Benzodiazepine Withdrawal

Upon the discontinuation of benzodiazepines, we recognize four syndromes to occur.

Recurrence

Recurrence or relapse of original symptoms, for example, sleep disorder. 


Rebound symptoms

Rebound symptoms when the symptoms are even more severe than the original symptoms. 


Pseudowithdrawal 

Pseudowithdrawal, when the patient is expecting withdrawal symptoms and the expectation leads to over interpretation of mild symptoms. 


True withdrawal

True withdrawal when the patient experiences true withdrawal symptoms after stopping the drug. 


Mechanism of benzodiazepine withdrawal

When benzodiazepines are used for an extended period, it produces certain nonadaptive changes in the brain to equipoise the repetitive benzodiazepine-induced GABA-release. These changes include the attenuation of GABA-ergic neuronal inhibition and a compensatory excitation of the glutamate system. This is how tolerance to the effect of benzodiazepines occurs. When such changes are produced, a sudden cessation of the agent will lead to a hyper-excited state. 


References

1.    Galarneau DW, Conrad EJ. Benzodiazepine Intoxication and Withdrawal: Assessment and Management. Hospital Medicine Clinics. 2015;4(4):513-525. doi:10.1016/J.EHMC.2015.06.005

2.    Gosselin P, Ladouceur R, Morin CM, Dugas MJ, Baillargeon L. Benzodiazepine discontinuation among adults with GAD: A randomized trial of cognitive-behavioral therapy. J Consult Clin Psychol. 2006;74