What is Diazepam Withdrawal?
Diazepam is a benzodiazepine drug used to manage seizures, anxiety, and several other conditions.1 While diazepam has legitimate medical uses in treating various mental health and neurological issues, it is important to understand certain risks associated with taking it. Dependence and withdrawal are two possible consequences that can develop when taking diazepam, and the likelihood of both may be increased when the drug is used nonmedically or otherwise in amounts that exceed prescription recommendations.1,2
Here, we are going to take a closer look at signs and symptoms of withdrawal from diazepam and effective detox strategies to safely manage withdrawal.
Diazepam (Valium) Withdrawal Symptoms
Diazepam—widely known by one of its brand names, Valium—is a controlled substance that requires a prescription from a medical professional. In its various formulations, it is available as an oral tablet, an oral suspension, and an injectable solution. Benzodiazepines like diazepam work by increasing inhibitory brain signaling and, as a result, they are able to essentially calm an overly-active nervous system.1
It is important to understand that, although they are prescribed for various disorders, benzodiazepines have the potential to be abused. Even chronic therapeutic use has the potential to give rise to withdrawal should diazepam be abruptly discontinued; however, the misuse of diazepam can increase the risk of significant physiological dependence and associated withdrawal.2,3
The symptoms of diazepam withdrawal can range from mild to severe and can affect you on both a physical and psychological level. Signs and symptoms of benzodiazepine withdrawal include:2,3
- Extreme anxiety.
- Difficulty focusing and concentrating.
- Sensory issues (hypersensitive to sight, sound, touch, and taste)
- Muscle pain.
- Skin numbness and tingling.
Benzodiazepines are generally prescribed for short-term use. This is due to the potential for dependence as well as other potential side effects that can occur when taken over an extended period of time.3 Additional benzodiazepine-related issues include:2
- Diversion and nonmedical misuse.
- Legal problems related to compulsive use.
- Impaired driving.
- Falls and other bodily injury risks.
- A decline in cognitive functioning.
- Worsening dementia (in an elderly population).
- Overdose (especially in the context of concurrent alcohol or other substance use).
Seizures and Severe Diazepam Withdrawal
Seizures, although uncommon, are possible when detoxing from benzos such as diazepam. Seizures have been reported among people detoxing from short, medium, and long half-life benzodiazepines and seizures usually occur in people who take a large dose of benzos over a long period of time.6 Seizures have been reported in less than 15 days of using benzodiazepines even when ingesting the therapeutic dose prescribed by a medical professional.6 If seizures are left untreated or not managed, there can be catastrophic consequences. Studies show that nearly all of the seizures reported due to benzodiazepine withdrawal are grand mal seizures and grand mal seizures can lead to coma and even death.6
Alcohol & Benzodiazepines
Using alcohol in conjunction with benzodiazepines increases the risk of severe withdrawal symptoms. This is because, like benzodiazepines, alcohol withdrawal symptoms also include the possibility for severe developments such as seizures, delirium tremens, and hallucinations.7 Detoxing from one substance puts a strain on your body. Detoxing from 2 substances that both have severe withdrawal symptoms that can cause significant medical complications and can lead to death is even more difficult.
In addition to some of the more common acute symptoms of withdrawal, some people report a problematic pattern of more persistent issues after quitting benzodiazepines. This additional phenomenon of benzodiazepine withdrawal is sometimes termed post-acute withdrawal syndrome—or PAWS, for short. PAWS encompasses some symptoms that you might normally see in certain mood disorders, such as depression and anxiety disorders.4 These delayed symptoms persist or develop beyond the period of acute withdrawal resolution.
While cases of protracted withdrawal exist for many types of substances, PAWS is most commonly described in connection with people stopping alcohol, opioids, or benzodiazepines. Unfortunately, those who misuse benzodiazepines may be the most at risk for experiencing PAWS. In some cases, people experience these persistently problematic symptoms for months to years after they stop using diazepam and other benzodiazepines.4 Common PAWS symptoms include depressed mood, anxiety and panic, irritability, cognitive challenges such as difficulty problem-solving and concentrating, memory issues, difficulty tolerating stress, sleep problems, obsessions and compulsions, issues maintaining relationships, and an increase in cravings for previously used substances.4
How Long Does Diazepam Withdrawal Last?
Both the acute and protracted diazepam withdrawal timelines are likely to vary somewhat from person to person. Many factors contribute to the development, severity, and duration of any withdrawal symptom experienced. Variables such as age, type of drug used, length of time the drug is used, amount of drug used and the presence of mental health disorders all play a role in the development and presentation of withdrawal symptoms.
