Physiological dependence on benzodiazepines is accompanied by a withdrawal syndrome typically characterized by sleep disturbances, irritability, increased tension and anxiety, panic attacks, hand tremors, sweating, difficulty concentrating, dry retching and nausea, some weight loss, palpitations, headaches, muscular pain and stiffness, and a host of perceptual changes.
In high-dosage cases, more serious developments such as seizures and psychotic reactions have also been reported. Withdrawal from normal-dose benzodiazepine treatment can result in several symptomatic patterns. The most common is a short-lived “rebound” anxiety and insomnia, which typically begins within 1–4 days of discontinuation, depending on the half-life of the particular drug.
The second pattern involves a full-blown withdrawal syndrome, usually lasting 10–14 days. Finally, a third pattern may involve the return of anxiety symptoms, which then persist until some form of treatment is initiated.
Physiological dependence can occur following prolonged treatment with therapeutic doses of benzodiazepines, but it is unclear what proportion of patients are likely to experience a withdrawal syndrome. It is also unknown to what extent the risk of physiological dependence is influenced by the minimum duration of exposure or the dosage of these drugs.
Withdrawal symptoms appear to be more severe following the discontinuation of high doses or short-acting benzodiazepines. Dependence on alcohol or other sedatives may increase the risk of benzodiazepine dependence. However, it has proved difficult to demonstrate unequivocally any differences in the relative abuse potential of individual benzodiazepines.