Does Acupuncture Help With Benzodiazepine Withdrawal and Anxiety?

Does acupuncture help with benzodiazepine withdrawal?

Acupuncture may help some people relax during a benzodiazepine taper, and a relaxed hour may take the edge off muscle tension, restlessness, and a bad evening for a while. It does not treat withdrawal, it does not shorten it, and it is not an alternative to reducing the medication slowly. The evidence for acupuncture in benzodiazepine withdrawal is limited, and experience varies from one person to the next.

Most people who ask this question took a benzodiazepine, or a z-drug such as zolpidem (Ambien), exactly as prescribed, and their nervous system adapted to it. That is physical dependence, and dependence is not addiction. It is a medical condition caused by the prescription, and the way out of it is a gradual taper.

Acupuncture is the placing of very thin needles through the skin at chosen points on the body, a practice that comes from traditional Chinese medicine. The traditional explanation, a flow of energy called qi, is the tradition’s own account and not established physiology. A person does not have to accept it to find a session calming.

So, what can acupuncture reasonably be expected to do during a taper, and what can it not do?

Why do people who are tapering look for acupuncture?

Benzodiazepines relax muscles, among their other effects. In Chapter III of the Ashton Manual, Professor C. Heather Ashton explained that coming off of them after long-term use brings a rebound increase in muscle tension, with stiffness and pain in the limbs, back, neck, and jaw. The twitches, jerks, and spasms of withdrawal come along with it, because the nerves to the muscles are overexcitable as well.

Sleep and anxiety wear patients down as well. Often, the anxiety of a taper is not the original anxiety coming back. It is a withdrawal symptom, produced by a nervous system that has lost part of its calming signal.

Then, there is the matter of trust. Many patients were assured that the medication was safe to take for years, and they are understandably wary of another prescription to cover the symptoms of the first one. A needle that puts nothing into the body looks like the gentler choice, and wanting that is reasonable.

What does the Ashton Manual say about acupuncture?

Professor Ashton mentioned acupuncture more than once, and she was candid about it. In Chapter II, she wrote that some people find techniques such as aromatherapy, acupuncture, or yoga helpful, but that these “probably act only as an aid to relaxation.”

In Chapter III, she listed acupuncture among the complementary techniques for anxiety, and wrote that all of them “can help with relaxation during the procedure but the effects tend to be short-lived.” She then described her own clinic. Patients who had a course of 12 sessions, with an acupuncturist trained in both Chinese and Western acupuncture, enjoyed the sessions and felt relaxed by them. Yet, they did no better in the long run than patients who did not have acupuncture.

That is one physician’s observation of her own patients, and there is not much more to go on. The evidence for acupuncture in people who are coming off of a benzodiazepine is limited, and there is no good reason to expect that it changes how a taper turns out.

Does that make it worthless? No. A calm hour counts for something during a taper that lasts months. It is comfort, and it should be judged as comfort.

What do patients report after a session?

Reports vary. Some patients describe looser shoulders and a quieter jaw for the rest of the day, less of the keyed-up restlessness, and an easier time falling asleep that night. The relief is usually brief.

Other patients notice nothing at all. And, some find a session hard to tolerate during a rough stretch, because a nervous system in withdrawal can be sensitive to touch, to an unfamiliar room, and to lying still with nothing to do but notice symptoms. Nobody can predict the response in advance.

While it is not a perfect comparison, acupuncture during a taper is closer to a hot bath than to a medicine. Professor Ashton listed hot baths, stretching, massage, and relaxation exercises among the measures that ease the muscle symptoms. She noted that they may give only temporary relief at first, though regular practice can speed the return of normal muscle tone. Still, nobody would call the bath the treatment.

Acupuncture is not an alternative to a slow taper.

Pages that sell acupuncture as a natural alternative to a medically supervised taper have it backward. There is one safe way off of a benzodiazepine, and that is to reduce the medication itself, gradually. Needles cannot stand in for a dose that the nervous system has adapted to.

