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Xanax Withdrawal Timeline

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 01/24/2021

Number of References: 31 Sources

The symptoms of Xanax withdrawal can be uncomfortable, maybe painful, or sometimes even fatal. This powerful drug can produce a strong physiological addiction and when someone suddenly stops using it, symptoms can include seizures, delirium, and intense anxiety which may last for several weeks. Here, we will take a look at the mechanisms that produce Xanax addiction, the symptoms of Xanax withdrawal, the timeline involved, and some effective treatment options.

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Xanax Withdrawal Symptoms

There are two distinct phases to Xanax withdrawal symptoms; the acute and post-acute phases. The acute phase is the most severe and exhibits both the psychological and physical symptoms and poses the greatest direct risks. For most people, these symptoms are not fatal but in the case of very heavy, or very long-term Xanax users they may be. Particularly of note is the risk of seizure, as injuries can occur from seizures simply by one occurring while someone is standing in place or even laying in bed. Additionally, experiencing a seizure could result in a unique seizure state known as status epilepticus, which is a medical emergency as it can cause brain damage or death. The post-acute phase is longer lived, sometimes substantially, but only manifests psychological symptoms.

Benzodiazepines tend to have a fairly long withdrawal timeline as far as drug withdrawal goes, and Xanax is no exception. While it can vary, sometimes greatly, between different people, it often lasts several weeks at the very least. Xanax has a half-life of ~11 hours in healthy adults. Due to the way Xanax is metabolized, this half-life increases with age, and more specifically with impaired kidney or liver function. Due to this, the half-life of Xanax can increase as does a user’s age, thus extending the withdrawal timeline as someone gets older. This also means, however, that as the half-life increases, the withdrawal symptoms will be less intense.

For the purposes of this article, we will stick to the timeline of a healthy, middle-aged Xanax user. Because of its half-life, symptoms of Xanax withdrawal often begin within 16 to 24 hours of the last use. These symptoms will often begin mild before escalating over the following days to intense levels. These may persist for a week, or several weeks, before starting a slow resolution which may take an additional week or more. All in all, an average Xanax user may expect acute withdrawal symptoms for several weeks to a month. Following the resolution of the physical symptoms, the post-acute symptoms may still persist for months, or sometimes years.

Week 1

Within a day of the last Xanax use, withdrawal symptoms will begin to appear. The first symptoms are usually an increase in anxiety, sweating, and irritability. The first few days often exhibit severe anxiety, known as rebound anxiety, as the anxiolytic effects of Xanax can produce increased sensitivity to anxious states through chronic use. Additionally, the risk of Xanax withdrawal seizure is high during the first few days of withdrawal, and this can present a great danger without medical supervision. Over the next several days, these symptoms will intensify and be joined by insomnia, nausea, diarrhea, elevated blood pressure, increased heart rate, tremors, and cognitive issues such as confusion or clouded thinking. Hyperreflexia may also be present, which is an exaggerated reflex response. Delirium, hallucinations, and psychosis may also manifest after several days, although this is usually only present in those who used large amounts of Xanax. These can often persist for several days but usually resolve during the first week.

Some of the symptoms of Xanax withdrawal that may be experienced during the first week can include:

  • Seizure
  • Tremors (usually resembling muscle jerks or spasms)
  • Hyperreflexia (amplified or exaggerated reflexes)
  • Severe Anxiety
  • Depression
  • Fatigue and Lethargy
  • Intense Cravings for Xanax
  • Headache
  • Increased Sensitivity to Light
  • Increased Irritability or Aggression (sometimes involving homicidal or suicidal ideation)
  • Diaphoresis (constant sweating)
  • Insomnia
  • Nausea and Vomiting
  • Diarrhea
  • Tachycardia (increased heart rate)
  • Hypertension (elevated blood pressure)
  • Cognitive Difficulties (disorganized or clouded thinking)
  • Hallucinations (either auditory, visual, tactile, or a combination)
  • Delirium and Psychosis (rare, but documented; most common in very heavy users)
  • Hypertensive Crisis (severely elevated blood pressure; rare, but documented)

Week 2

The second week is usually quite rough and Xanax withdrawal symptoms usually reach their peak intensity during this time. After the previous week of little food or sleep, and combined with the psychological symptoms, someone is usually in a fragile state of mind. If these symptoms emerged in the first place, delirium and psychosis may begin to resolve early in the second week. Depression may join the roster around this time, and anxiety is often still quite high, but often reduced somewhat. Insomnia is still common, as is gastrointestinal upset, but cardiovascular problems may be lessened by now. Strong cravings for Xanax may appear now if they haven’t already, and cognitive difficulties often persist throughout the second week.

