Do Yoga, Breathing, and Gentle Movement Help During a Benzodiazepine Taper?

Does yoga help with benzodiazepine withdrawal?

It can, in a modest way. Gentle yoga, slow breathing, muscle relaxation, and meditation can take some of the edge off anxiety, tight muscles, and poor sleep while a dose is coming down. However, they do not treat withdrawal itself.

What manages withdrawal is the taper. A gradual, physician-directed reduction, taken at a pace the patient can tolerate, gives the nervous system time to adjust. Yoga helps a person cope alongside that taper, and it never stands in for it.

Unfortunately, much of what is written about yoga and benzodiazepines was written for addiction treatment, and it does not describe most people who take these medications. A person who took a benzodiazepine as prescribed, and who now feels unwell when the dose drops, is not misusing a drug. That is physical dependence. Dependence is not addiction.

In fact, the United States Food and Drug Administration (FDA) noted in its 2020 boxed-warning update that physical dependence can occur after several days to weeks of steady use, even as prescribed. What the condition is called matters, because the wrong name sends a person toward the wrong kind of care.

Why do anxiety, muscle tension, and insomnia flare when the dose comes down?

Benzodiazepines strengthen the effect of gamma-aminobutyric acid (GABA), the brain’s main calming signal. That is why they quiet anxiety, relax muscles, and bring on sleep. With steady use, the nervous system adapts to having the medication on board.

When the dose is lowered, the calming signal is weaker than the nervous system has come to expect. The symptoms the medication once covered can rebound, often stronger than before. The brain does readjust, but it needs time.

This is why nobody should stop a benzodiazepine abruptly. The FDA warns that stopping suddenly or reducing the dose too quickly can cause withdrawal reactions, including seizures, which can be life-threatening. A seizure or any other medical emergency is a reason to call 911 or go to the nearest emergency room.

Fortunately, a gradual taper lowers that risk. A taper takes months, and sometimes longer.

Chapter III of the Ashton Manual also describes a minority of people whose symptoms continue for months or even years after the last dose before fading. Anything safe that makes that time more livable has value.

What does the Ashton Manual say about yoga, breathing, and exercise?

Professor C. Heather Ashton addresses the question in Chapter III of the Ashton Manual, in her section on anxiety, panics, and phobias. There, she lists progressive muscular relaxation, which she notes reduces muscle tension and anxiety, and diaphragmatic breathing, because many anxious people hyperventilate. She lists yoga and meditation as well, next to walking, swimming, and any other activity a person enjoys.

Professor Ashton adds that none of these measures is essential for everybody, and that the choice of them, and the response to them, depends very much on the individual. Later in the chapter, in her advice for people with long-lasting symptoms, she writes, “Physical exercise improves the circulation and function of both brain and body.” Her instruction is to find an enjoyable exercise, start at a low level, and work up gradually.

That is where the solid ground ends. Evidence for yoga in benzodiazepine withdrawal specifically is limited, and what follows is practical experience, which varies from person to person.

Which yoga poses are gentle enough during a taper?

The poses that tend to suit a sensitive nervous system are slow, supported, and close to the floor. Seated forward folds, child’s pose, legs-up-the-wall pose, and savasana, the resting pose on the back, ask for no strength and no balance. Each can be held for a few slow breaths or a few minutes, with a pillow or folded blanket for support.

For muscle symptoms, the Ashton Manual lists muscle stretching, moderate exercise, hot baths, and general relaxation exercises among the measures that help. Savasana is also a natural place for progressive muscular relaxation, which means tensing and then releasing one muscle group at a time.

The rule for every pose is the same. Modify or rest as needed. Dizziness, weakness, and unsteadiness are common during a taper, so a person may skip standing balances, come up from the floor slowly, and end a session early without counting it as a failure.

How are diaphragmatic and paced breathing done?

Diaphragmatic breathing means breathing low, so that the belly rises on the way in and falls on the way out while the chest and shoulders stay quiet. Paced breathing adds a slow, even rhythm, often with the breath out a little longer than the breath in. Neither involves forcing the breath or holding it.

For a panic attack, the Ashton Manual passes along the advice to take much slower and deeper breaths that bring air deep into the lungs and not just the top of the chest. Professor Ashton describes controlling panic as a skill that improves with practice. So, the time to practice is a calm hour, not the middle of a wave of symptoms.

A few minutes once or twice a day builds the habit, and meditation can be as simple as sitting quietly and returning attention to the breath. There is more in the article on mindful breathing during a slow taper.

Start gently, because some people in withdrawal find intense classes over-stimulating.

Of course, not everything sold as yoga or breathwork is gentle. Some people in withdrawal report that fast or forceful breathing, long breath holds, heated rooms, and vigorous flow classes leave them more stirred up, not less. Others find that effort they once handled easily now brings a flare of symptoms later that day or the next.

This does not happen to everyone. Yet, it is a good reason to begin with less than seems necessary, see how the next day goes, and build from there. A teacher who is told about the taper, and who is comfortable with a person sitting out part of a class, makes that easier.

The same caution applies to exercise during a benzodiazepine taper in general. A short, easy practice on most days tends to serve better than one long class a week. On a bad day, a slow walk outdoors still counts.

What about tai chi and qigong?

Tai chi and qigong are slower still. Both are usually done standing, with soft, flowing movements timed to the breath, and neither requires getting down to the floor and back up. Both can also be done seated, or beside a sturdy chair, on an unsteady day.

For a person who finds even restorative yoga too much, or who gets dizzy when changing position, they are a reasonable alternative. The Ashton Manual does not name either practice, and the evidence for them in benzodiazepine withdrawal is as limited as it is for yoga. They do fit Professor Ashton’s broader advice to choose something active and enjoyable and to keep it up regularly.

Yoga supports a taper. It does not replace one.

A slow taper is like a long staircase, and each dose reduction is one step down. Yoga and breathing are the handrail. A handrail makes each step steadier, but it does not carry anyone down the stairs, and it is no reason to take them two at a time.

Chapter II of the Ashton Manual describes gradual reductions at a pace the patient controls, and the Maudsley Deprescribing Guidelines describe reductions that get smaller as the dose gets lower. While feeling calmer after a few weeks of practice is welcome, the pace of the taper remains a decision between the patient and the prescribing physician.

Dr. Mark Leeds is an osteopathic physician and deprescribing specialist in Fort Lauderdale, Florida, and his practice offers medically supervised benzodiazepine and z-drug tapering for patients in Florida. Each taper is gradual, built for one person, and directed by the patient, and comfort measures such as yoga remain the patient’s own choice. Contact the office to ask about a medically supervised taper.

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.