Ambien is a member of a group of drugs known as non-benzodiazepine hypnotics along with several other newer sleep aids. While these medications produce effects somewhat similar to those of benzodiazepines (benzos), they are chemically unrelated. The benzo class includes medications like Xanax, Klonopin, and Valium, and while they may produce roughly similar effects as Ambien, they are distinct classes of drugs. Also known as “Z-drugs” Ambien and similar sleep aids work by increasing the effect of the neurotransmitter GABA which is a major inhibitory neurotransmitter in the brain.
The way Ambien works is similar to classic benzos in that it stimulates the GABAA receptors at ω subunits. These have also been referred to as “benzodiazepine receptors” as this is a part of the mechanism through which benzodiazepines exert their effects. Ambien, while binding to these receptors similar to benzodiazepines, is very selective in its binding and preferentially binds to ω-1 and ω-2 receptors. This leads to a similar effect of sedation but results in a distinct pharmacologic profile. For example, while benzos are potent anticonvulsants all across their dosing range, Ambien only exhibits anticonvulsive and muscle relaxant activity at extremely high doses. 1, 2, 3, 4, 5, 6
When someone takes Ambien repeatedly, tolerance to its sedative effects on cognition can develop through a process known as downregulation. Due to the increased impact of GABA due to Ambien use, after a time, the brain will begin to reduce its sensitivity to GABA in an attempt to compensate and maintain balance and effective function. This initially produces tolerance to the drug, and continued use will result in dependence. Additionally, once downregulation has begun, a further, more comprehensive process of neurological remodeling begins. This is the brain’s attempt to better function in a GABA-downregulated environment. While downregulation can begin fairly soon and produce tolerance, sometimes as soon as just a few weeks of use, the remodeling process is much slower and will take time to produce noticeable effects. 7, 8, 9
When taken as prescribed, Ambien rarely produces withdrawal symptoms even after prolonged use. That being the case, those who abuse Ambien often need to take substantially more than therapeutic doses to produce euphoria. It has been documented that several people who abused Ambien were taking between 100-120 times the prescribed dose per day. In these amounts, Ambien is capable of producing withdrawal symptoms, possibly of life-threatening severity.
Once downregulation has begun, someone will begin experiencing symptoms of Ambien withdrawal when they go for too long without using the drug. GABA is a major inhibitory and calming neurotransmitter, and if it is less effective, then the brain and body have a reduced ability to calm and slow themselves. Since the brain has reduced its sensitivity to GABA, and the increase in GABA impact is no longer provided by Ambien, the brain and body will exhibit hyperactive symptoms, sometimes to a dangerous degree.
The symptoms of Ambien withdrawal can be divided into two distinct phases: acute and post-acute. The acute phase is the time immediately after someone stops using Ambien and may last for days or weeks at most. The post-acute phase is much longer-lasting, although much less intense and may last for weeks, months, or sometimes even years after the last Ambien use. These timelines can exhibit some variability between people, and we will discuss this more a little later.
Some of the immediate symptoms of Ambien withdrawal include:
Dangerous symptoms do not usually occur in moderate users, however, the risks rise dramatically as the amount of Ambien regularly used increases. Seizures are very rare in light-to-moderate users but in those who used large amounts of Ambien, or used for long periods, the risk of seizure becomes appreciable. In general, the acute phase of withdrawal exhibits both physical and psychological symptoms and these will be at their most severe in the days or weeks shortly after Ambien use has ceased.
Even after the acute and most intense symptoms subside, the post-acute phase can exhibit more minor symptoms that may persist for weeks, months, or even years. These symptoms are strictly psychological, but may still be very disruptive and mentally uncomfortable. It should be mentioned that severe depression can lead to suicidal ideation or suicide attempt, and this can obviously produce physical problems even though the causes are psychological.
Some of the post-acute symptoms of Ambien withdrawal include:
Again, while these symptoms may not be as intense as in the acute phase, they may still be very disruptive to someone’s continued sobriety. The persistence of these symptoms and their slow resolution can be very demoralizing, but they will fade with time. Obtaining professional psychiatric and therapeutic care during this period can go a long way towards improving the subjective experience of these symptoms, and helping someone cope with their effects. While these treatments may improve the symptoms, the only way to be certain that these symptoms will improve is through continued abstinence from Ambien and other drugs.
