I was prescribed 1mg alprazolam twice daily for generalized anxiety. It worked brilliantly for two years. Then it started working less. My doctor added an SSRI and began what became an 8-month taper.
The Ashton method: switching to an equivalent dose of diazepam (long half-life) and reducing by roughly 10% every 2-4 weeks. Even with this slow approach, every reduction was brutal.
Weeks 1-4 of each cut: rebound anxiety worse than what I started with. Insomnia so severe I'd go 72 hours without sleep. Tinnitus. Muscle twitches. A horrifying symptom called "depersonalization" where nothing feels real — like watching your life through a screen.
Month 4: I wanted to quit the taper and go back to my full dose. My psychiatrist talked me through it. We held the dose for a month before continuing. This flexibility was essential.
Month 8: I took my last dose. The acute withdrawal lasted another 3 weeks. The protracted withdrawal — waves of anxiety, insomnia, and cognitive fog — continued for about 6 months after that.
I'm now 14 months free and finally feeling normal. Benzodiazepines are effective medications but the exit cost is enormous. If you're starting them, have an exit plan from day one.