Benzodiazepine medications are frequently prescribed for anxiety and for patients with anxiety disorders. These are drugs such as Xanax, Klonopin, Valium, and Ativan. Xanax is one of the most addictive of the benzodiazepines. Outpatient detoxification, or medically supervised withdrawal, can be done for benzodiazepine medications such as Xanax.
The withdrawal symptoms from a drug are the exact opposite of the effect of the drug. So if Xanax is prescribed for a patient with Generalized Anxiety Disorder, and the Xanax is taken away, the anxiety from that disorder is going to come out and rear its ugly head. However, there will also be anxiety from withdrawal anxiety. In addition, there can also be withdrawal anxiety immediately after the detox, as well as for a longer period of time afterwards.
Benzodiazepine detoxification can be extremely difficult for patients because the anxiety level can be so high. So it is important to have a close therapeutic alliance between the patient and the physician.
The best way to do a benzo detoxification is to take a long acting benzo such as Valium or Klonopin, and substitute it for a short acting benzodiazepine such as Xanax. So a dose of Valium or Klonopin is calculated that is roughly equivalent to the dose of Xanax being abused. The taper is started at that dose, and then the dose is gradually and slowly decreased over a long period of time. It is really important to taper down very slowly, otherwise the taper will be destroyed and the patient will not be able to complete it. Going too quickly will cause way too much anxiety.
Withdrawal anxiety can be managed with non-addictive medications. I use a class of medications that work at the same receptor as the benzodiazepines, the GABA-A receptor. However, they do not have the addictive properties and negative effects of using Xanax at high doses. So, as the taper dose decreases, I start adding the medications that are used to balance out the withdrawal anxiety.
It’s also important to make sure that the primary anxiety disorder is treated. So for things such as Panic Disorder, Social Anxiety Disorder, and Generalized Anxiety Disorder, the first line agents are the serotonin reuptake inhibitors such as Celexa, Zoloft, and Prozac, as well as the serotonin norepinephrine reuptake inhibitors such as Cymbalta and Effexor.
In addition to psychological anxiety, there can also be what is called somatic anxiety. The word somatic means body, so some patients will have palpitations, chest tightness, and even a feeling they want to crawl out of their skin. Beta blockers can be very effective for this. Beta blockers are a cardiac medication that are used to slow the heart rate down, so palpitations during detoxification can be alleviated. Beta blockers also calm the nervous system down.
The other thing that I strongly encourage during benzodiazepine detox, and during any detoxification, are weekly acupuncture treatments. I have found acupuncture to be extremely effective, and a really great complement to the treatments just outlined. In addition, I highly encourage exercise, and always encourage gym memberships.
If you have problems with overuse of benzodiazepine medications such as Xanax, Klonopin, Ativan, or Valium, an addiction medicine physician can be helpful to you.
Stuart Kloda, M.D. is an addiction medicine physician in New York City who is particularly skilled with the medical detoxification from benzodiazepines: come acquistare Xanax in Italia