What Are Benzo Flu and Brain Zaps During a Benzodiazepine Taper, and What Helps?

What is benzo flu?

Benzo flu is the name patients give to the flu-like symptoms that show up while a benzodiazepine dose is coming down. Fatigue, aching muscles, chills, sweats, nausea, and a heavy, weak feeling in the legs are the usual complaints. It feels like the first day of influenza. There is no virus.

The term comes from patients, not from a textbook. Yet, the symptom is in the Ashton Manual.

In Chapter III, Professor C. Heather Ashton lists “fatigue, influenza-like symptoms” among the physical symptoms of benzodiazepine withdrawal. The same table lists “electric shocks,” which patients call brain zaps.

Neither one waits for the last dose. In fact, both tend to follow a dose reduction, in people who are still taking the medication every day and who took it exactly as prescribed.

Physical dependence is not addiction. It is the nervous system’s adaptation to a medication taken daily, and a flare after a dose cut is that adaptation showing itself.

Why does a dose reduction feel like the flu?

A benzodiazepine does not supply the brain’s calming chemical, gamma-aminobutyric acid (GABA). It boosts the effect of the GABA that is already there. In the first chapter of the Manual, Professor Ashton explains that with long-term use the receptors compensate by becoming less responsive.

A stereo with two hands on the volume is a fair picture. The medication has been holding the volume down, and the nervous system has answered by turning its own dial up. Each dose reduction lifts the medication’s hand a little, and until the nervous system turns its dial back down, everything plays too loud.

The loudness reaches the whole body. Chapter III describes muscles held in constant tension, which probably accounts for the aches, and hyperexcitable nerves whose constant activity “contributes to a feeling of fatigue and weakness.” Sweating, flushing, and sensations of hot and cold belong to the same picture.

So, the body produces the feeling of influenza with no infection behind it. Nothing has run out. The receptors readjust with time, and withdrawal fatigue and the aches ease as they do.

The same holds for the z-drugs, such as zolpidem (Ambien) and eszopiclone (Lunesta). They are not benzodiazepines. The first chapter of the Manual lists them as drugs with similar effects, and a taper off one can bring the same symptoms.

What do brain zaps feel like, and are they dangerous?

A brain zap is a sudden, brief sensation like an electric shock or a jolt inside the head, sometimes running into the neck or the limbs. It is over almost as soon as it starts. Some patients feel a moment of dizziness afterward.

Brain zaps are frightening. They are not dangerous.

In Chapter III, Professor Ashton includes “feelings of electric shocks” among the strange bodily sensations of withdrawal, and she explains that the sensory nerves become hyperexcitable. She adds that these sensory symptoms, “though disconcerting, are usually nothing to worry about.”

A zap does not come from a shortage of GABA. It is the same turned-up dial, felt in the sensory nerves.

Brain zaps are best known from stopping other psychiatric medications, so a patient whose other medications are also being changed should tell the physician managing the taper, since either change could be the source. In a benzodiazepine taper, zaps usually follow a reduction that was too large or came too soon. They fade as the nervous system settles.

How is a brain zap different from a seizure?

A brain zap passes in an instant, and the person stays awake and aware throughout. A seizure is different. It can bring a loss of consciousness, stiffening or jerking of the body that cannot be stopped, and confusion afterward.

Seizures are the reason a benzodiazepine is never stopped abruptly. When the United States Food and Drug Administration (FDA) updated the boxed warning on benzodiazepines in 2020, it stated that stopping abruptly or reducing the dose too quickly can result in withdrawal reactions, including seizures, which can be life-threatening. Professor Ashton writes in Chapter III that such fits are extremely rare with slow dosage tapering.

Call 911 for a seizure, a loss of consciousness, severe confusion, hallucinations, chest pain, or trouble breathing. None of those is benzo flu or a brain zap.

The first response is to slow down or hold.

Benzo flu and brain zaps after a dose cut are information. Do they mean the taper is failing? No.

They mean that the last reduction was larger, or came sooner, than the nervous system could absorb. So, one response is a short hold at the current dose and a smaller next step, planned with the prescriber, though everybody is different, and some patients do better continuing at a steady pace than waiting out a long hold, with the medication never stopped suddenly.

