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Pamphlet Details and References

See Pamphlet #1 – I Need Your Help

    Pelissolo A, Bisserbe JC. Dependence on benzodiazepines. Clinical and biological aspects. Encephale.1994;20(2):147-57 Abstract
Rickels K, Schweizer E, Case G, Greenblatt DJ. Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry. 1990;47(10):899-907.  Abstract

Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18:249–55.  Abstract

 

3. Miller LG, Koff JM. Interaction of central and peripheral benzodiazepine sites in benzodiazepine tolerance and discontinuation. Prog Neuropsychopharmacol Biol Psychiatry. 1994;18(5):847-57.  Abstract

 

8. Ashton H. Benzodiazepine withdrawal: outcome in 50 patients. Br J Addict. 1987;82:655-71.  Full text

Pamphlet #3:  BZRA Discontinuation 1:  Getting Started

Some BZDs are available in formulations that facilitate tapering, others are not.  See Table 1: Benzodiazepine Dosages, Solutions and Suspensions to determine if the prescribed BZD has such a formulation, and what to do if it does not.

Some patients can tolerate only very small cuts, some as small as 1%.  See the document “Best Practices for Tapering off of Benzodiazepines“, sections 2.3 “Part 3: Fine Taper” and section 2.4A “Ultrafine Taper” for fine and ultrafine tapering formulations and methods.

Here are some of the references which were used to create pamphlet #3:

  1. Fialip J, Aumaitre O, Eschalier A, et al. Benzodiazepine withdrawal seizures: analysis of 48 case reports. Clin Neuropharmacol. 1987;10(6):538-44.  Abstract
  2. Lader M, Kyriacou A. Withdrawing benzodiazepines in patients with anxiety disorders. Curr Psychiatry Rep. 2016;18(1):8.  Abstract
  3. Ashton H. The Ashton Manual: Benzodiazepines – How They Work and How to Withdraw. 2002.  Full text of the Ashton Manual
  4. Becker WC, Fiellin DA, Desai RA. Non-medical use, abuse and dependence on sedatives and tranquilizers among US adults: psychiatric and socio-demographic correlates. Drug Alcohol Depend. 2007;90(2-3):280-7.  Abstract
  5. Allison C, Pratt JA. Neuroadaptive processes in GABAergic and glutamatergic systems in benzodiazepine dependence. Pharm Ther. 2003;98(3):171-95.  Abstract
6. Fixsen AM, Ridge D. Stories of hell and healing: internet users’ construction of benzodiazepine distress and withdrawal. Qual Health Res. 2017;27(13):2030-41.  Abstract
Pittman CM, Youngs W, Karle E. Social networking and benzodiazepine withdrawal: the realities of dependence and the necessity of support. Presented at the 33rd Annual National Conference of the Anxiety and Depression Association of America, La Jolla, California. April 2013.  Full text

 

Pamphlet #4:  BZRA Discontinuation 2:  Symptomatic Relief

Since the references for this pamphlet were not listed, the statements which have references are repeated, followed by the references themselves.

Even with a carefully managed taper, many patients experience significant symptoms.1

Consider these medications:2  [followed by a list of medications]

Cognitive Behavioral Therapy (CBT) – strong evidence of effectivity.3 

Adjunctive medications for insomnia relief4

  1. Ashton H. Benzodiazepine withdrawal: outcome in 50 patients. Br J Addict. 1987;82:655-71.A  Full text
  2. Welsh, JW, Tretyak V, McHugh RK, et al. Review:  Adjunctive pharmacologic approaches for benzodiazepine tapers. Drug Alcohol Depend. 2018;189:96-107.  Abstract
  3. Darker CD, Sweeney BP, Barry JM, et al. Psychosocial interventions for benzodiazepine harmful use, abuse or dependence. Cochrane Database Syst Rev. 2015;(5):CD009652.  Abstract
  4. Gould RL, Coulson MC, Patel N, et al. Interventions for reducing benzodiazepine use in elderly:  meta-analysis of randomised controlled trials. Br J Psychiatry. 2014;204(2):98-107.  Abstract
  5. Baandrup L, Ebdrup BH, Rasmussen JØ, et al. Pharmacological interventions for benzodiazepine discontinuation in chronic benzodiazepine users. Cochrane Database Syst Rev. 2018;3:CD011481.  Abstract

Pamphlet #5:  BZRA Discontinuation 3:  Completion and Repair

Here are some of the references which were used to create this pamphlet:

  1. Tyrer P et al. Gradual withdrawal of diazepam after long-term therapy.  Lancet. 1983;1(8339):1402-1406 Abstract

2. Peppin J et al. The Benzodiazepine Crisis: An Overview of the Down-Side of an Overused Drug Class  Oxford Ed Press 2020

3. Barker MJ et al.. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs. 2004;18(1). Full article 

Pétursson H. The benzodiazepine withdrawal syndrome. Addiction. 1994;89(11):1455-9.  Abstract

4. Ashton H. Protracted withdrawal syndromes from benzodiazepines. J Subst Abuse Treat. 1991;8(1-2):19-28.  Abstract

5. Kamath A. Fluoroquinolone induced neurotoxicity: a review. J Adv Pharmacy Ed Res. 2013;3(1):16-9. Full article

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Pamphlet #6:  BZRA Discontinuation 4:  It Takes a Team

Since the references for this pamphlet were not listed, the statements which have references are repeated, followed by the references themselves.

The unpredictability of symptoms often strains the patient/prescriber relationship, cause the patient to stop discontinuing, or leads to excessive visits to the prescriber or the ER.1

However, when it comes to BZDs, even the major teaching university sites may not be complete or accurate.2

In addition to following the prescription plan developed in concert with the prescriber, patients are responsible for stress minimization, proper sleep hygiene, diet and nutrition, and exercise.3

  1. Moro RN et al. Emergency Department Visits Attributed to Adverse Events Involving BZDs, 2016-2017. Am J Prev Med. 2020;58(4).  Abstract
  2. Examples:  Harvard notes only that BZWS “symptoms usually start 2-10 days after cessation of medication”, the Mayo Clinic doesn’t address BZWS, and WebMD only addresses BZD “abuse” and ignores dependence as a possible effect of long-term use.
  3. See the “Alternatives to BZRAs” tab of  benzoreform.org/resources-for-prescribers/ for details and links for each of these lifestyle items.