Benzodiazepine withdrawal syndrome

Benzodiazepine withdrawal syndrome
Other namesBenzo withdrawal
Diazepam is sometimes used in the treatment of benzodiazepine withdrawal.[1]
SpecialtyAddiction medicine, Psychiatry
SymptomsAnxiety, irritability, panic attacks, paranoia, tremor, akathisia, dissociation, confusion, insomnia, sensory disturbances, seizures
ComplicationsSeizures, suicide, hyperthermia, psychosis, delirium, catatonia, psychological trauma, death
DurationAverage: ~2 months
CausesStopping or reducing intake of benzodiazepines in a state of dependence
PreventionGradual dose reduction
Benzodiazepines
Chemical structure diagram of a benzene ring fused to a diazepine ring. Another benzene ring is attached to the bottom of the diazepine ring via a single line. Attached to the first benzene ring is a side chain labeled R7; to the second, a side chain labeled R2'; and attached to the diazepine ring, two side chains labeled R1 and R2.
The core structure of benzodiazepines. "R" labels denote common locations of side chains, which give different benzodiazepines their unique properties.

Benzodiazepine withdrawal syndrome (BZD withdrawal) is the cluster of signs and symptoms that may emerge when a person who has been taking benzodiazepines as prescribed develops a physical dependence on them and then reduces the dose or stops taking them without a safe taper schedule.

Typically, benzodiazepine withdrawal is characterized by sleep disturbance, irritability, increased tension and anxiety, depression, panic attacks, hand tremor, shaking, sweating, difficulty with concentration, confusion and cognitive difficulty, memory problems, dry mouth, nausea and vomiting, diarrhea, loss of appetite and weight loss, burning sensations and pain in the upper spine, palpitations, headache, nightmares, tinnitus, muscular pain and stiffness, and a host of perceptual changes.[2] More serious symptoms may also occur such as depersonalization, restless legs syndrome, seizures, and suicidal ideation.

Benzodiazepine withdrawal can also lead to disturbances in mental function that persist for several months or years after onset of symptoms (referred to as post-acute-withdrawal syndrome in this form).

Withdrawal symptoms can be managed through awareness of the withdrawal reactions, individualized taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance, and referral to benzodiazepine withdrawal support groups.[3][4]

  1. ^ Cite error: The named reference pmid28328330 was invoked but never defined (see the help page).
  2. ^ Petursson, H. (1994). "The benzodiazepine withdrawal syndrome". Addiction. 89 (11): 1455–9. doi:10.1111/j.1360-0443.1994.tb03743.x. PMID 7841856.
  3. ^ Onyett, SR (1989). "The benzodiazepine withdrawal syndrome and its management". The Journal of the Royal College of General Practitioners. 39 (321): 160–3. PMC 1711840. PMID 2576073.
  4. ^ Ashton, Heather (1991). "Protracted withdrawal syndromes from benzodiazepines". Journal of Substance Abuse Treatment. 8 (1–2): 19–28. doi:10.1016/0740-5472(91)90023-4. PMID 1675688.