Xanax Withdrawal: A Major Obstacle in the Rehabilitation Journey

Last Updated: January 19, 2021

Authored by Nena Messina, Ph.D.

Reviewed by Michael Espelin APRN

Xanax (Alprazolam) is a highly addictive drug of the benzodiazepines class. Whenever it is taken, either medically or recreationally, both physical and mental dependence upon the drug is highly likely. Once reliance on the drug occurs, withdrawal symptoms are likely to arise when the user stops taking the medication. Depending on how strong the addiction is, Xanax withdrawal may be mild, moderate, or severe. In many cases, the user experiences pain and psychological disturbances. In some cases, unsupervised Xanax detox without tapering can result in death. Therefore the only recommended way to go through Xanax withdrawal is tapering.

Causes Of Alprazolam Withdrawal

The U.S. Food and Drug Administration warns that prescribing Alprazolam can lead to addiction, especially if the patient takes large doses, for example the whole Xanax bar at once, for over a month. There is a risk of addiction and possible alprazolam side effects even when this drug is used according to doctors’ guidelines. When abuse occurs, the risk is even greater. It is that addictive due to its influence on GABA production (inhibitory neuron gamma-aminobutyric acid), which mutates our brain’s natural reaction to stress, slowing it down and sedating the brain.

Nervous woman.

This is a great feature of the drug and the reason why it is prescribed, for example, to fight anxiety. However, what has been discovered is that with prolonged use, Alprazolam may actually start affecting how our brain produces GABA on its own. Over time our brain may not be able to produce it at all without the drugs’ help. This is why many people experience Xanax withdrawal when initially trying to get off it. This is because their brain can no longer do what it’s meant to, and complete its calming process and restore balance. This is why it may be dangerous to attempt coming off of long-term Alprazolam use without medical supervision. In some cases, it may be life-threatening.

Xanax Withdrawal Symptoms

To understand how withdrawal from Xanax sets in, it’s important to briefly dive into how the body processes the drug and how the brain responds to this drug in the short term and long term.

As earlier alluded, this drug is a benzodiazepine. This group of drugs works in the central nervous system to produce CNS depression by potentiating GABA (An inhibitory neurotransmitter). The net effect is a continuum of initial excitement, sedation, and anxiolysis, hypnosis, anesthesia, or medullary depression (cessation of breathing with potential for cardiovascular collapse) depending on the administered dose. If used in combination with other classes of depressants (alcohol and barbiturates), a coma might result.

Woman undergoing xanax withdrawal in the hospital.

If the brain is dosed with this benzodiazepine for a prolonged period of time, ‘adaptation’ occurs. The brain starts to produce less of the natural inhibitory neurotransmitters to dull down the effects of this ‘alien’ depressant.

Regardless of the way of intake, snorting the drug or taking it orally, in the event of sudden Xanax withdrawal, problems are bound to occur. The brain has not been given time to up production of GABA (the main inhibitory neurotransmitter). For this reason, the central nervous system will go into overdrive due to unchecked action of excitatory neurotransmitters leading to both physical and psychological symptoms.

Psychological:

  • Anxiety
  • Hallucinations
  • Inability to sleep
  • Inability to concentrate
  • Inability to enjoy usually pleasurable activities

Physical:

  • Hand tremors
  • Seizures
  • Delirium Tremens
  • Headaches
  • Elevated blood pressure
  • Increased heart rate
  • Diarrhea

Rebound Symptoms

As earlier discussed, after suddenly stopping taking this drug after prolonged use, the GABA level is usually low. For this reason, users will experience the negative effects of CNS over-excitation at an increased intensity. Anxiety, panic attacks, or inability to sleep will intensify for a short duration (usually a week or so) before the levels of GABA in the brain are corrected. Simply put, the symptoms that led to Alprazolam use will come back more strongly for a few days.

Factors that can affect Alprazolam Withdrawal

The severity of withdrawal from substances and the timeline will be different for every individual.

Various Factors Can Influence the Withdrawal Process:

  • Dosing of Xanax will play a major role in the intensity of withdrawal symptoms from Xanax. Individuals taking larger doses for prolonged durations of time are more likely to experience more pronounced symptoms than those taking smaller doses for shorter durations.
  • Usage with other substances. If used in combination with other benzodiazepines, alcohol, or barbiturates, the intensity of the symptoms will be created because of the enhanced central nervous depression.
  • Underlying mental illnesses can also compound the symptoms of Alprazolam withdrawal. People who have anxiety disorders, sleep disturbance, and but not limited to panic attacks will experience more Xanax withdrawal symptoms.
  • Genetics also play an important role in the severity of Xanax withdrawal. Different individuals using the same amount of this drug for the same duration will sometimes report different severities of symptoms.