The timeline for Ambien withdrawal has not been well described due to the relative rarity of Ambien addiction. That being said, there are case reports in the medical literature that can help us describe this timeline in detail. Additionally, with classic benzos, there is substantial variability in the withdrawal timeline between individuals, and since Ambien works in a roughly similar way, this variability may also apply to the Ambien withdrawal timeline.
The active ingredient in Ambien, zolpidem, has quite a short half-life of around 2.5 hours and is metabolized rapidly. While there are many contributing factors that affect the withdrawal timeline, Ambien’s half-life may be contrasted to the classic benzo half-lives of 11 hours (Xanax), 13 Hours (Ativan), and ~35 hours (Klonopin). This indicates a shorter withdrawal period than with the classic benzos, although this may not translate due to the differences between Z-drugs and benzos regarding their specific neurological interactions. Due to the lack of well studied and documented Ambien withdrawal timelines, what follows is a generalization based on case reports. 10, 11, 12, 13
A broad generalization of the week-by-week Ambien withdrawal timeline may look something like this:
Due to its short half-life, someone who was a regular and heavy user will begin to experience Ambien withdrawal symptoms within 8 hours of the last drug use. The first symptoms to emerge are most likely anxiety, heavy sweating regardless of ambient temperature, and irritability. The first night of abstinence should exhibit severe insomnia, stomach cramps, and irritability. These symptoms will intensify over the next few days and may be joined by nausea, vomiting, and tremors. Within days of the last use, tremors, myoclonic muscle spasms, muscle aches, and hallucinations may be present. Additionally, the risk of seizure will be highest during the first week.
The beginning of the second week may still exhibit physical symptoms, but they are often reduced substantially. By the middle of the second week, most of the physical symptoms may be resolved, with the exception of insomnia, sweating, stomach issues, and possibly headaches. While the physical symptoms may be resolving, the psychological symptoms may become more noticeable. Even though depression, anxiety, cravings, and irritability may have been present all the while, the physical symptoms can often distract from the psychological ones. Anxiety may see some slight decrease throughout the second week, but these psychological symptoms are often still present at a fairly high level.
By the start of the third week, the physical symptoms are often fully resolved. Insomnia may still be present, but it is usually much improved from the previous weeks. Cravings may actually begin to intensify during this time and as the memory of the discomfort of withdrawal begins to fade, the desire to use Ambien again may be heightened. Depression and anxiety are usually still at a high level, and social anxiety may be especially pronounced. This specific type of anxiety is usually present from the beginning, although it may not be until someone feels well enough to go out that they notice this symptom.
The fourth week should show some significant improvement from the first week. While psychological symptoms are often still disruptive, the physical symptoms, including insomnia, are much improved if not resolved completely. Even though the most physically difficult and uncomfortable stage is in the past, this does not mean that the struggle is over. Most relapses happen either during or shortly after acute withdrawal, and if someone hopes to stay clean, they will have a much better chance if they get further treatment and care.
Even though Ambien withdrawal symptoms are not usually dangerous, the relative rarity of this withdrawal syndrome leads to a lot of unknowns regarding the exact risks involved. Due to this, if someone is expecting to undergo Ambien withdrawal, it is highly recommended that they enter an Ambien detox center. These programs can reduce the risks of dangerous health complications through medical monitoring and medications. Furthermore, they can reduce the psychological discomfort through therapies while also helping someone develop new, healthier coping skills. Finally, the various connections that these facilities have with their local recovery communities can help someone build a solid foundation in recovery and form friendships with others who have been through the same struggle and made it out the other side.Ambien Detox Centers
Being similar to benzos in their effect on the brain and body through use, the physical effects of Ambien withdrawal are roughly similar to withdrawal from benzos. This includes general hyperactivity and includes gastrointestinal distress and motor control. The role of GABA in the brain and body is multifaceted and influences a variety of systems. The specific way that Ambien interacts with the GABA system results in downregulation to this system which can cause many physical effects once someone suddenly stops using the drug.
These issues may be simply uncomfortable in mild-to-moderate users but may be potentially life-threatening in very heavy users. Here, we will do a breakdown of the effects of Ambien withdrawal on different physical systems:
The effects of Ambien withdrawal can exhibit multiple issues with motor control, coordination, and may lead to seizures in high-dose users. Resting tremor, intention tremor, and ataxia are all effects that may be experienced during Ambien withdrawal. The specific GABA receptors that Ambien binds to, the ω-1 and ω-2 subunits, have a large presence in the cerebellum. This part of the brain is a hub for motor function and combining sensory information into a comprehensive picture of the world. Through continued Ambien use and subsequent withdrawal, there may be severe motor function issues as well as perceptual distortions during Ambien withdrawal.
