Does Meditation Help With Benzodiazepine Withdrawal Symptoms? How to Start Small and When to Set It Aside

Does meditation help with benzodiazepine withdrawal symptoms?

Meditation helps some people with a few of the symptoms of benzodiazepine withdrawal. It can quiet a keyed-up nervous system for a while, make it a little easier to fall asleep, and loosen tight muscles. It does not treat withdrawal, and there is no reason to think it shortens it.

What keeps withdrawal manageable is the pace of the taper. A gradual dose reduction, directed by the patient and supervised by a physician, gives the nervous system time to adapt at each step. A person may add meditation to that plan or leave it out, and the plan stays the same.

Unfortunately, much of what is written about meditation and withdrawal is borrowed from addiction programs, as if the reader were fighting the pull of a drug. That does not describe a person who took alprazolam (Xanax), clonazepam (Klonopin), or lorazepam (Ativan) exactly as prescribed. Physical dependence is not addiction.

In fact, there is no pull to fight. There is a nervous system that adapted to a medication, and it needs time to adapt back. So, what can a few quiet minutes do for it?

What can meditation realistically help with during a taper?

Benzodiazepines strengthen the action of gamma-aminobutyric acid (GABA), which Professor C. Heather Ashton described in Chapter I of the Ashton Manual as, in some ways, the body’s natural tranquilizer. Over time the brain compensates, and its GABA receptors become less responsive. Each time the dose comes down, the calming system is outmatched for a while.

The result is hyperarousal. The heart pounds, the muscles brace, ordinary sounds seem too loud, and sleep will not come. Meditation works at the edges of that state, and it tends to help with three things: the on-alert feeling, the long wait to fall asleep, and the tension carried in the neck, jaw, and shoulders.

Professor Ashton included meditation in Chapter III of the Manual, in her list of non-drug techniques for anxiety. She was careful about it. She wrote that certain individuals respond very well to yoga and meditation, that not everyone is able to give these techniques the concentration they require, and that different approaches suit different people.

The evidence is limited. There is little formal testing of meditation in people who are tapering off of a benzodiazepine, so what follows is clinical experience, and experience varies. Some patients describe a few quiet minutes as the best part of the day, and others find that it does nothing for them.

Start with two to five minutes.

Much of the advice written for beginners assumes a settled nervous system and asks for twenty minutes or more. A person in withdrawal does not have that kind of concentration to spare, and a long session leaves too much time alone with the symptoms. Two to five minutes is enough.

Meditation during a taper is like stretching a pulled muscle. A gentle stretch that stops short of pain helps the muscle loosen, and forcing the stretch sets it back. So, the rule is to stop short of pain.

In practice, that means one short session a day, in a chair or lying down. The eyes may stay open and rest on a spot on the floor. The mind will wander within seconds.

That is not failure. Noticing that the mind has wandered, and bringing it back, is the whole exercise. If a week of short sessions feels good, the time can grow by a minute or two, and if it does not, the time can shrink.

Breath counting, a body scan, and a slow walk are enough to begin with.

Breath counting is the simplest of the three. The person breathes slowly and low in the belly, without strain, and silently counts each breath out from one to ten, then begins again at one. When the count is lost, which happens to everyone, it starts over. The articles on mindful breathing during a slow taper and on how mindfulness helps during a taper at home go into more detail.

A body scan is the practice best suited to muscle tension. After a few slow breaths, the attention moves through the body from the top of the head to the toes, pausing at each region. The task is to notice tightness, warmth, or tingling without calling it good or bad, and to let a tense area soften on the next breath out. Of course, withdrawal fills the body with odd sensations, and any region that is unpleasant to look at closely can be skipped.

Walking meditation is the same attention with the eyes open and the body moving. The person walks slowly across a room or along a quiet path, feels each foot meet the ground, and turns around at the end. It is the best choice on a restless day, when sitting still feels impossible.

What about meditation at bedtime, when sleep will not come?

A body scan can be done in bed with the lights off. Some people prefer guided imagery, at bedtime or during a spike of anxiety, in which the mind builds a peaceful place in detail: how it looks, what can be heard there, and how the air feels on the skin. Professor Ashton listed it in Chapter III as well, and noted that relaxation recordings can be used at home.

None of this cures withdrawal insomnia. Sleep often gets worse during a taper for reasons that no technique can reach, as the article on why insomnia gets worse during a benzodiazepine taper explains. Yet, Chapter III is reassuring on this point: the need for sleep is so strong that normal sleep eventually reasserts itself.

The goal at bedtime is smaller. It is a body that is a little less braced, and a mind with something neutral to do while it waits.

What if closing the eyes and sitting still makes the symptoms worse?

This happens often enough to plan for. During the hardest stretches of withdrawal, sitting still with the eyes closed can turn the attention toward a pounding heart, ringing ears, or burning skin, and the symptoms can seem louder. A session that was meant to calm can end in panic.

People with derealization or depersonalization need particular care. These are the feelings that the world is unreal, or that a person is detached from their own body, and Chapter III describes them as withdrawal symptoms that resolve in time. Turning inward in silence can deepen the strangeness, and there is a separate article on why withdrawal can make a person feel unreal.

Fortunately, the fix is simple. The session can be shortened, the eyes can stay open, or the practice can switch to movement. A slow walk keeps the attention on the outside world, and so does a grounding exercise, such as naming five things in sight, four within reach, three sounds, two smells, and one taste.

Stopping altogether is also a reasonable answer. A person who cannot meditate during a taper has not failed at anything, and the practice can wait for a calmer month or be left alone for good. It is still worth mentioning to the prescribing physician, who may want to look at the pace of the taper.

Meditation is never a reason to speed up a taper.

A few calm weeks can tempt a person to take bigger steps. The calm is welcome. However, GABA receptors adapt on their own schedule, and there is no reason to think that a practice that eases symptoms makes them adapt any faster.

Unfortunately, the opposite mistake also happens. Patients are sometimes told to breathe or meditate their way through symptoms that come from reductions that are too large or too fast. Symptoms that break through are information about the pace, and the answer is a smaller step or a longer hold, agreed with the prescribing physician.

Chapter II of the Ashton Manual suggests reductions of up to one tenth of the dose at each step, and it says the person tapering must be in control of the pace. The Maudsley Deprescribing Guidelines describe hyperbolic tapering, in which the steps get smaller as the dose gets lower. Where it helps, a crossover taper to diazepam (Valium), a long-acting benzodiazepine, allows a smoother fall in drug levels.

Most tapers take months, and some take longer. The United States Food and Drug Administration (FDA) warned in its 2020 update to the benzodiazepine boxed warning that stopping abruptly, or reducing the dose too quickly, can cause withdrawal reactions, including seizures. For a seizure or any other medical emergency, call 911.

What is meditation for, then?

With time, and with a taper that is slow enough, the nervous system settles. Meditation does not make that happen. For some people it makes the waiting a little easier, and that is all it has to do.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, and his practice provides medically supervised benzodiazepine and z-drug tapering for patients in Florida. He works from the Ashton Manual and the Maudsley Deprescribing Guidelines, and the pace of each taper is set together with the patient.

Meditation is the patient’s own tool, to pick up or put down, and a taper in Dr. Leeds’ practice does not depend on it. Contact the office to ask about a slow, medically 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.