Benzodiazepines are prescribed in both short-acting and long-acting forms and this is another factor that determines the onset of withdrawal symptoms. Withdrawal symptoms can begin to occur within hours to days for short-acting benzodiazepines and within several days to a week for longer-acting benzodiazepines.5 In the case of diazepam, a benzodiazepine with relatively long-acting metabolites, withdrawal symptoms may not be felt for 1-2 days or longer after last use.10
Can I Detox from Diazepam Safely at Home?
Deciding to recover from problematic diazepam use can be one of the biggest and best decisions you can make for yourself. If you are wondering how to ease diazepam withdrawal symptoms, it is important to know and understand the facts about diazepam and benzodiazepine withdrawal before you decide how to detox effectively. Benzodiazepine withdrawal symptoms can range from mild and uncomfortable to severe and life-threatening. Because of this, safe and effective diazepam withdrawal management benefits from the help and support from not only your loved ones, but necessitates the supervision and care of professionals as well.
Before you decide to stop taking benzos, you should speak to your doctor. Your doctor can provide you with referrals and resources to help ensure you have the safest and most comfortable detoxification experience possible. Factors that your doctor may take into consideration include the age you started using benzodiazepines, how long you have been using benzos, your dosage, your current health status, and risk factors as well as any co-occurring mental health disorders you may have.
Medical interventions can ensure your withdrawal experience is as comfortable as possible and that your physical health needs are being attended to. It is important to remember that withdrawing from benzodiazepines can lead to significant physical health problems including seizures. Choosing to detox on your own without the assistance of medical professionals can increase your risk of experiencing uncomfortable and even harmful symptoms of withdrawal.
Diazepam Withdrawal Treatment
The process of withdrawing from benzodiazepines is unique to each person. Your experience is going to be specific to you and your unique needs and challenges. Medical detoxification is a set of professional interventions that target acute withdrawal symptoms with the ultimate goal of minimizing physical harm.9 Oftentimes, medical detoxification involves the addition of medications to help stabilize your body and reduce the effects of the withdrawal symptoms. A doctor or other medical professional can respond to you and your body’s needs throughout the process of detoxification.
Depending on the circumstance, a separate benzodiazepine medication may be substituted to begin the tapering process and ensure a successful detox. For example, depending on the type of benzodiazepine you use, a medical professional may introduce a relatively long-acting benzodiazepine such as chlordiazepoxide (Librium) at the beginning of your detoxification process to begin the tapering process.10
Detoxification is the first step in the process of recovery. Detox addresses your physical dependence on benzodiazepines but does not sufficiently address the cognitive and behavioral components of addiction and substance use. For many, detoxification leads into longer-term substance abuse rehabilitation. Similar to the process of detoxification, substance abuse rehabilitation may be somewhat different for everyone. The good news is that there are a variety of ways to treat addiction and substance abuse.
Substance abuse rehabilitation can occur in a variety of settings including inpatient, residential, and outpatient. Rehabilitation may include ample therapy sessions conducted on an individual, group, and family level. One of the most common methods of treatment is behavioral therapy, which can be conducted on an inpatient, residential, and/or outpatient level. Behavioral therapy addresses the underlying causes of addiction that can include unhealthy ways of thinking, past traumas, and unhealthy behavioral patterns. Receiving the right support can be the factor between successful rehabilitation from substances and a life of addiction.
If you are considering detoxification and treatment, choosing the right provider is essential to your success. Having a team of professionals support you from the very first step and throughout your recovery journey is one of the biggest determiners of your success in recovery. Deciding to change your life is not easy, nor is the process of detox and recovery. However, with the right team of professionals and the right treatment provider, you can achieve your recovery goals. You don’t have to live a life of dependence and discomfort. Successful detox and recovery are possible.
- 1.U.S. National Library of Medicine. (2019). Diazepam.
- Brett, J. (2015). Management of benzodiazepine misuse and dependence. Australian Prescriber, 38(50).152-155. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/
- U.S. Department of Health and Human Services—U.S. Food & Drug Administration. (2016). Labeling-Medication Guide: Valium.
- Semel Institute for Neuroscience and Human Behavior. (2020). Post-Acute Withdrawal Syndrome.
- Government of Western Australia. (n.d.). Benzodiazepine withdrawal.
- U.S. National Library of Medicine. (2011). Benzodiazepine withdrawal seizures and management.
- Sachdeva, A., Choudhary, M. & Chandra, M. (2015). Alcohol withdrawal syndrome: Benzodiazepines and beyond. Journal of Clinical and Diagnostic Research. 9(9). VE01-VE07. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606320/
- Lann, M.A. & Molina, D.K. (2009). A fatal case of benzodiazepine withdrawal. American Journal of Forensic and Medical Pathology. 30(2). 177-179. https://pubmed.ncbi.nlm.nih.gov/19465812/
- U.S. National Library of Medicine. (n.d.). Detoxification and substance abuse treatment:1 Overview, essential concepts and definitions in detoxification.
- Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.