What supplements can alleviate benzodiazepine (BZD) withdrawal symptoms?

From the Guidelines

Benzodiazepine withdrawal symptoms can be alleviated with supplements such as valerian root, magnesium glycinate, L-theanine, omega-3 fatty acids, melatonin, and passionflower extract, which should be used under medical supervision during tapering. These supplements have been found to support GABA function, reduce excitatory neurotransmission, or address specific withdrawal symptoms, and can be used in conjunction with lifestyle modifications like regular exercise, stress reduction techniques, and avoiding caffeine and alcohol 1.

Key Supplements

• Valerian root (300-600mg before bedtime) may help with sleep disturbances and anxiety
• Magnesium glycinate (200-400mg daily) can reduce muscle tension and irritability
• L-theanine (200-400mg daily) promotes relaxation without sedation
• Omega-3 fatty acids (1-2g daily) may help with mood regulation and inflammation
• Melatonin (1-3mg before bedtime) can assist with sleep disruption
• Passionflower extract (300-600mg daily) has mild anxiolytic effects It is essential to start with low doses and increase gradually, as some people may be more sensitive during withdrawal, and to remember that supplements cannot replace proper medical tapering protocols, which should always be managed by a healthcare provider who can monitor symptoms and adjust the tapering schedule as needed 1. A commonly used tapering schedule is a reduction of the benzodiazepine dose by 25% every 1–2 weeks, and cognitive behavioral therapy (CBT) can increase tapering success rates and might be particularly helpful for patients struggling with a benzodiazepine taper 1.

From the Research

Supplements for Benzodiazepine Withdrawal

The following supplements have been studied for their potential to alleviate benzodiazepine withdrawal symptoms:

• Valproate: may have a potential benefit for benzodiazepine discontinuation 2
• Tricyclic antidepressants: may have a potential benefit for benzodiazepine discontinuation and reduction of benzodiazepine withdrawal symptoms 2
• Pregabalin: may have a positive effect on benzodiazepine withdrawal symptoms 2
• Captodiame: may have a positive effect on benzodiazepine withdrawal symptoms 2
• Paroxetine: may have a positive effect on benzodiazepine withdrawal symptoms, but this effect may not persist until longest follow-up 2
• Flumazenil: may have a positive effect on benzodiazepine withdrawal symptoms 2
• Carbamazepine: may have a positive effect on reduction of anxiety symptoms and benzodiazepine withdrawal symptoms 3, 2
• Phenobarbital: may be a viable alternative to prolonged outpatient tapers for the management of benzodiazepine withdrawal 4

Mechanisms of Action

These supplements may work by:

• Reducing anxiety symptoms: carbamazepine, pregabalin, captodiame, paroxetine, and flumazenil 2
• Reducing benzodiazepine withdrawal symptoms: pregabalin, captodiame, paroxetine, and flumazenil 2
• Facilitating benzodiazepine discontinuation: valproate and tricyclic antidepressants 2

Study Limitations

The studies had limitations, including:

• High risk of bias in all trials but one 2
• Imprecision for all comparisons due to limited sample sizes and heterogeneity of studies 2
• Insufficient reporting of adverse events 2