Tolerance and Interdose Withdrawal
These are two major problems people can experience when taking benzodiazepines and they are related to how your body processes the medication. Let’s look more into tolerance and interdose withdrawal, and what to watch out for with these issues.
TOLERANCE – WHEN YOUR DOSE STOPS WORKING
Tolerance occurs when your body learns to overcome or negate the drug’s effects on you. In the case of benzos, when the receptors in your brain adapt to the drug dose you’re on, they no longer work as well as they once did, and you require an ever- increasing dose to achieve the same therapeutic effect.
Unfortunately, this is a common occurrence with this type of medication, especially when you take them regularly (longer than 2 – 4 weeks). That’s why you may have your dose increased as you go along or you may even have additional drugs added, resulting in becoming poly-drugged.
There are two theories as to why tolerance occurs in the first place. One is that the receptors in your brain that benzos target begin to down-regulate. In other words, you end up with fewer receptors than when you started the benzos. The second is that the receptor binding sites become separated, causing the medications to become less effective over time.
Whichever is the case, you can begin to go through withdrawal symptoms even if you’re not decreasing your dose. In fact, long-term benzodiazepine use may even worsen anxiety disorders and and you could begin to experience panic attacks or agoraphobia for the first time.
Tolerance can occur as quickly as a few weeks of regular use, or it may not occur for years, or not at all. There is no way to predict who will experience tolerance to a drug or how fast.
With benzos, tolerance is nearly always associated with some degree of physical dependence. If you find that you are experiencing tolerance, this is a clear warning sign that you may have formed a dependency and this means it is time to consider tapering off the medication.
From the Ashton Manual:
“Tolerance is a phenomenon that develops with many chronically used drugs (including alcohol, heroin and morphine and cannabis). The body responds to the continued presence of the drug with a series of adjustments that tend to overcome the drug effects. In the case of benzodiazepines, compensatory changes occur in the GABA and benzodiazepine receptors which become less responsive, so that the inhibitory actions of GABA and benzodiazepines are decreased. At the same time there are changes in the secondary systems controlled by GABA so that the activity of excitatory neurotransmitters tends to be restored.
Tolerance to different effects of benzodiazepines may vary between individuals - probably as a result of differences in intrinsic neurological and chemical make-up which are reflected in personality characteristics and susceptibility to stress. The development of tolerance is one of the reasons people become dependent on benzodiazepines, and also sets the scene for the withdrawal syndrome.”
what is dependence vs addiction?
Physical dependency refers to the need to continue taking the drug in order to avoid experiencing withdrawal symptoms. People who have become dependent on prescribed therapeutic doses of benzodiazepines rarely have an actual addiction. Most are taking their medications exactly as prescribed and not seeking any sort of “high”.
It is very important to not confuse dependence with drug addiction.
In medical terms, dependence specifically refers to a physical condition in which the body has adapted to the presence of a drug. It happens to all human brains exposed to drugs such as benzos and it is not the same as addiction.
Addiction refers to compulsive drug use despite harmful consequences. The person may be experiencing issues meeting work, social, or family obligations which may indicate a problem.
Dependence is often a part of addiction and non-addictive drugs can also produce dependence in patients, which makes this a bit confusing to understand at first.
Note: If anyone with drug dependence stops taking that drug suddenly, that person will experience predictable and measurable symptoms, known as a withdrawal syndrome.
INTERDOSE WITHDRAWAL – TOLERANCE AT WORK OR A SHORT HALF-LIFE
One of the continuing effects of tolerance is interdose withdrawal, which is where you begin to experience withdrawal symptoms between your regular doses of benzodiazepines. It can also be related to the half-life of the benzodiazepine you’re taking. In other words, drugs with a short half-life work more quickly but also clear your system more rapidly, leaving you to experience withdrawal just as fast.
Some people describe interdose withdrawal as a “craving” for their next dose. Because of this desire, you may feel irritable or anxious and find yourself needing to take “a little more” just to get through.
For example, if you take your medication for insomnia at 8 pm each night, you may start to have withdrawal symptoms between 1 and 3 pm each day, not feeling better until you finally take your medication again.
For this reason, many benzo patients who experience interdose withdrawal may run out of their prescription prior to refill time and can be labeled as “drug-seekers”. This interdose withdrawal can create a “pseudo addiction,” where you’re constantly looking for relief from your symptoms rather than a high.
THE BENZO CYCLE
It’s easy to see why so many fall into the never-ending cycle of benzodiazepines, taking increasing dosages and an increasing number of medications to try and achieve the same effects they experienced when they first started on the medication. It’s a pharmaceutical roller coaster ride that can only end in disaster, leaving far too many patients benzo injured.
So, it is possible to take your benzodiazepines exactly as prescribed and then find yourself suffering bizarre and distressing symptoms that could be related to tolerance, dependence or interdose withdrawal.
Currently there is no test to detect benzodiazepine withdrawal and many users when they try to get to the bottom of things get told all their lab work is clear, making things even more confusing.
If your doctor says you need to increase your dose of your benzo in order to have the same effect as when you first started taking it, you may already be in tolerance. It is possible you are even experiencing withdrawal symptoms too that you are trying to understand.
time to taper
In most cases, the majority of withdrawal symptoms do gradually disappear after successful slow tapering and withdrawal of benzodiazepines.