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Table of Contents

Contents
Introduction
Chapter 1: The benzodiazepines: what they do in the body
Chapter 2: How to withdraw from benzodiazepines after long-term use
Chapter 2: Slow withdrawal schedules
Chapter 3: Benzodiazepine withdrawal symptoms, acute & protracted
Supplement

THE ASHTON MANUAL SUPPLEMENT, APRIL 2011

IMPORTANT MESSAGE FROM PROFESSOR ASHTON, JANUARY 2007

FOREWORD TO REVISED EDITION, AUGUST 2002

FOREWORD 2001

ABOUT PROFESSOR C HEATHER ASHTON, DM, FRCP

SUMMARY OF CONTENTS

MEDICAL DISCLAIMER

CHAPTER 1. THE BENZODIAZEPINES: WHAT THEY DO IN THE BODY

Background

About this chapter

The benzodiazepines
Potency
Speed of elimination
Duration of effects
Therapeutic actions of benzodiazepines
Mechanisms of action

Adverse effects of benzodiazepines
Oversedation
Drug interactions
Memory impairment
Paradoxical stimulant effects
Depression, emotional blunting
Adverse effects in the elderly
Adverse effects in pregnancy
Tolerance
Dependence
    Therapeutic dose dependence
    Prescribed high dose dependence
    Recreational benzodiazepine abuse

Socioeconomic costs of long-term benzodiazepine use

Further reading

Table 1. Benzodiazepines and similar drugs
Table 2. Therapeutic actions of benzodiazepines
Table 3. Some socioeconomic costs of long-term benzodiazepine use
Fig. 1. Diagram of mechanism of action of the natural neurotransmitter GABA (gamma aminobutyric acid) and benzodiazepine on nerve cells (neurons) in the brain

CHAPTER 2. HOW TO WITHDRAW FROM BENZODIAZEPINES AFTER LONG-TERM USE

Background

Why should you come off benzodiazepines?

Before starting benzodiazepine withdrawal
    Consult your doctor and pharmacist
    Make sure you have adequate psychological support
    Get into the right frame of mind
        Be confident
        Be patient
        Choose your own way

The withdrawal
    Dosage tapering
    Switching to a long-acting benzodiazepine
    Designing and following the withdrawal schedule
    Withdrawal in older people
    Withdrawal of antidepressants

Further reading

Slow withdrawal schedules

CHAPTER 3. BENZODIAZEPINE WITHDRAWAL SYMPTOMS, ACUTE AND PROTRACTED

Mechanisms of withdrawal reactions

Acute withdrawal symptoms

Individual symptoms, their causes and how to deal with them
    Insomnia, nightmares, sleep disturbance
    Intrusive memories
    Panic attacks
    Generalised anxiety, panics and phobias
    Psychological techniques
    Complementary medicine techniques
    Exercise and other techniques
    Sensory hypersensitivity
    Depersonalisation, derealisation
    Hallucinations, illusions, perceptual distortions
    Depression, aggression, obsessions
    Muscle symptoms
    Bodily sensations
    Heart and lungs
    Problems with balance
    Digestive problems
    Immune system
    Endocrine problems
    Fits, convulsions

Extra medication during benzodiazepine withdrawal
    Antidepressants
    Beta-blockers
    Hypnotics and sedatives
    Other drugs

Benzodiazepine use during and after withdrawal

Diet, fluids and exercise
    Smoking

Course of withdrawal

Protracted withdrawal symptoms
    Anxiety
    Depression
    Insomnia
    Sensory and motor disturbances
    Possible mechanisms of persisting sensory and motor symptoms
    Poor memory and cognition
    Do benzodiazepines cause structural brain damage?
    Gastrointestinal symptoms
    Coping with protracted symptoms
    How long do benzodiazepines stay in the body after withdrawal?

Epilogue
    Education
    Research
    Treatment methods
    Provision of facilities

Further reading

Table 1. Benzodiazepine withdrawal symptoms
Table 2. Antidepressant withdrawal symptoms
Table 3. Some protracted benzodiazepine withdrawal symptoms
Table 4. Some possible causes of protracted benzodiazepine withdrawal symptoms