Even though Ambien does not strongly affect seizures directly, the neurotransmitter GABA has a profound and critical impact on the seizure threshold; the limit for which neurological activity will result in a seizure. Due to GABA downregulation, the seizure threshold is lowered which results in a greatly increased likelihood of suffering a seizure. Additionally, seizures due to Ambien withdrawal may progress to a certain seizure state known as status epilepticus. While very rare, this is still possible. This is extremely dangerous and is considered a medical emergency by healthcare workers as it can lead to brain damage or death. Aside from the primary risk of seizures, there are also complications that may arise secondary to a seizure. This could include falling down or biting through the tongue that may happen if someone experiences a seizure while standing, or even simply laying in bed. 13, 14, 15, 16
The role of GABA in the gastrointestinal tract is not fully understood, although it is known to play a role in healthy gut function. Its inhibitory effects can help slow and moderate intestinal muscle contractions and promote effective digestion, among many other functions. Aside from this, there is a relationship between GABA function and the perception of abdominal discomfort and pain, although the exact mechanisms and relationship are currently unclear. While the GABA receptors in the gastrointestinal tract are unable to undergo remodeling, they can and do undergo downregulation in the continued presence of Ambien. Due to GABA downregulation, the normal slowing and calming effects it produces are reduced, leading to hyperactive muscle contractions and resulting in diarrhea, nausea, vomiting, and stomach cramps. These are very common effects of Ambien withdrawal, and they may persist for several weeks after the last use. 17, 18, 19, 20
While the physical effects pose a direct and potentially fatal risk, the psychological effects of Ambien withdrawal can be just as dangerous. The dangers posed by these symptoms are more indirect and subjective, but they are nevertheless a very real challenge. The disruptions to GABA systems in the brain can lead to hyperactive psychological effects coupled with greatly lowered energy levels. This can lead someone to a dark place of despair, and help is highly recommended to make it through this difficult time while the brain attempts to heal itself.
Probably one of the most common psychological effects of Ambien withdrawal, anxiety arises both from GABA downregulation and the remodeling that occurs alongside downregulation. The reduced impact of GABA reduces the brain’s ability to slow itself down in the absence of Ambien, and the remodeling that occurs will result in elevated baseline anxiety, sometimes for very long periods after Ambien use ceases. This can manifest as heightened general anxiety, and commonly exhibits increased social anxiety as well. While often going unnoticed during early Ambien withdrawal due to the common tendency for people to isolate during the most severe physical symptoms, increased social anxiety may only become apparent after someone tries to go out around other people.
Aside from the neurological component, there is a behavioral aspect to consider as well. Ambien use can become a powerful coping mechanism to deal with the stresses of life. While powerful, it is also extremely unhealthy to cope with stress and problems through substance use, but this can frequently become a vicious cycle. Once this powerful coping mechanism is suddenly removed, it is common for someone to feel scared and anxious. When these neurological and behavioral sources combine, the levels of anxiety someone experiences can be increased greatly. 21, 22, 23
Another very common psychological effect of Ambien withdrawal is the emergence of depression. This, like anxiety, can have both neurological and behavioral causes and may present the greatest direct risk out of all of the psychological symptoms. Thoughts of suicide and, more rarely, suicide attempts have been documented during withdrawal and this is an extremely serious danger.
From a neurological perspective, GABA has a strong correlation to the manifestation of symptoms of depression. Those suffering from major depressive disorder consistently have lower levels of GABA in certain areas of their brain. While Ambien withdrawal doesn’t lower GABA levels, it reduces the impact GABA has on receptors. Even though these two instances of GABA dysregulation are caused by different mechanisms, the end result is a deficit of GABA signaling in the brain. This may also contribute to anxiety as well, and there is a trend for anxiety and depression to be co-occurring in those suffering from substance use disorders.
Behaviorally, a contributor to depression is similar to that of anxiety in the form of the sudden loss of a powerful coping mechanism. While this loss can contribute to anxiety, it can also result in depressive mental states. Having suddenly lost the thing that made problems “go away” someone can feel overwhelmed, helpless, and hopeless. It can often seem like someone will always feel this way, and that life without Ambien is not worth living. This is definitely not the case, and it will take time for this attitude to lift. Someone can accelerate this process by undertaking behavioral therapies that will help them develop new, healthier coping mechanisms and skills. 24, 25
The symptoms of Ambien withdrawal can vary greatly between individuals, both in intensity and duration. This has to do with multiple factors, some of which are based on choices such as Ambien use habits, while others are genetic and beyond someone’s control. Depending on the person, someone may recover quickly and completely within weeks or months, while others may have severe, lingering symptoms for many months or even years.