When the United States Food and Drug Administration (FDA) updated the boxed warning on benzodiazepines in 2020, it warned that stopping abruptly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. Call emergency services for a seizure or any other medical emergency.

Fortunately, a slow taper works. Chapter II of the Ashton Manual describes reductions of up to one tenth of the dose at each step, with the patient in control of the pace, and, where it helps, a crossover taper to diazepam (Valium), a long-acting benzodiazepine. The Maudsley Deprescribing Guidelines add that the reductions get smaller as the dose gets lower, a pattern known as hyperbolic tapering. That takes months, sometimes longer.

So, when symptoms are bad enough that a person is searching for relief, the first question is about the taper. Was the last reduction too large? Did it come too soon? Often, the answer is a hold at the current dose or a smaller next step, and the doctor must be willing to slow down.

What should the acupuncturist and the prescriber know?

The acupuncturist should hear about the taper before the first needle goes in. That means the medication, the slow reduction in dose, and a nervous system that is more sensitive than usual. It is reasonable to ask for a gentle first session, and to stop anything that makes symptoms worse.

For most people, acupuncture from a licensed practitioner who uses sterile, single-use needles is low risk. The products offered with the needles are a different matter. Many acupuncturists also offer herbal formulas, teas, or supplements, and, unfortunately, an herb is not a needle.

Herbs are pharmacologically active, some are sedating, and some may act on the same gamma-aminobutyric acid (GABA) system that benzodiazepines act on. Supplement decisions during a taper are made per patient, with a physician who understands the pharmacology. So, herbal support during a taper is a question for the prescriber before the first cup or capsule, not after.

The acupuncture itself is worth mentioning to the prescriber too. If sessions begin in the same week as a dose reduction, nobody can tell which one produced the good week or the bad one. And, an acupuncturist is not the person to decide the dose. One relaxed afternoon is no reason to make a larger cut or to skip a dose.

What about acupuncture for everyday anxiety and stress?

The same answer holds outside of a taper. Many people find a session relaxing, and for ordinary stress that may be all they ask of it. The evidence that acupuncture treats an anxiety condition is limited, and it is hard to test, because half an hour of lying still in a quiet room tends to calm almost anyone, whatever the needles are doing.

Can acupuncture take the place of a benzodiazepine that was prescribed for anxiety? No. It may make the days easier for some people, but it does not replace the medication. For a person who decides to come off, the way off is still a gradual taper.

Someone who has not yet started a benzodiazepine for anxiety is owed a full conversation first. Informed consent means the risks first, including physical dependence and withdrawal, then the alternatives, including no medication at all, and a plan for how the medication would eventually be stopped. The person keeps the right to decline.

What else do patients ask about acupuncture during a taper?

Is it safe to have acupuncture while taking Xanax, Klonopin, or Ativan?

There is no known interaction between acupuncture needles and alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), or any other benzodiazepine. Some people feel drowsy or lightheaded after a session, and these medications already slow reaction time, so it makes sense to see how the first session feels before planning to drive home.

How many sessions does it take to know whether acupuncture helps?

There is no established number. In Professor Ashton’s clinic the course was 12 sessions, and the benefit was relaxation at the time, not a better outcome later. If several sessions bring nothing, or bring worse symptoms, there is no reason to continue.

The taper is the treatment, and acupuncture is optional comfort.

Withdrawal symptoms ease with time and with a taper that is slow enough. Acupuncture, like a hot bath or a walk, can make some of the days in between easier for some people. It never takes the place of the taper.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida. The practice’s primary service is medically supervised benzodiazepine and z-drug tapering for patients in Florida, with a plan built around one person and a pace the patient directs. Whether to try acupuncture is the patient’s decision, and it becomes part of the taper conversation, like anything else added along the way. Contact the office to ask about a slow, supervised taper in Florida.

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.