Benzodiazepine Withdrawal

Overview

Main Concepts:

  • Benzodiazepines are still commonly used in the treatment of insomnia and mixed anxiety and depression.

Notable Features:

  • Symptoms from short-acting benzodiazepine withdrawal can appear as early as 24 hours after cessation.

High Yield:

  • The use of benzodiazepines can be problematic due to their potential for tolerance, dependence, and abuse. The risk is greater with shorter-acting benzodiazepines like alprazolam.

  • Symptoms include seizures, tremors, anxiety, perceptual disturbances, and psychosis

Other:

Definition


Diagnostics


Assessment

Symptoms of acute benzodiazepine withdrawal include:

  • Anxiety

  • Insomnia

  • Tremors

  • Psychomotor agitation

  • Dysphoria

Abrupt discontinuation can commonly lead to early rebound effects of insomnia and increased anxiety, which may be hard to distinguish withdrawal from the return of an underlying psychiatric disorder (anxiety disorders).

Benzo withdrawal may also present with psychosis and seizures. In severe cases, it can be life-threatening.

Onset and severity of benzodiazepine withdrawal depends on the half-life of the drug. Shorter-acting drugs like alprazolam and lorazepam produce earlier and more severe symptoms. (For instance, lorazepam has a half-life of 12 hours, and so may produce withdrawal symptoms within 1 - 2 days.)

Management

The strategy for managing benzodiazepine withdrawal includes:

  • Using a longer half-life benzodiazepine, such as diazepam, and

  • Gradually tapering it over the course of several months