Benzodiazepine Withdrawal Syndrome (BWS) and Protracted Withdrawal Syndrome (PWS)

Benzodiazepine withdrawal can come with physical, emotional, and behavioral changes due to the fact that your body has become accustomed to having the drug in your system. This is known as benzodiazepine withdrawal syndrome, or BWS. Symptoms range in severity and length, both of which can be reduced by using slow, tapering methods to come off safely.

It’s estimated that 30 percent of people coming off of benzos experience severe BWS, and the severity is more likely to increase in people who have a history of insomnia, anxiety, and seizures - the very conditions for which benzos are prescribed.

Symptoms of withdrawal can occur for a number of reasons, including stopping benzo use cold, development of tolerance, interdose withdrawal, or due to a paradoxical reaction (where the drug does the opposite of its intended effect).

The cause behind the withdrawal symptoms is the altering function of the GABA receptors. Once the drug is discontinued, the receptors can no longer function normally, resulting in increased anxiety, seizures, and a host of other symptoms. The severity of these symptoms varies, and while some may experience simply uncomfortable issues, others can have severe problems that lead to death from either the withdrawal itself or suicide.

Extended Suffering

Along with the severity of symptoms, the length of suffering also varies widely from a few weeks to years. In fact, up to 15 percent of people suffer from what’s known as PWS, or protracted withdrawal syndrome. Factors that may increase the risk of PWS include higher doses of benzos, longer length of time taking the drug, and going cold-turkey rather than using a slow tapering method as mentioned before.

After a longer period of time, it’s believed that any remaining symptoms are likely no longer due to withdrawal, but rather from the damage done to GABA receptors. People with PWS can go through days of calm, where their symptoms are lessened (called a “window”), as well as flares of more severe symptoms (known as a “wave”) until the receptors normalize. These same types of windows and waves can also be seen in regular BWS, just over a shorter period.

BWS/PWS Dangers

Although BWS and PWS can be dangerous conditions for any benzo user, they come with even greater risk for those who are elderly or frail. Benzodiazepines should never be stopped abruptly (cold-turkey), but instead a slow, as-tolerated taper method should be used to mitigate as much risk as possible.

Improvements Over Time

Symptoms generally improve gradually over time, with more good days than bad as withdrawal progresses for most. Others on the other hand, may experience constant, severe symptoms without the relief of “windows” for weeks, months, or even years before a sudden improvement.

Although the journey is different for everyone, the majority recover completely, feeling better mentally and physically than they did while taking benzos.