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Lived Nervous-System States (Modes)
- Valsa Madhava, MD
- 6 days ago
- 5 min read
Week 1 — What Are Nervous-System States?
Introduction
Many people initially experience benzodiazepine withdrawal as a long list of separate symptoms. A racing heart. Insomnia. Internal shaking. Burning skin. Dizziness. Fear.
Restlessness. Emotional numbness.
At first, these symptoms often feel random and unrelated. But many people eventually begin noticing something important:
The symptoms do not only occur individually. They often begin organizing into recognizable nervous-system states.
Some days the system feels intensely activated and impossible to settle. Other days it feels heavy, slowed, emotionally flat, disconnected, or physically restless. At times the system may shift rapidly between these states.
This is one reason withdrawal can feel so confusing. The experience can change dramatically even within the same person and the same nervous system.
What Is a Nervous-System State?
Symptoms rarely show up alone. They often travel in groups.
At one moment, the whole system may feel intensely activated. Heart pounding. Internal shaking. Thoughts looping. The body feels restless and impossible to settle.
Later that same day, the system may feel completely different — slowed down, emotionally flat, disconnected, physically heavy, exhausted, or unreal.
Same person. Same nervous system. Different states.
A nervous-system state refers to the overall pattern the brain and body are functioning within at a particular moment.
These states often involve multiple systems shifting together, including stress activation, autonomic regulation, perception, movement, and energy level.
Rather than appearing as isolated symptoms one at a time, the nervous system often shifts into broader patterns that affect how the entire system feels and functions.
Many people eventually begin recognizing these patterns as familiar states:
“My system feels activated today.”
“I feel shut down.”
“Everything feels unreal.”
“I cannot settle.”
Understanding these states can make withdrawal feel less random and more understandable.
What People Actually Experience
Many people eventually begin noticing that withdrawal does not feel the same from one moment to the next.
A person may wake feeling intensely activated — restless, overstimulated, unable to settle, and highly sensitive to stress or stimulation.
Later that same day, the system may feel completely different. Heavy. Slowed down. Emotionally flat. Disconnected. Exhausted.
These shifts can feel sudden and confusing. Many people describe it as feeling like “a switch flipped.”
Others notice mixed states, where opposite experiences seem to occur at the same time:
wired but exhausted
emotionally numb but physically restless
overstimulated but disconnected
physically tired but unable to sleep
Because these states can shift and overlap, withdrawal often feels unpredictable. Many people initially believe they are developing entirely new problems each time the state changes.
In reality, the same nervous system may simply be moving through different patterns of activation and regulation.
Why Symptoms Often Begin to Cluster Together
These states are not simply ‘all in the brain’ or ‘all in the body.’ They reflect ongoing interaction across the nervous system and the body.
For example, poor sleep may increase stress-system activation. Increased stress activation can affect breathing, heart rate, digestion, temperature regulation, and sensory sensitivity.
Hypervigilance may increase symptom monitoring, while inflammation and autonomic activation can contribute to fatigue, overstimulation, and feelings of physical or emotional unease.
As these processes begin interacting with one another, symptoms often stop feeling isolated. Instead, they begin occurring in recognizable combinations and patterns.
This is why many people notice recurring experiences such as:
internal shaking, panic, insomnia, and tachycardia
dizziness, derealization, visual sensitivity, and fatigue
emotional numbness, heaviness, and slowed thinking
agitation, pacing, and inability to sit still
Because these states can shift and overlap, benzodiazepine withdrawal often feels unpredictable. Some people describe it as feeling like “a switch flipped.” Others notice mixed states — wired but exhausted, emotionally numb but physically restless, overstimulated but disconnected.
The nervous system does not simply generate separate symptoms one at a time. It often shifts between broader patterns involving multiple interacting systems. In addition, over time, the nervous system may begin to anticipate and predict certain states based on prior experiences. A person who repeatedly experiences activation at night, during stress, or around hormonal shifts may begin noticing that the nervous system enters similar patterns more easily in those situations. This does not mean the symptoms are imagined. It reflects how the brain and body continuously learn, adapt, and prepare in response to past experiences and current signals.
The States We’ll Explore
Over the next several weeks, we will explore some of the most common nervous-system states reported during withdrawal.
These include:
Hyperarousal — intensely activated, overstimulated, restless, and difficult to settle
Shutdown / Low Activation — slowed down, emotionally flat, disconnected, heavy, or exhausted
Depersonalization / Derealization — feeling unreal, detached, distant, or disconnected from yourself or the world around you
Motor Activation / Akathisia-Like States — inner restlessness, pacing, inability to sit still, and strong urges to move
These states are not rigid categories. They can overlap, combine, and shift from one pattern to another. Some people remain mostly in one dominant state, while others fluctuate rapidly between several different states within the same day.
Understanding these patterns can help withdrawal feel more understandable and less random.
Figure 1. Common nervous-system states experienced during withdrawal. These states can overlap, shift, and interact over time.
Why This Matters
One of the most frightening parts of benzodiazepine withdrawal is the feeling that symptoms are constantly changing.
A person may spend the day wondering:
“Why do I suddenly feel different?”
“Why did my symptoms completely change?”
“Why does my nervous system feel so different from one moment to the next?”
Understanding nervous-system states can help organize these experiences into more recognizable patterns.
Instead of asking: “What new symptom is happening now?”
It becomes possible to ask: “What state is my nervous system in right now?”
That shift can reduce some of the confusion and fear surrounding withdrawal.
None of this means symptoms are imaginary or “just psychological.” The symptoms are real.
The suffering is real.
This framework is simply a way of understanding how symptoms often organize and change across different nervous-system states. In many cases, these shifts reflect changes in overall nervous-system organization rather than new damage suddenly appearing everywhere.
It is a map — not the terrain itself– but maps can help people feel less lost while moving through difficult and changing experiences.
Next Week
Next week, we will explore hyperarousal states — when the nervous system feels intensely activated, overstimulated, and difficult to settle.
Selected References
Barrett, L. F., & Simmons, W. K. (2015). Interoceptive predictions in the brain. Nature Reviews Neuroscience, 16(7), 419–429.
McEwen, B. S. (2007). Physiology and neurobiology of stress and adaptation: Central role of the brain. Physiological Reviews, 87(3), 873–904.
Menon, V. (2011). Large-scale brain networks and psychopathology: A unifying triple network model. Trends in Cognitive Sciences, 15(10), 483–506.
Madhava, V. S., et al. (2025). Benzodiazepine withdrawal symptom clusters: Distinct phenotypes with treatment implications. medRxiv.
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