Some symptoms of Xanax withdrawal that may be expected during the second week could include:

  • Seizure
  • Tremors (usually resembling muscle jerks or spasms)
  • Hyperreflexia (amplified or exaggerated reflexes)
  • Severe Anxiety
  • Depression
  • Fatigue and Lethargy
  • Strong Cravings for Xanax
  • Increased Irritability or Aggression (sometimes involving homicidal or suicidal ideation)
  • Diaphoresis (constant sweating)
  • Insomnia
  • Nausea and Vomiting
  • Diarrhea
  • Tachycardia (increased heart rate)
  • Hypertension (elevated blood pressure)
  • Cognitive Difficulties (disorganized or clouded thinking)
  • Hallucinations (either auditory, visual, tactile, or a combination)
  • Delirium and Psychosis (rare, but documented; most common in very heavy users)

Week 3

The beginning of the third week may mark some relief from the most severe Xanax withdrawal symptoms. Insomnia may be improved alongside appetite and anxiety is often a little less severe. Tremors and sweating may also be improved and usually show further improvement throughout the week. Depression may actually increase during this time; as the physical symptoms improve they no longer distract so much from the psychological symptoms, thus making them more apparent. Cardiovascular function may remain slightly elevated, although it is usually much better now than during the first week.

Some symptoms of Xanax withdrawal that may persist into the third week may include:

  • Severe Anxiety
  • Depression
  • Fatigue and Lethargy
  • Cravings for Xanax
  • Increased Irritability or Aggression
  • Insomnia
  • Cognitive Deficits

Week 4

While the physical symptoms may be well on their way to resolution by now, the psychological symptoms often remain at a moderate level. Anxiety is often high along with depression and cravings and the cognitive deficits may still persist. Clouded thinking and memory issues may persist for quite some time, and in some cases are even permanent.

Some of the symptoms of Xanax withdrawal that may linger into the fourth week can include:

  • Severe Anxiety
  • Depression
  • Fatigue and Lethargy
  • Cravings for Xanax
  • Increased Irritability or Aggression
  • Insomnia
  • Cognitive Deficits

If someone has not already sought post-detox treatment, it is highly recommended for them to do so. The risk of relapse is very high with Xanax, and as the memory of the physical discomfort fades, going back to Xanax use can seem more and more attractive as time passes. Medications and therapy can provide some relief while the body and mind heal from the changes made and damage done through chronic Xanax use.

Post-Acute Xanax Withdrawal

While the physical symptoms are certainly dangerous and sometimes extremely uncomfortable, the psychological symptoms are no walk in the park either. Even though the immediate risks are gone, it is not uncommon for these post-acute symptoms to persist for many months or even years in some cases. This can make it extremely difficult for someone to rebuild their life as anxiety, depression, agoraphobia, and increased irritability will work to keep someone from making meaningful connections with others, and begin the interpersonal healing process.

Some of the most common post-acute symptoms of Xanax withdrawal include:

  • Anxiety (particularly social anxiety)
  • Depression
  • Cognitive Deficits
  • Cravings for Xanax
  • Insomnia
  • Fatigue and Lethargy

These symptoms are sometimes considered an improvement over the more severe form suffered immediately after someone stops Xanax use, but they can be very disruptive to normal life. In addition, these symptoms commonly last several months, sometimes years, and can be permanent in some cases. Medications and therapy can help, but time is required for the body and mind to begin repairing the damage and reverse the remodeling that occurred due to chronic Xanax use.

What Factors Influence the Intensity of Xanax Withdrawal?

There can be some great variation between both the intensity of Xanax withdrawal symptoms as well as their duration. Some of these factors are behavioral, thus based on choices someone makes, while others are completely out of their control. Some people who have been addicted to Xanax will make a swift and complete recovery in just a few weeks, while others may suffer from post-acute symptoms for months or even years.

