Benzodiazepine Withdrawal Syndrome - Signs and Symptoms

Signs and Symptoms

Some withdrawal symptoms are identical to the symptoms for which the medication was originally prescribed, and can be acute or protracted in duration. Onset of symptoms from long half-life benzodiazepines might be delayed for up to three weeks, although withdrawal symptoms from short-acting ones often present early, usually within 24–48 hours. There may be no fundamental differences in symptoms from either high or low dose discontinuation, but symptoms tend to be more severe from higher doses.

Daytime reemergence and rebound withdrawal symptoms, sometimes called interdose withdrawal, may occur once dependence has set in. Reemergence is the return of symptoms for which the drug was initially prescribed, in contrast, rebound symptoms are a return of the symptoms for which the benzodiazepine was initially taken for, but at a more intense level than before. Withdrawal symptoms, on the other hand, may appear for the first time during dose reduction, and include insomnia, anxiety, distress, weight loss, panic, depression, derealization, and paranoia, and are more commonly associated with short-acting benzodiazepines discontinuation, like triazolam and lorazepam. Daytime symptoms can occur after a few days to a few weeks of administration of nightly benzodiazepine use or z-drugs such as zopiclone; withdrawal-related insomnia rebounds worse than baseline even when benzodiazepines are used intermittently.

The following symptoms may emerge during gradual or abrupt dosage reduction:

• Aches and pains
• Agitation and restlessness
• Anxiety, possible terror and panic attacks
• Blurred vision
• Chest pain
• Depersonalization
• Depression (can be severe), possible suicidal ideation
• Derealisation (feelings of unreality)
• Dilated pupils
• Dizziness
• Dry mouth
• Dysphoria
• Electric shock sensations
• Elevation in blood pressure
• Fatigue and weakness
• Flu-like symptoms
• Gastrointestinal problems (irritable bowel syndrome)
• Hearing impairment
• Headache
• Hot and cold flushes
• Hyperosmia
• Hypertension
• Hypnagogia-hallucinations
• Hypochondriasis
• Increased sensitivity to touch
• Increased sensitivity to sound
• Increased urinary frequency
• Indecision
• Insomnia
• Impaired concentration
• Impaired memory and concentration
• Loss of appetite and weight loss
• Metallic taste
• Mild to moderate Aphasia
• Mood swings
• Muscular spasms, cramps or fasciculations
• Nausea and vomiting
• Nightmares
• Numbness and tingling
• Obsessive compulsive disorder
• Paraesthesia
• Paranoia
• Perception that stationary objects are moving
• Perspiration
• Photophobia
• Postural hypotension
• REM sleep rebound
• Restless legs syndrome
• Sounds louder than usual
• Stiffness
• Taste and smell disturbances
• Tachycardia
• Tinnitus
• Tremor
• Visual disturbances

An abrupt or over-rapid discontinuation of benzodiazepines may result in a more serious and very unpleasant withdrawal syndrome that may additionally result in:

• Attempted suicide
• Catatonia, which may result in death
• Confusion
• Convulsions, which may result in death
• Coma (rare)
• Delirium tremens
• Delusions
• Hyperthermia
• Homicide ideations
• Mania
• Neuroleptic malignant syndrome-like event (rare)
• Organic brain syndrome
• Post-traumatic stress disorder
• Psychosis
• Self-harm
• Suicidal ideation
• Suicide
• Urges to shout, throw, break things or to harm someone
• Violence

As withdrawal progresses, patients often find their physical and mental health improves with improved mood and improved cognition.