From the Guidelines
Benzodiazepine withdrawal symptoms can be severe and potentially life-threatening, and therefore, it is crucial to manage withdrawal through a gradual tapering process under medical supervision, typically reducing the dose by 25% every 1-2 weeks, as recommended by the CDC guideline for prescribing opioids for chronic pain 1.
Symptoms of Benzodiazepine Withdrawal
The symptoms of benzodiazepine withdrawal include:
- Anxiety
- Insomnia
- Irritability
- Tremors
- Muscle tension
- Seizures or psychosis in severe cases These symptoms occur because the brain has adapted to the presence of benzodiazepines by reducing its natural GABA activity, and when the drug is removed, the brain needs time to restore normal neurotransmitter function 1.
Management of Benzodiazepine Withdrawal
To manage benzodiazepine withdrawal, a gradual tapering schedule should be used, with a reduction of the benzodiazepine dose by 25% every 1-2 weeks 1. Cognitive behavioral therapy (CBT) can also increase tapering success rates and may be particularly helpful for patients struggling with a benzodiazepine taper 1. If benzodiazepines prescribed for anxiety are tapered or discontinued, evidence-based psychotherapies, such as CBT, and/or specific anti-depressants or other nonbenzodiazepine medications approved for anxiety should be offered 1.
Importance of Medical Supervision
It is essential to consult a healthcare provider to create a personalized tapering schedule, as the process may take months, especially for long-term or high-dose users 1. Abrupt withdrawal from benzodiazepines can be associated with rebound anxiety, hallucinations, seizures, delirium tremens, and, in rare cases, death 1. Therefore, medical supervision is crucial to minimize potentially dangerous withdrawal symptoms.
From the FDA Drug Label
Acute withdrawal signs and symptoms associated with benzodiazepines have included abnormal involuntary movements, anxiety, blurred vision, depersonalization, depression, derealization, dizziness, fatigue, gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea, weight loss, decreased appetite), headache, hyperacusis, hypertension, irritability, insomnia, memory impairment, muscle pain and stiffness, panic attacks, photophobia, restlessness, tachycardia, and tremor More severe acute withdrawal signs and symptoms, including life-threatening reactions, have included catatonia, convulsions, delirium tremens, depression, hallucinations, mania, psychosis, seizures, and suicidality Protracted withdrawal syndrome associated with benzodiazepines is characterized by anxiety, cognitive impairment, depression, insomnia, formication, motor symptoms (e.g., weakness, tremor, muscle twitches), paresthesia, and tinnitus that persists beyond 4 to 6 weeks after initial benzodiazepine withdrawal.
The symptoms of Benzodiazepine (BZD) withdrawal include:
- Acute withdrawal symptoms:
- Anxiety
- Blurred vision
- Depersonalization
- Depression
- Derealization
- Dizziness
- Fatigue
- Gastrointestinal adverse reactions (e.g., nausea, vomiting, diarrhea)
- Headache
- Hyperacusis
- Hypertension
- Irritability
- Insomnia
- Memory impairment
- Muscle pain and stiffness
- Panic attacks
- Photophobia
- Restlessness
- Tachycardia
- Tremor
- More severe acute withdrawal symptoms:
- Catatonia
- Convulsions
- Delirium tremens
- Hallucinations
- Mania
- Psychosis
- Seizures
- Suicidality
- Protracted withdrawal symptoms:
- Anxiety
- Cognitive impairment
- Depression
- Insomnia
- Formication
- Motor symptoms (e.g., weakness, tremor, muscle twitches)
- Paresthesia
- Tinnitus 2
From the Research
Symptoms of Benzodiazepine Withdrawal
The symptoms of benzodiazepine withdrawal can vary in severity and duration, but common symptoms include:
- Sleep disturbance
- Irritability
- Increased tension and anxiety
- Panic attacks
- Hand tremor
- Sweating
- Difficulty in concentration
- Dry wretching and nausea
- Some weight loss
- Palpitations
- Headache
- Muscular pain and stiffness
- Perceptual changes 3 In some cases, more serious symptoms can occur, such as seizures and psychotic reactions, particularly in individuals who have been taking high doses of benzodiazepines 3.
Patterns of Withdrawal
There are several patterns of withdrawal that can occur when discontinuing benzodiazepine treatment, including:
- A short-lived "rebound" anxiety and insomnia, which can occur within 1-4 days of discontinuation 3
- A full-blown withdrawal syndrome, which can last 10-14 days 3
- A return of anxiety symptoms, which can persist until treatment is instituted 3
Factors Influencing Withdrawal Severity
The severity of benzodiazepine withdrawal can be influenced by several factors, including:
- The dose and duration of benzodiazepine treatment 3
- The type of benzodiazepine being used, with short-acting benzodiazepines potentially leading to more severe withdrawal symptoms 3
- The presence of other substance use disorders, such as alcohol or sedative dependence, which can increase the risk of benzodiazepine dependence 3