Some of the factors that influence Xanax withdrawal symptom intensity and duration include:

  • The amount of Xanax someone regularly used
  • The length of time someone used Xanax
  • Co-occurring mental health issues
  • A genetic predisposition towards addiction

The factor that most greatly influences the intensity of Xanax withdrawal symptoms is the amounts of the drug someone used on a regular basis. Higher doses of Xanax will produce a greater amount of downregulation to GABA receptors, and with continued use, a larger degree of remodeling to GABA systems and the brain in general. This will directly impact the severity of the symptoms of Xanax withdrawal, with larger doses of Xanax producing more severe symptoms.

The duration of withdrawal symptoms is most heavily impacted by the duration of Xanax use. Similar to the way the amounts used play a role, the length of time someone uses the drug can allow for a greater degree of remodeling to occur. While remodeling only contributes to the post-acute withdrawal symptoms, it can still cause great discomfort due to the fact that these symptoms are long-lived to begin with. Remodeling takes longer to occur than downregulation and likewise takes longer to reverse. In general, the longer someone used Xanax, the longer the withdrawal symptoms will last.

If someone had a co-occurring mental health issue, they may experience worse withdrawal symptoms than if someone had no such mental health issue. This contribution is indirect but it does play a role. If someone were to have a prior issue with anxiety or depression, then these symptoms would be more intense during withdrawal than someone with no such previous mental health issues. Additionally, these symptoms may persist even longer in the presence of a co-occurring mental health issue, so medical detox and continuing care are highly recommended in these situations.

Genetics may play a role, although this is very tangential and indirect at best. A genetic predisposition for addiction may not affect the intensity of withdrawals per se, but it may affect someones using habits. Someone with such a genetic predisposition may begin using Xanax earlier, and in greater amounts, than someone with no genetic predisposition.

More About Xanax Addiciton

Xanax, and its active ingredient alprazolam, is an intermediate-acting benzodiazepine (benzo) drug, which is a class of sedative-hypnotic medications. These are FDA approved for the treatment of anxiety and seizure disorders, as they are very potent anxiolytics and anticonvulsants. The way Xanax works is by increasing the brain’s response to the neurotransmitter GABA, an inhibitory neurotransmitter, and the downstream effects that result from increased GABA efficacy. This can produce relaxation, reduction in anxiety, increased seizure threshold, drowsiness, and impaired memory.

Even though Xanax use increases the effect of GABA on receptors, it does so in a roundabout way. Xanax can bind at certain GABA receptors, known as GABA-α receptor subunits, and specific benzodiazepine receptors in these subunits, particularly BNZ-1 and BNZ-2 receptors. This has a downstream effect on the GABA receptor’s sensitivity to GABA, meaning that less of the neurotransmitter is required to produce stimulation. This results in more inhibitory signaling from the same amounts of GABA, thus producing neurological depression of a variety of functions.

Through continued Xanax use, the brain will adapt to the increased GABA signaling by turning down sensitivity at the receptors themselves through a process known as downregulation. This is the brain’s attempt to maintain balance, and correct the consistent neurological depression produced by frequent, strong GABA stimulation. This will at first produce tolerance to Xanax, meaning that more of the drug is needed to produce the same effect. Continued, daily use for around four weeks is able to produce a physical dependence on Xanax, where someone will feel physically and mentally unwell if they go too long without using the drug. Continued use after downregulation has occurred will result in further structural changes in the brain through a process known as remodeling.

While it may take around a month of daily Xanax use to produce possibly dangerous withdrawal symptoms, minor withdrawal can begin after even a week of daily use, although these symptoms are not usually dangerous. Due to the potent anti-anxiety effects of Xanax, there is also a phenomenon known as “rebound anxiety” that is very common during withdrawal, where anxiety levels will increase above what they had been before someone used the drug. This may have to do with either GABA downregulation, remodeling, or a combination of the two. The ability of Xanax to increase the seizure threshold can also lead to an increased risk of seizure when undergoing Xanax withdrawal.

