlessness known as athesia
• 04:00 - 04:30 cognitive impairment dissociation neuropathic pain like numbness tingling or shock-like Sensations internal feelings of vibration ear ringing or tenus and light sensitivity because protracted withdrawal is a neurological injury rather than a simple withdrawal issue the recovery time is unpredictable while some recover in less than 12 months many are still recovering several years after their injury the best way to prevent protracted withdrawal injury is to come
• 04:30 - 05:00 off these medications with a slow taper you want to avoid going into severe withdrawal because it's thought that these withdrawal symptoms are really the things that lead to the neuronal injury that causes protracted withdrawal as a general rule of thumb reducing the dose by 5 to 10% of the previous dose per month and holding when moderate withdrawal symptoms emerge appears to be the safest strategy for most people to come off this method will allow the brain to adapt gradually to the absence
• 05:00 - 05:30 of the drug minimizing the risk of having any severe withdrawal symptoms the most important piece to be aware of is at the highest risk period for severe withdrawal and potentially developing protracted withdrawal is at the lower doses of the drug Dr Mark horowitz's research which analyzed brain scans for drug receptor occupancy at the different doses of psychiatric medications essentially showed that at lower doses a small reduction in psychiatric medication can result in a large drop in
• 05:30 - 06:00 receptor binding this means that a seemingly smaller reduction can cause a significant increase in withdrawal symptoms for example reducing a dose of Xanax from 6 mg to 4 mg could be seen as a large 2 mg reduction but it might only reduce receptor binding by 10% while reducing from 1 mg to half a migr may seem much like a smaller reduction a half a milligram drop but it might change in receptor binding by up to 50%
• 06:00 - 06:30 this could result in higher symptoms even though the person doing the drop thinks that the reduction is much smaller Mark's Imaging findings have been further supported by the lived experience of many people who had increased difficulties tapering off the final few milligrams of their medications so consequently the most important advice is to taper cautiously in a way that avoids severe withdrawal symptoms and especially towards the end of the taper where the risks of
• 06:30 - 07:00 developing severe withdrawal symptoms are the highest you need to really go slow then if you already experiencing protracted withdrawal the most important thing is to not lose hope although the condition can be severe and extremely uncomfortable it has a good prognosis the overwhelming majority of people gradually improve over several years and go on to live normal lives this is due to the innate neuroplasticity of the brain which really does have the capacity to heal during recovery it is
• 07:00 - 07:30 crucial to stay engaged with your support network explore symptom management therapies and focus on activities that keep you busy and distracted importantly try to not overwhelm your caregivers as caring for someone with protracted withdrawal can be very challenging ensure that they are also engaged in activities they enjoy to prevent burnout as we wrap up remember that protracted withdrawal is an uncommon reaction not a certainty of Rapid tapering if you if you have been
• 07:30 - 08:00 through a rapid taper it is very likely that you won't develop protracted withdrawal injury despite this unless there's a really good reason for a rapid taper like a serious side effect a slow and symptom Le taper will reduce your risk of developing protracted withdrawal if you are looking for more tips on the best way to taper while avoiding protracted withdrawal injury we cover all of this here on our channel in the tapering tips of psychiatric medications playlist so so that's it for today if
• 08:00 - 08:30 you found this video helpful please give it a thumbs up share it with someone who might need it and if you're looking for personal help with your taper we work in several US states and they're listed on my website which is linked in the description below this video