Benzodiazepine withdrawal symptoms

Withdrawal symptoms may result from dosage reduction as well as from complete withdrawal (1). In around 20-30% of patients, withdrawal symptoms from benzodiazepine develop after 4-6 weeks of use (1)

The most important effect of benzodiazepine is the anti anxiety effect, hence most of the acute symptoms of withdrawal are those of anxiety state (2).

• symptoms similar to anxiety state in general include:
  • anxiety, panic attacks, agoraphobia
  • insomnia, nightmares
  • depression, dysphoria
  • poor memory and concentration
  • dizziness, light headedness
  • tremor
  • muscle pain, stiffness
  • sweating, night sweats
  • palpitations
  • blurred or double vision
• symptoms less common in anxiety state but relatively specific to benzodiazepine withdrawal are:
  • perceptual distortions, sense of movement
  • depersonalization, derealisation
  • hallucinations (visual, auditory)
  • distortion of body image
  • tingling, numbness, altered sensation
  • formication (skin ‘crawling’)
  • sensory hypersensitivity (light sound, taste, smell)
  • muscle twitches, jerks, fasciculation (3)

A minority of patients may suffer from long term effects (protracted symptoms) which might be present months or even years after withdrawing from benzodiazepines.

• in patients who have undergone a slow taper under their own control is less likely to have protracted symptoms
• some protracted withdrawal symptoms include:
  • anxiety
  • insomnia
  • depression
  • various sensory and motor symptoms - tinnitus, tingling, numbness, muscle pain, weakness, painful cramps
  • poor memory and cognition
  • gastrointestinal disturbance

Reference:

• (1) National Addiction Centre, King's College London and School of Social and Community Medicine 2011. The changing use of prescribed benzodiazepines and z-drugs and of over-the-counter codeine-containing products in England: a structured review of published English and international evidence and available data to inform consideration of the extent of dependence and harm.
• (2) Ashton, C.H.  2002. Benzodiazepines: how they work and how to withdraw. The Ashton Manual
• (3) Ashton H. The diagnosis and management of benzodiazepine dependence. Curr Opin Psychiatry. 2005;18(3):249-55