The Importance of Xanax Detox

Xanax withdrawal symptoms are often extremely uncomfortable, or even painful, and can even be fatal in some cases. If someone is expecting to undergo Xanax withdrawal, it is very highly recommended to enter a Xanax detox center for medical supervision and psychiatric care during this difficult process. These centers can reduce the discomfort and risks via trained professional care, support, medications, and therapies. In addition to the immediate benefits, these centers may provide referrals or act as a liaison to further care and treatment after detox has been completed. Entering one of these facilities can make a huge difference in someone’s chances of successful, long-term recovery and a life free from Xanax addiction.

Xanax Detox Centers

Article References (In Addition to 5 in-article references)

  1. 1 Basic Neurochemistry: GABA Receptor Physiology and Pharmacology
  2. 2 Progress in Brain Research: GABAα Receptors - Structure and Function in the Basal Ganglia
  3. 3 Journal of Psychiatry & Neuroscience: Pharmacology of Benzodiazepine Receptors - An Update
  4. 4 Anesthesia Progress: The Benzodiazepine Receptor
  5. 5 Comprehensive Handbook of Drug & Alcohol Addiction: Protracted Withdrawal Symptoms from Benzodiazepines
  6. 6 BMC Psychiatry: High-dose Benzodiazepine Dependence - A Qualitative Study of Patients’ Perception on Cessation and Withdrawal
  7. 7 Therapeutic Advances in Psychopharmacology: Challenges of the Pharmacological Management of Benzodiazepine Withdrawal, Dependence, and Discontinuation
  8. 8 The British Journal of General Practice: The Benzodiazepine Withdrawal Syndrome and its Management
  9. 9 The British Journal of General Practice: Withdrawal from Long-term Benzodiazepine Use - Randomised Trial in Family Practice
  10. 10 Drug and Alcohol Services South Australia: Benzodiazepines - Information for GPs
  11. 11 Archives of General Psychiatry: Decreased Brain GABAA-Benzodiazepine Receptor Binding in Panic Disorder - Preliminary Results From a Quantitative PET Study
  12. 12 Behavioural Neurology: The Effect of Chronic Alprazolam Intake on Memory, Attention, and Psychomotor Performance in Healthy Human Male Volunteers
  13. 13 Neuropsychopharmacology: Effects of Alprazolam on Driving Ability, Memory Functioning, and Psychomotor Performance - A Randomized, Placebo-controlled Study
  14. 14 Case Reports in Cardiology: Takotsubo Cardiomyopathy and Catatonia in the Setting of Benzodiazepine Withdrawal
  15. 15 Journal of Medical Case Reports: Withdrawal-induced Delirium Associated with a Benzodiazepine Switch - A Case Report
  16. 16 Frontiers in Pharmacology: A Gut Feeling About GABA - Focus on GABA-B Receptors
  17. 17 Northeastern University Antimicrobial Discovery Center: GABA Modulating Bacteria in the Human Gut Microbiome
  18. 18 Trends in Neurosciences: Hooked on Benzodiazepines - GABA-A Receptor Subtypes and Addiction
  19. 19 Advances in Pharmacological Sciences: Central and Peripheral GABA-A Receptor Regulation of the Heart Rate Depends on the Conscious State of the Animal
  20. 20 American Journal of Physiology - Heart and Circulatory Physiology: Interaction Between Glutamate and GABA Systems in the Integration of Sympathetic Outflow by the Paraventricular Nucleus of the Hypothalamus
  21. 21 International Journal of Clinical and Experimental Medicine: Effect of GABA on Blood Pressure and Blood Dynamics of Anesthetic Rats
  22. 22 Brain Communications: Dependence, Withdrawal, and Rebound of CNS Drugs - An Update and Regulatory Considerations for New Drugs Development
  23. 23 Primary Care Companion to the Journal of Clinical Psychiatry: Benzodiazepines - Revisiting Clinical Issues in Treating Anxiety Disorders
  24. 24 Journal of the International Neuropsychological Society: An Evaluation of Persisting Cognitive Effects After Withdrawal from Long-term Benzodiazepine Use
  25. 25 Journal of the American Osteopathic Association: Complicated Withdrawal Phenomena During Benzodiazepine Cessation in Older Adults
  26. 26 British Journal of Pharmacology: Studies on the Interaction Between Cerebral 5-Hydroxytryptamine and y-Aminobutyric Acid in the Mode of Action of Diazepam in the Rat

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