In Chapter II of the Manual, Professor Ashton proposes reductions of up to one tenth of the dose at each step, and she insists that the person tapering must be in control of the pace. The Maudsley Deprescribing Guidelines add the hyperbolic shape, in which each reduction is sized to the dose that remains. The steps get smaller as the dose gets lower, and a taper built this way takes months, sometimes longer.

Professor Ashton preferred standing still to going back up, so the hold comes first. Sometimes it is not enough, because the cut itself was too large, and a small step back up is a legitimate choice then, made with the prescriber. The dial comes down on its own when the steps are small and there is time between them.

Unfortunately, many people do the opposite. They feel terrible, conclude that the medication is the problem, and speed up or stop in order to get it over with. That is the one response that makes benzo flu worse, and it is the one that brings real danger.

What helps on a benzo flu day?

Rest comes first, and it is not laziness. A nervous system playing too loud is doing hard work, and an early night helps where sleep allows. Fluids through the day and plain, regular meals keep thirst and an empty stomach from adding their own headache and shakiness.

Gentle movement helps many patients more than staying in bed. A short walk or some easy stretching is enough, and for some patients hard exercise on a bad day makes the next day worse.

The evidence that food, fluids, or movement change withdrawal itself is limited. This is clinical experience, and it varies from person to person.

Alcohol acts on the same receptors as a benzodiazepine, so it is best avoided during a taper. Caffeine is a stimulant, and a person who notices more jitters, more zaps, or worse sleep after coffee has good reason to cut back gradually. Abrupt changes of any kind, such as a skipped dose or a dose taken hours late, can set off the same symptoms as a cut.

The same habits apply to brain zaps. There is no specific treatment for a zap, and sitting down until it passes is enough.

Patients also ask about cold and flu products, pain relievers, antihistamines, and supplements. The evidence that any of them eases withdrawal is limited, and individual response varies. Each one is a decision for the patient and a physician who understands the pharmacology, and none takes the place of a gradual taper.

Benzo flu is not an infection, yet a real fever still needs a doctor.

Benzo flu is not contagious. However, a person in the middle of a taper can still catch a cold, influenza, or another infection, and withdrawal does not rule out an unrelated illness.

Sweating, flushing, and sensations of hot and cold are in Chapter III. A measured fever is not.

So, a thermometer reading that stays up, a cough, a sore throat, pain with urination, or any new illness that does not fit the usual pattern deserves a visit to the person’s own doctor. A companion article explains the difference between feeling feverish and having a fever during a taper.

A wave brings low mood along with the aches.

Days of feeling ill wear a person down. Irritability, tearfulness, and a flat, hopeless mood often arrive with benzo flu, and depression and irritability are in the same Chapter III table, among the psychological symptoms. And, they tend to lift when the wave does.

It helps to have one person at home who believes the symptoms are real and does not push for speed. If the low mood turns into despair or thoughts of suicide, call or text the 988 Suicide and Crisis Lifeline at any hour.

Patients also ask about timing.

How long does benzo flu last?

There is no fixed answer, and no one can promise a date. In Chapter III, Professor Ashton writes that withdrawal symptoms “wax and wane” from day to day and week to week, and that windows of feeling well appear, become more frequent, and last longer.

Patients call the bad stretches waves. A wave of benzo flu after two good weeks is not starting over.

Why do symptoms show up at the same time every day?

With a short-acting benzodiazepine such as alprazolam (Xanax) or lorazepam (Ativan), the level of the medication falls between doses. Symptoms can surface before the next dose is due, which patients call interdose withdrawal. The Ashton Manual’s answer, where it helps, is a crossover taper to diazepam (Valium), which is long-acting and keeps the level steadier.

Fortunately, the symptoms usually settle when the pace is right.

The nervous system does readjust, on its own schedule. Benzo flu passes, the zaps thin out, and the windows widen. How rough the months in between will be depends mostly on the size and the pace of the reductions.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. In his practice, a flare of benzo flu or a run of brain zaps after a reduction is read as a message about the pace, never as a failure by the patient. The response is planned with the patient: often a short hold and a smaller next step, for some a steady pace, and the patient decides when to move again.

Dr. Leeds’ practice is a concierge practice, not an insurance practice, and its primary service is medically supervised benzodiazepine and z-drug tapering for patients in Florida. Contact the office to discuss a taper with room for the bad days.

This article is educational. It is not medical advice, and reading it does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.