Why Does Benzodiazepine Withdrawal Make a Person Feel Unreal? Depersonalization, Derealization, and the Slow Taper

Feeling unreal during a benzodiazepine taper is a recognized withdrawal symptom.

Feeling unreal is one of the more frightening things that can happen during a benzodiazepine taper. A person looks at their own hands and they seem to belong to someone else, or the kitchen looks flat and staged. Time stretches or skips, and a familiar street looks strange.

Doctors call these two experiences depersonalization and derealization. Depersonalization is the sense of being detached from one’s own body, thoughts, or feelings, as if watching oneself from a few feet away. Derealization is the sense that the world outside is unreal, dreamlike, or seen through glass.

Together they are called dissociation, or feelings of unreality, and they are recognized benzodiazepine withdrawal symptoms. The Ashton Manual, written by Professor C. Heather Ashton, lists “depersonalisation, derealisation” in Chapter III, Table 1, among the psychological symptoms of withdrawal, beside perceptual distortions.

The feeling of unreality is the nervous system readjusting, not a new illness.

Benzodiazepines work by amplifying gamma-aminobutyric acid (GABA), the brain’s main calming messenger. GABA tells neurons to slow down or stop firing, and Chapter I of the Ashton Manual calls it the body’s natural tranquilizer. A benzodiazepine turns that quieting signal up.

Over months or years of regular use, the brain adjusts. Chapter I explains that the GABA receptors become less responsive, so the drug is propping up a system that has partly stood down. When the dose falls faster than the receptors can recover, the brain is left short of GABA and overexcitable, which Chapter II names as the root cause of most withdrawal symptoms.

The same GABA system helps filter sensation. When that filter thins, light is too bright, sound is too sharp, and the mind can step back from the flood. Professor Ashton described depersonalization as probably a normal defensive reaction against intolerable suffering.

So, the feeling of unreality is a withdrawal phenomenon, not psychosis and not a new psychiatric diagnosis. A person in withdrawal knows the feeling is a feeling. The Manual is plain: these feelings resolve in time and are not a sign that anything is wrong with the person.

Prescribed dependence is a medical condition, and the wrong label leads to the wrong treatment.

Much of the internet calls benzodiazepines highly addictive and describes withdrawal as overcoming addiction. That framing is wrong for most people who feel unreal during a taper, who took the medication as prescribed for as long as the prescriber kept renewing it.

Physical dependence is not addiction. Dependence means the body has adapted to a drug’s presence and reacts when the drug is reduced, and it can happen to anyone who takes a benzodiazepine regularly for long enough. Addiction is compulsive use despite harm, a different problem with a different treatment.

The 2020 boxed-warning update from the United States Food and Drug Administration (FDA) put the point on the label itself. Physical dependence can develop within days to weeks of regular use, even at prescribed doses, and stopping abruptly or reducing too quickly can bring on withdrawal reactions, including seizures, that can be life-threatening. The label calls for a gradual taper.

That is why an addiction-treatment setting is the wrong tool for a person whose only problem is dependence. The answer is a slow taper, not a curriculum.

Symptoms that come and go are the expected course, not a sign that the taper failed.

Withdrawal symptoms do not fade in a straight line. Chapter III of the Ashton Manual, in its section on the course of withdrawal, says symptoms characteristically wax and wane, varying in severity and type from day to day. Patients call this windows and waves.

A common pattern is a good stretch of days when the world looks solid again, then a morning when the room goes flat and the fear returns that nothing has changed. The Manual describes exactly this: windows of normality that appear after some weeks, then become more frequent and last longer, while the discomfort between them ebbs away.

Is it permanent? In most cases it is not, though after months of the feeling coming and going it can seem that way. Nobody can honestly promise a date. Yet, under a slow taper, the direction of travel is toward longer windows and shorter waves.

Stopping too fast makes the unreality worse, and stopping abruptly is never the answer.

