Xanax can help people who are in acute distress, but it is not intended for long-term use. The long-term use of benzodiazepines like Xanax can potentially create problems with dependence and withdrawal.
Overview of Xanax Withdrawal
Even if you only take Xanax for a period of several days, you may develop a physical dependence on the drug. This means that you will likely experience Xanax withdrawal, or the uncomfortable physical and mental symptoms of discontinuing the drug. The intensity of your symptoms depends on your dosage, or how much Xanax you’ve been taking and for how long. For more mental health resources, see our National Helpline Database. Xanax withdrawal can also be medically serious. If you have been taking Xanax several times a day, then quitting is going to take time, patience, and determination. The only safe way to quit is to slowly taper down your dose under the direction of a doctor. Delirium is a state that involves temporary, abrupt changes in cognition and behavior characterized by agitation and disorientation. A grand mal seizure (also known as a tonic-clonic seizure) involves violent muscle contractions and a loss of consciousness. In 2017, doctors wrote nearly 45 million prescriptions for alprazolam (Xanax). Reckless prescribing practices have contributed to thousands of cases of dependence and misuse. Research shows that in 2018, an estimated 5.4 million people over the age of 12 misused prescription benzodiazepines like Xanax.
Xanax Withdrawal Symptoms & Signs
The signs and symptoms of Xanax withdrawal vary from person to person. Research indicates that roughly 40% of people taking benzodiazepines for more than six months will experience moderate to severe withdrawal symptoms. The remaining 60% can expect milder symptoms. Xanax is a high-potency drug, which makes its withdrawal symptoms more intense than symptoms of withdrawal from other types of benzodiazepines such as Valium (diazepam).
What Does Xanax Rebound Mean?
Xanax’s potency is linked with increased rebound effects. A rebound effect is the reoccurrence of a symptom after a person stops taking the medication that was treating it. For instance, someone taking Xanax for anxiety is likely to have a reoccurrence of their anxiety symptoms during withdrawal. This is sometimes called Xanax rebound anxiety. Many people experience irritability and agitation, which can cause problems at home, work, or school. You might be easily annoyed or short-tempered with family or friends. Insomnia, another symptom, can also contribute to these feelings of anxiety and agitation.
How Long Does Xanax Withdrawal Last?
The symptoms of Xanax withdrawal typically appear within 8 to 12 hours of your last dose. If you fail to taper your dose, your withdrawal symptoms will grow increasingly intense. Withdrawal is generally at its worst on the second day, and improves by the fourth or fifth day; however, acute symptoms can last significantly longer.
Early withdrawal symptoms: These symptoms usually occur within the first two days after your last dose. They usually include: headaches, insomnia, anxiety, restlessness, and/or panic attacks. Acute withdrawal symptoms: Symptoms tend to peak between the third day and the fifth or sixth day after your last dose. Additional symptoms may include: hallucinations, aggression, confusion, memory problems, high blood pressure, muscle aches, nausea, tremors, and more. Late withdrawal: After about a week of Xanax withdrawal, the physical symptoms may become more tolerable; however, other symptoms may occur after this period which include Xanax cravings, anxiety or depression, insomnia, and/or suicidal ideation.
Estimates suggest that about 10% to 25% of people who use benzodiazepines long term experience what’s known as protracted withdrawal. For more mental health resources, see our National Helpline Database. Protracted withdrawal is a prolonged withdrawal experience marked by waves of mild psychological symptoms that come and go over the course of several months. Protracted Xanax withdrawal can last up to one year.
Factors That Affect Xanax Withdrawal
Xanax withdrawal isn’t the same for everyone—there are unique factors that come into play. Be sure to consult with a healthcare professional if you have any mental health conditions including but not limited to:
Panic disorder: One small study found that 15 out of 17 patients with panic disorder who were treated with alprazolam experienced panic attacks again (some at higher levels than pre-treatment) after discontinuing Xanax. These patients were tapered off of Xanax after four weeks, yet this rebound effect still occurred. Post-traumatic stress disorder (PTSD): In another small study, all eight patients with PTSD who tapered off of Xanax after eight weeks experienced worsened anxiety, sleep disturbance, nightmares, irritability, rage, and homicidal ideation. Pregnancy: If you are pregnant, you are at an increased risk of Xanax withdrawal symptoms, including seizures.
Coping & Relief for Xanax Withdrawal
The best way to try to lessen the severity of your Xanax withdrawal symptoms is by slowly tapering down your dose of Xanax. Tapering means taking progressively smaller doses over the course of several weeks. It is not recommended to taper without the assistance and recommendations from your prescribing doctor. Xanax is a short-acting drug, which means your body metabolizes it very quickly. Tapering Xanax is challenging because the amount of the drug in your system quickly goes up and down with each dose. To help you avoid these peaks and valleys, doctors often switch you from Xanax to a long-acting benzodiazepine such as Valium (diazepam).
Alleviating Symptoms of Breakthrough Withdrawal
If you have breakthrough withdrawal symptoms when your dose is reduced, your prescribing doctor can pause or stretch out your taper. It’s up to you and the doctor to figure out the best tapering schedule for your individual needs. The doctor may also recommend one or more of the following treatment types:
Cognitive behavioral therapy (though research is mixed on the effectiveness of CBT after three months) Exercise Herbal sleep aids such as valerian root and chamomile Meditation Melatonin Mindfulness practice
Warnings About Xanax Withdrawal
Unlike many other withdrawal syndromes, benzodiazepine withdrawal can be complicated and, occasionally, life-threatening.
Xanax withdrawal seizures may occur in some people—especially in those undergoing unsupervised and untreated withdrawal from Xanax. If you have been diagnosed with a serious mental illness in the past, such as a panic disorder, PTSD, bipolar disorder, or borderline personality disorder (BPD), then great care should be taken when coming off of Xanax. In such cases, a doctor’s help will be invaluable. It can be difficult to predict which dormant symptoms, if any, may return when Xanax is removed from the equation. People with a history of complicated withdrawal syndromes and people with underlying health issues should also work closely with a doctor. Older adults and people with cognitive decline should also work closely with a doctor as there are unique risks for these groups.
If you are using Xanax without a prescription, you can still work with a doctor to taper down your dose. Start by visiting a primary care doctor or urgent care center and tell them that you are in or are planning to be in benzodiazepine withdrawal. If you don’t have insurance, visit a community health center. If you are concerned about the risks involved in Xanax tapering for any reason, discuss these concerns with a doctor. You may be better suited for inpatient detoxification. While inpatient treatment is typically more expensive, it is covered by many insurance plans.
Long-Term Treatment for Xanax Withdrawal
When it comes to the long-term management of getting off benzodiazepines, there are two directions you can go. Research shows that most stable, healthy adults will achieve long-term abstinence after completing a taper. The key to achieving this goal is to follow the tapering schedule to the very end. By the end of your taper, you might be cutting pills into halves or quarters. Some people may be better suited for a harm reduction approach, in which the taper leads to a maintenance dose rather than abstinence.
A Word From Verywell
Quitting Xanax takes time, patience, and determination. If you’ve been using it for longer than a few months, quitting can be hard. There will be days where you want to give up and give in. But with medical supervision and support, you can be successful. In the long-term, the health benefits to you will be considerable.