Some factors that contribute to both the intensity and duration of Ambien withdrawal symptoms include:
The single largest contributor to the intensity of Ambien withdrawal symptoms is the amount of Ambien someone used regularly. The more that someone uses Ambien, the more GABA downregulation will occur. The more downregulation occurs, the more intense the withdrawal symptoms will be once they stop using the drug. This affects the acute and short-term symptoms of Ambien withdrawal directly and can indirectly impact the post-acute, long-term symptoms as well. The largest contributor to the duration of post-acute withdrawal symptoms is the length of time that someone used Ambien. The neurological remodeling that occurs after downregulation has begun is an exceptionally slow process; both slow to perform and slow to reverse. The longer someone uses Ambien, the more complete this process becomes. When someone stops using Ambien, it can take quite some time for remodeling to reverse and return their brain to return to pre-Ambien function.
Someone’s age has an effect, although the real contributor is liver function. As someone gets older, liver function tends to decline and is a normal part of the aging process. The vast majority of Ambien metabolism occurs in the liver, and impaired liver function can increase the half-life of Ambien, sometimes by a substantial amount. The longer the half-life of the drug, the longer the withdrawal duration will be. At the same time, a long half-life leads to less severe withdrawal symptoms, so while symptoms may persist for longer, they will be less intense. 2, 26, 27
The existence of co-occurring mental health issues can worsen the subjective experience of the symptoms of Ambien withdrawal. Since depression and anxiety are such common symptoms, if someone were to have a pre-existing disorder involving either of these symptoms then they would experience worse depression or anxiety during withdrawal.
Genetics certainly plays a role in addiction, although as it relates to the symptoms of Ambien withdrawal, it is a very indirect influence. Someone with a genetic predisposition for addiction may be more likely to take more Ambien more regularly than someone with no such predisposition. This, in turn, would lead to worse withdrawal symptoms. While very indirect and tangential, the influence may still be present.
The symptoms of Ambien withdrawal are often unpleasant, but there are effective treatments available. Both medications and therapies have been found effective in treating both short-term and long-term symptoms. Medications can help reduce the risks and dangers presented by the physical symptoms, while other medications, behavioral therapies, and counseling can help with the long-term psychological symptoms.
There are currently no FDA approved medications for the treatment of Ambien withdrawal, but this does not mean there are no effective medications. Some of the longer-acting benzodiazepines have been used effectively for the short term relief of severe symptoms and to reduce the risk of seizure. Other medications may be used to treat individual symptoms as they arise.
Some medications that have been used to treat Ambien withdrawal symptoms include:
These are just a few examples of the classes of medications used, and there may be multiple medications available per class. Everyone responds to medications in their own way, so some medications that are effective for some people may not be effective for others. Finding the right medications is an important way to help make it through Ambien withdrawal in the most comfortable way possible. Having the help of medical professionals at an Ambien detox center can accelerate this process and give someone the support, guidance, and care that they need during this difficult time.
Aside from the immediate relief that can be provided by medications, therapeutic techniques can also provide relief and help as well. While the benefits of therapy may take some time to become evident, the benefits are certainly real. These therapeutic techniques can aid in neurological remodeling to help speed the process of undoing the structural changes in the brain that were performed due to downregulation. Helping develop new ways to handle the stresses of life and to build new relationships and friendships with people in recovery can be a massive boost to someone’s chances of successful, long-term recovery.
Some therapies commonly used to treat Ambien withdrawal symptoms include:
Similar to medications, therapies may be more or less effective for different people depending on their specific needs or issues. Finding the right therapeutic approach may take some time, but it can provide substantial benefits over time. Working with the clinical professionals at an Ambien detox center can help someone identify any issues they may be struggling with, and point them in the direction of the most effective therapies for their issue. Additionally, trauma of some form is fairly common among those who have substance abuse issues, so having the support and resources to begin healing from this can be a great help as well.
The benefits of entering an Ambien detox center cannot be overstated. Support, guidance, medical supervision, medications, and connection to further treatment can make the difference between long-term recovery and relapse. Recovery is possible and help is available. The only requirement is the courage to reach out for help and the willingness to receive help.
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