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Concept
Benzodiazepine withdrawal syndrome
Summary
Benzodiazepine withdrawal syndrome, often abbreviated to benzo withdrawal or 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, panic attacks, hand tremor, shaking, sweating, difficulty with concentration, confusion and cognitive difficulty, memory problems, dry retching and nausea, burning sensations and pain in the upper spine, weight loss, palpitations, headache, muscular pain and stiffness, and a host of perceptual changes. More serious symptoms may also occur such as mini-seizures, seizures, and suicide.
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, all increase the success rate of withdrawal.
Withdrawal symptoms occur during dose reduction and may include insomnia, anxiety, distress, weight loss, dizziness, night sweats, shakes, muscle twitches, aphasia, panic attacks, depression, derealization, paranoia, indigestion, diarrhea and photophobia. As withdrawal progresses, patients often find their physical and mental health improves with improved mood and improved cognition.
A more complete list of possible symptoms stated in publications:
Rapid discontinuation may result in a more serious syndrome
Benzodiazepine dependence#Mechanism
Alcohol withdrawal syndrome#Kindling and Kindling (sedative–hypnotic withdrawal)
The neuroadaptive processes involved in tolerance, dependence, and withdrawal mechanisms implicate both the GABAergic and the glutamatergic systems. Gamma-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter of the central nervous system; roughly one-quarter to one-third of synapses use GABA.
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