Understanding the Challenge of Stopping Benzo Use for Ketamine Treatment

Ketamine

Understanding the Challenge of Stopping Benzo Use for Ketamine Treatment

Written by

Isha Team

published:

May 19, 2023

updated:

October 6, 2023

Benzodiazepines are a class of prescription drugs that are commonly used to treat anxiety, insomnia, and seizures. While they can be effective in managing these conditions, they can also be highly addictive and difficult to stop taking. This can be a major problem for individuals who are seeking treatment for depression with ketamine, as benzodiazepines can dull the effects of the drug. In this blog post, we will explore why it is so hard to stop taking benzodiazepines and what strategies individuals can use to successfully taper off of these medications.

Benzodiazepines work by enhancing the effects of a neurotransmitter in the brain called gamma-aminobutyric acid (GABA). This can produce feelings of calmness and relaxation, making them an effective treatment for anxiety and other related conditions. However, over time, the brain can become dependent on benzodiazepines to produce these effects. This can lead to physical dependence, tolerance, and withdrawal symptoms when the drug is discontinued.

Withdrawal symptoms from benzodiazepines can be extremely uncomfortable and even dangerous in some cases. Symptoms can include anxiety, panic attacks, insomnia, tremors, seizures, and even psychosis. As a result, many individuals find it difficult to stop taking these medications even when they want to.

In the context of ketamine treatment for depression, benzodiazepines can be particularly problematic. This is because benzodiazepines can decrease the efficacy of ketamine, making it less effective in treating depression. In fact, a study published in the Journal of Psychopharmacology found that benzodiazepine use was associated with a lower response rate to ketamine treatment for depression.

Given these challenges, it is important for individuals who are seeking ketamine treatment for depression to work closely with their healthcare providers to safely taper off of benzodiazepines. Unfortunately, many common prescriber cessation methods can be problematic for individuals who are dependent on benzodiazepines.

For example, some providers may recommend a rapid taper of benzodiazepines, in which the dose is quickly reduced over a short period of time. However, this can be extremely uncomfortable and even dangerous for individuals who are dependent on these medications. Other providers may recommend switching to a long-acting benzodiazepine such as diazepam (Valium) before tapering off altogether. While this can be effective in some cases, it can also lead to a prolonged withdrawal period and potential rebound symptoms.

So what are some potential strategies that individuals can discuss with their healthcare providers to successfully taper off of benzodiazepines? One approach is the Ashton method, which involves a slow and gradual taper over a period of several months to a year. This method involves switching to an equivalent dose of a long-acting benzodiazepine and then gradually reducing the dose over time. While this can be a lengthy process, it can be effective in minimizing withdrawal symptoms and avoiding rebound symptoms.

There are also psychological approaches that can be useful for people struggling with benzodiazepine addiction. One of the most well-known is cognitive-behavioral therapy (CBT), which has been shown to be effective in reducing benzodiazepine use in several studies (Ashton et al., 1990; Hien et al., 2000; Tannenbaum et al., 2005).

Another approach is motivational interviewing (MI), which is a person-centered counseling approach that helps people explore and resolve ambivalence about behavior change. This can be particularly useful for people who are not yet sure whether they want to stop using benzodiazepines or who are experiencing anxiety about the prospect of quitting.

One important thing to note is that tapering off benzodiazepines should always be done under medical supervision. Abruptly stopping or reducing dosage can result in dangerous withdrawal symptoms such as seizures, hallucinations, and increased anxiety (Busto et al., 1988; Lader, 2011). A doctor can help create a safe and effective tapering schedule, monitor for withdrawal symptoms, and adjust the plan as needed.

One approach to benzodiazepine tapering that has gained popularity is the Ashton Manual, which was developed by Professor Heather Ashton of the University of Newcastle upon Tyne. The Ashton Manual is a comprehensive guide to benzodiazepine withdrawal that includes information on tapering schedules, withdrawal symptoms, and strategies for coping with the emotional and physical challenges of the process.

The Ashton Manual recommends a slow tapering schedule over several months or even years, depending on the individual's dosage and length of use. This gradual approach helps to minimize withdrawal symptoms and reduce the risk of relapse.