Many descriptions of withdrawal say it starts within hours to days of the last dose and peaks within the first week. That is the timeline of abrupt cessation. Under a slow taper there is no last-dose cliff and no first-week peak, because the dose never drops far enough at once to produce one.

Professor Ashton wrote that people who develop severe symptoms have usually come off the drugs too rapidly. Chapter III notes that rapid withdrawal, especially from high-potency benzodiazepines, can precipitate seizures, and that psychotic reactions hardly ever occur with slow tapering. Anyone who has a seizure, or any other medical emergency, needs emergency services called at once.

There is a particular temptation for the person who feels unreal: to speed up the taper and get it over with. Unfortunately, the faster reduction deepens the very symptom it is trying to escape. A spike in derealization is a reason to slow down, never a reason to jump.

How does a medically supervised taper handle a spike in depersonalization?

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, and his practice does one thing: medically supervised benzodiazepine and z-drug tapering, over months and sometimes longer. The shape follows Chapter II of the Ashton Manual: each reduction is small, up to about one tenth of the current dose, and each is followed by enough time for the nervous system to settle.

The pace belongs to the patient. When depersonalization spikes, the taper holds at the current dose until the wave passes, which the Manual explicitly allows. The Manual advises against going back up in dose, but standing still costs nothing.

Where it helps, Dr. Leeds uses the Manual’s crossover taper to diazepam. Chapter II explains why: diazepam is eliminated slowly, so its blood level falls smoothly, while a short-acting drug produces peaks and troughs that a sensitive brain reads as small withdrawals. Unreality that arrives between doses is often that trough.

As the dose gets low, the steps get smaller still. The Maudsley Deprescribing Guidelines describe hyperbolic dose reductions, each step a fraction of what remains rather than a fixed amount, because the last portion of the dose does a disproportionate share of the work at the receptor. The final stretch is the slowest, not the fastest.

Consider walking out of a dark theater at noon. Throw open the exit door and the street looks bleached and flat, almost unreal, until the eyes catch up. A slow taper walks the brain out through the lobby, one dim room at a time, so the world never has to look that way.

Grounding and daily routine help a person get through a wave, and they support the taper without replacing it.

Grounding means giving the senses something ordinary and solid to hold. A person can name five things they can see, four they can hear, and three they can touch, run cold water over the hands, or press both feet into the floor and say the date out loud. A long, slow exhale tells an overexcited nervous system that nothing is chasing it.

The same wake time each day, morning daylight, regular meals, a short walk, less caffeine, and screens off before bed all lower the baseline of excitability. None of this is treatment for withdrawal. It is support for a nervous system that is doing the healing itself, slowly, as the dose comes down.

It also helps to tell one trusted person what the symptom is, so that on a bad morning they can say it back: this is the withdrawal, and it passes. Checking and re-checking whether things are real feeds the feeling, and hearing plainly that it is expected starves it.

When is a symptom an emergency?

A feeling of unreality by itself is expected in withdrawal. Some things are not, and they need care now. Call 911 or go to the nearest emergency department for a seizure, for severe confusion, for hallucinations the person cannot tell from reality, for chest pain or trouble breathing, or for any thought of ending one’s life.

Anyone having thoughts of suicide can call or text 988, the 988 Suicide and Crisis Lifeline, at any hour. Those thoughts can appear during withdrawal, and they are never a reason for shame. Emergency care is never the wrong choice when a person is unsure.

Dr. Leeds’ practice tapers at the patient’s pace.

Dr. Leeds’ practice offers medically supervised tapering from benzodiazepines and from z-drugs, the related sleep medications, as a concierge practice for patients in Florida, with one physician who works directly with each patient. Informed consent comes first: the risks, the alternatives, an exit plan from the start, and the right to slow down, hold, or decline at any point. A person who feels unreal during a taper is living through a known symptom that a slower taper can soften. Contact Dr. Leeds to talk about a taper built around that fact.

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.