Alprazolam Withdrawal Timeline

Benzodiazepines are classified into three categories; short, intermediate, and long-acting. Xanax falls in the intermediate-acting category. It has a half-life of 11 hours. This means that the body will clear off most of the drug from the system in about 11 hours. For this reason, Xanax withdrawal to this drug will set in very quickly (6-12 hours after the last dose)

After the initial 6-12 hours, the intensity of the symptoms will peak. “Boomerang” symptoms are experienced during this phase, where the negative effects that led to the prescription of Xanax hit real hard. Over the next few days to weeks, these Xanax withdrawal symptoms abate gradually. The average duration is about two weeks. However, a few individuals will experience protracted symptoms, which will last anywhere between a few months to years. Heavy users are more prone to this phenomenon.

More often than not, withdrawal from Xanax will follow the following timeline:

 

0-6 hours Being a short-acting benzodiazepine, withdrawal symptoms from Xanax will set in early. Anxiety and insomnia are the hallmarks of this stage
12 hours – Day 4 Rebound symptoms will set in at this stage. Symptoms experienced before the start of Xanax will come back more strongly
Day 5 – 14 Some rebound symptoms might persist beyond day 4 and spill over to this phase. Somewhere along the way, they may peak and then get better or even disappear
Day 14 + At this stage, most of the severe symptoms will have disappeared. The mild ones that remain will then disappear as time goes by, and the individual can go back to normal or near-normal functioning

Post-Acute Withdrawal Syndrome

This phenomenon, also referred to as protracted withdrawal syndrome or post-acute withdrawal syndrome (PAWS), is observed in a section of individuals trying to quit Alprazolam and several other drugs. Long after they quit, they still experience anxiety, panic attacks, irritability, depression, difficulty with cognitive tasks, obsessive-compulsive behaviors, among other symptoms. How this phenomenon comes to be is not fully understood, but it’s theorized that prolonged substance use produces physical changes within the brain that ultimately results in PAWS.

Tapering Off Alprazolam

Due to the possibility of adverse Xanax withdrawal symptoms, breaking an addiction to the drug should be carefully monitored. Quitting “cold turkey” is not recommended because it can cause grand mal seizures, which may be fatal. Heart rate, breathing, and blood pressure should also be monitored.

Medical supervision while tapering off Xanax.

Needless to say, a hospital or a detox center is the best and safest solution, where the patient can gradually get clean without facing life-threatening issues or long-term damage.

Weaning off refers to a specific schedule followed to slowly taper the dose of alprazolam being taken until the patient is completely off the medication. When users do not follow an Alprazolam taper, they are more likely to experience severe and painful Xanax withdrawal symptoms, up to and including death.

Tapering off alprazolam alone is not recommended. There is no standard taper schedule; the taper schedule used in each case is based on the needs of the patient. Besides, withdrawal symptoms from Xanax can be life-threatening.

Things considered when making a taper schedule are the dose taken, the dose frequency, how long the medication was taken, and any underlying medical conditions the patient has.

In general, the taper schedule begins by taking the total daily dose used by the patient and dividing it into three doses each day. The dose is then decreased every two weeks, often by about 25%, until it is safe to stop using it. However, as noted, this varies from person to person. As such, tapering should only be done under the supervision of a medical professional.

Although withdrawal symptoms from Xanax can be scary, the process should not be life-threatening as long as Xanax detox is done under the supervision of an experienced medical team. The exact taper schedule used varies from patient to patient, but in every case, there will be one that works. No matter how intimidating these symptoms sound, it is ultimately less painful than continuing to use Xanax. When looking for alternative treatment for anxiety or panic disorders, Ativan vs. Xanax comparison may be taken into account. Medical professionals will aim at reducing the chances of  relapse, as subsequent Xanax overdose is more likely in this case.


Page Sources

  1. Jonathan Brett, Management of Benzodiazepines, Misuse and Dependence, 2015, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4657308/
  2. Semel Institute of neuroscience and human behavior, Post-Acute Withdrawal syndrome, https://www.semel.ucla.edu/dual-diagnosis-program/News_and_Resources/PAWS
  3. McIntosh B, Clark M, Spry C. Benzodiazepines in Older Adults: A Review of Clinical Effectiveness, Cost-Effectiveness, and Guidelines, 2011, https://www.ncbi.nlm.nih.gov/books/NBK174563/table/T1/
  4. P. Metten, Genetic determinants of severity of acute withdrawal from diazepam in mice: commonality with ethanol and pentobarbital, 1999, https://pubmed.ncbi.nlm.nih.gov/10418790/
  5. Food and Drug Administration, https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018276s044,021434s006lbl.pdf
  6. H. Petursson, The benzodiazepines withdrawal syndrome, 1994, https://pubmed.ncbi.nlm.nih.gov/7841856/

Published on: October 20th, 2016

Updated on: January 19th, 2021

About Author

Nena Messina, Ph.D.

Nena Messina is a specialist in drug-related domestic violence. She devoted her life to the study of the connection between crime, mental health, and substance abuse. Apart from her work as management at addiction center, Nena regularly takes part in the educational program as a lecturer.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.