Symptoms of anxiety include: agitation, tension, irritability, the sensation of having a 'thumping heart' (palpitations), shakiness, sweating, excess worry, sleeping badly, poor concentration, fast breathing and sometimes a knotted feeling in the stomach and other muscles. Although most people will feel anxious at some time, sometimes the symptoms become prolonged and distressing.
Simply talking things over with a friend, counselor, or with members of a self-help group may also help. However, if symptoms become very severe, you may occasionally be advised to take a benzodiazepine medicine for a short time.
A large dose is commonly given as a sedative during medical procedures that may cause anxiety or discomfort. Some benzodiazepines are occasionally used to treat muscle spasm and certain types of epilepsy as they can prevent fits (seizures).
If you are not used to taking benzodiazepines or Z drugs, the first doses are usually good at easing symptoms of anxiety or promoting sleep. A benzodiazepine does nothing to remove any underlying cause of anxiety such as a life crisis.
Benzodiazepines and Z drugs work best in situations where anxiety or sleeping difficulty is expected to last only a short while. You can usually stop a benzodiazepine or a Drug without any problems if you take it for just a short period of time (no more than 2-4 weeks).
In 1981, benzodiazepines were the most commonly prescribed medicines in western countries. It was because benzodiazepines worked so well to ease symptoms of anxiety and poor sleep that many people came back for more.
However, it is now known that if you take a benzodiazepine or a Drug for more than 2-4 weeks, you may develop problems (see below). There is a good chance that you will become addicted to (dependent on) a benzodiazepine or a Drug if you take it for more than four weeks.
The duration of withdrawal symptoms varies but often lasts up to six weeks and sometimes longer. Withdrawal symptoms may not start for two days after stopping the tablet and tend to be worst in the first week or so.
Some people have minor residual withdrawal symptoms for several months. But note: you are unlikely to become dependent on a benzodiazepine or a Drug if you take it for a short period only.
Even if you take a benzodiazepine or Drug for a short time, you may feel drowsy during the daytime. The Yellow Card Scheme is used to make pharmacists, doctors and nurses aware of any new side effects that medicines or any other healthcare products may have caused.
People found in possession illegally, or attempting to supply them to others, could face a fine or a prison sentence. People on normal doses of benzodiazepines and Z drugs prescribed by their doctor do not need to inform the Driver and Vehicle Licensing Agency (DLA).
If you have been taking a benzodiazepine or a Drug for over four weeks and want to come off it, it is best to discuss the problem with a doctor. However, many people develop withdrawal symptoms if they suddenly stop taking a benzodiazepine or a Drug.
To keep withdrawal effects to a minimum, it is often best to reduce the dose of the medicine gradually over a number of weeks or months before finally stopping it. See separate leaflet called Stopping Benzodiazepines and Z Drugs.
If you have been taking a benzodiazepine or Drug for over four weeks and want to stop it, it is best to discuss the problem with a doctor. Some people can stop taking benzodiazepines and Z drugs without any difficulty, as they have only minor withdrawal effects which soon ease off.
However, for a lot of people the withdrawal effects are too severe to cope with if the medicine is stopped suddenly. Therefore, it is often best to reduce the dose gradually over several months before finally stopping it.
Often, coming off benzodiazepines and Z drugs is just a matter of very slowly reducing them. In this situation a common plan is to switch from whatever benzodiazepine tablet or Drug you are taking to diazepam.
With diazepam, the dose can be altered very gradually and with greater ease compared to other benzodiazepines. After this, you can decide with your doctor a plan of how to reduce the dose gradually.
This can be flexible, so you can come off your medication more quickly or more slowly depending on how you are feeling. A common plan is to reduce the dose by a small amount every 1-2 weeks.
The gradual reduction of dose keeps any withdrawal symptoms to a minimum. Occasionally other medication may be prescribed to help you cope with symptoms while you are coming off benzodiazepines.
For example, you may be offered antidepressants if depression emerges whilst you are on a withdrawal program. If anxiety is a problem, sometimes you may be prescribed a tablet called a beta-blocker, such as propranolol.
Before coming off a benzodiazepine or a Z drug it may be best to wait until any life crisis has passed and your level of stress is as low as can be. Consider starting whilst on holiday, when you have less pressure from work, fewer family commitments, less stress, etc.