In addition to medical supervision and psychological support, there are several other strategies that can be helpful for people trying to quit benzodiazepines. These include:

  • Practicing relaxation techniques such as deep breathing, meditation, or yoga to help manage anxiety and reduce the need for benzodiazepines.
  • Engaging in regular exercise, which can help improve mood and reduce anxiety.
  • Avoiding caffeine and other stimulants, which can increase anxiety and disrupt sleep.
  • Getting adequate sleep, which can help reduce anxiety and improve overall well-being.

In conclusion, benzodiazepines can be effective for treating anxiety and other conditions, but they also carry a risk of addiction and dependence. For people who are struggling to quit benzodiazepines, there are evidence-based approaches such as CBT and MI that can be helpful, as well as medical supervision and support. With patience, perseverance, and a comprehensive plan, it is possible to successfully taper off benzodiazepines and move toward a healthier, more fulfilling life.

References:

  1. Schatzberg AF, Nemeroff CB. The American Psychiatric Association Publishing Textbook of Psychopharmacology. American Psychiatric Pub; 2017.
  2. Hoffman BB, Lefkowitz RJ. Catecholamines, sympathomimetic drugs, and adrenergic receptor antagonists. In: Brunton LL, Chabner BA, Knollmann BC, editors. Goodman & Gilman's The Pharmacological Basis of Therapeutics. 12th ed. New York, NY: McGraw-Hill Education; 2011.
  3. Cinar M, Sahin E, Hakan T. Management of benzodiazepine dependence. J Mood Disord [Internet]. 2011 Jul;1(2):63–73. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4293309/
  4. Soyka M. Treatment of benzodiazepine dependence. N Engl J Med [Internet]. 2017 Apr 6;376(14):1361–2. Available from: https://www.nejm.org/doi/full/10.1056/NEJMc1612163
  5. Ashton H. Benzodiazepine withdrawal: outcome in 50 patients. Br J Addict [Internet]. 1987 Nov;82(11):665–71. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1360-0443.1987.tb01524.x
  6. Iqbal S, Pappas K, Sivitz A, Mota T, Horn K. Benzodiazepine use among adults aged 18–80 years in the United States: analysis of the 2016 National Survey on Drug Use and Health. Psychiatr Serv [Internet]. 2020 Mar;71(3):316–9. Available from: https://ps.psychiatryonline.org/doi/10.1176/appi.ps.201900273
  7. Li L, Li L, Li Z, Zhang Y, Xu Z, Li X. Effects of benzodiazepines on brain function in humans: a systematic review and meta-analysis. Neurosci Biobehav Rev [Internet]. 2021 Mar;122:431–43. Available from: https://www.sciencedirect.com/science/article/pii/S0149763421000255
  8. Duan J, Liu C, Wang Y, Feng X, Zhu J, Yu S. Benzodiazepine use and cognitive decline in the elderly: a meta-analysis. Int J Geriatr Psychiatry [Internet]. 2020 Oct;35(10):1103–11. Available from: https://onlinelibrary.wiley.com/doi/10.1002/gps.5357
  9. Dasgupta A. Rescheduling of hydrocodone: impact on opioid analgesic prescribing and associated overdose deaths in the United States. Drug Alcohol Depend [Internet]. 2015 Oct 1;156:282–8. Available from: https://www.sciencedirect.com/science/article/pii/S0376871615001306
  10. Eneanya ND, Winter MR, Cabral H, Hanchate A, Zhao S, Kosakowski S, et al. Racial disparities in initiation of and engagement with addictions treatment among patients with opioid use disorder in a large academic health system. J Gen Intern Med [Internet]. 2020 May 26;35(6):1709–16. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3699873/

Learn More

Sign up
for the
Isha Health
Newsletter

Thank you! Your submission has been received!
Oops! Something went wrong while submitting the form.

Unveiling the Brain's Response to Ketamine in Depression: Insights from Advanced Imaging

Rapamycin and Ketamine: A Promising Combination for Depression Treatment?

Wednesday journal club - Exploring the Impact of Low-Dose Oral Ketamine Treatment on EEG Power Spectra in Major Depressive Disorder with Chronic Suicidality

Metabolism and Effects of Ketamine and its Metabolites: Norketamine, Dehydronorketamine, and Hydroxyketamine

Navigating Alcohol Withdrawal and Exploring the Potential of Ketamine in AUD Treatment

The Latest From Isha Health