Advice and support from other people in similar circumstances, or who have come off a benzodiazepine or a Z drug, can be very encouraging. Your doctor will be able to advise you or refer you on to local services which can help.
If anxiety symptoms persist or are severe, your doctor may advise on other treatments such as cognitive behavioral therapy (CBT). For many people, the gradual withdrawal and eventual stopping of diazepam take several months.
However, some take up to a year to reduce the dose gradually before finally stopping it. NB that Lines is eszopiclone, a cousin of the three Z drugs: collided (Ambient), zopiclone (Simone) and gallon (Sonata), and it is being marketed as safe for long-term use.
They are said to be more selective, binding mainly to the a1 GAZA receptor subtype which mediates the hypnotic effects of benzodiazepines. They concluded that the Z drugs produced the same therapeutic and adverse effects as benzodiazepine hypnotics, including tolerance, dependence and abuse, and were also more expensive.
“As a clinical example, a psychiatrist recently asked my advice about the nursing sister he was helping to withdraw from lorazepam (Asian). “There are a number of cases in the literature of such escalation of dosage with zopiclone, followed by dependence and withdrawal symptoms on stopping.
There are also an increasing number of cases reported of misuse and abuse of high doses of collided (Ambient). This can result in hallucinations and psychosis and is reminiscent of the adverse effects of midazolam (Halcyon), the short-acting benzodiazepine hypnotic now banned in the UK.
“Now eszopiclone is being promoted for long-term use and the manufacturers report trials lasting two weeks to six months of its hypnotic effects. They report little tolerance or loss of efficacy over these periods and a low incidence of rebound insomnia or anxiety (3.7%) on stopping.
I remain skeptical of these results which involved relatively small numbers of subjects with various types of insomnia. For every drug action in the body there is an equal (as far as possible) reaction which tends to restore the status quo.
If these are suddenly stopped there is a rebound of increased heart rate and raised blood pressure. We accept that tolerance and withdrawal reactions occur with benzodiazepines, barbiturates and all the hypnotic and sedative drugs that have gone before.
Most other hypnotics and sedatives act similarly to benzodiazepines, including barbiturates, chloral derivatives (Noted), ethchlorvynol (Placidly), zopiclone (Simone, Imogene), collided (Ambient), gallon (Sonata) and, incidentally, alcohol. That might be effective in inducing sleep, but it is the equivalent of increasing your dose and reversing your recovery process.
In addition, addiction, or dependence, can be caused by Ambient, especially when used regularly for longer than a few weeks or at high doses. People who have been dependent on alcohol or other drugs in the past may have a greater chance of becoming addicted to Ambient.
When people develop dependence, stopping the medicine suddenly may cause unpleasant symptoms (see Withdrawal below). However, people who have been dependent on alcohol or other drugs in the past may have a higher chance of becoming addicted to sleep medicines.
If you have been addicted to alcohol or drugs in the past, it is important to tell your doctor before starting LINES or any sleep medicine. Withdrawal symptoms may occur when sleep medicines are stopped suddenly after being used daily for a long time.
In more severe cases, abdominal and muscle cramps, vomiting, sweating, shakiness, and, rarely, seizures may occur. Although withdrawal symptoms have not been observed in the relatively limited controlled trials experience with LINES, there is, nevertheless, the risk of such events in association with the use of any sleep medicine.
Most other hypnotics and sedatives act similarly to benzodiazepines, including barbiturates, chloral derivatives (Noted), ethchlorvynol (Placidly), zopiclone (Simone, Imogene), collided (Ambient), gallon (Sonata) and, incidentally, alcohol. These reported symptoms range from mild dysphoria and insomnia to a withdrawal syndrome that may include abdominal and muscle cramps, vomiting, sweating, tremors, and convulsions.
The U.S. clinical trial experience from collided does not reveal any clear evidence for withdrawal syndrome. Nevertheless, the following adverse events included in DSM-III-R criteria for uncomplicated sedative/hypnotic withdrawal were reported during U.S. clinical trials following placebo substitution occurring within 48 hours following last collided treatment: fatigue, nausea, flushing, lightheadedness, uncontrolled crying, nemesis, stomach cramps, panic attack, nervousness, and abdominal discomfort.