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| The core structure of benzodiazepines. "R" labels denote common locations of side chains, which give different benzodiazepines their unique properties. |
Benzodiazepine withdrawal syndrome - often abbreviated to benzo withdrawal - is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug(s) or during dosage reductions. Benzodiazepine withdrawal is similar to alcohol withdrawal syndrome and barbiturate withdrawal syndrome and can in severe cases provoke life threatening withdrawal symptoms such as seizures. Severe and life threatening symptoms are mostly limited to abrupt or over-rapid dosage reduction from high doses. A protracted withdrawal syndrome may develop in a proportion of individuals with symptoms such as anxiety, irritability, insomnia and sensory disturbances. In a small number of people it can be severe and resemble serious psychiatric and medical conditions such as schizophrenia and seizure disorders. A serious side effect of benzodiazepine withdrawal is suicide.
The protracted withdrawal can be minimised in intensity and severity by a slow gradual reduction in dosage. Withdrawal of benzodiazepines is usually beneficial due to the adverse effects associated with the long-term use of benzodiazepines. However, it has been recommended that long-term users of benzodiazepines not be forced to withdraw against their will.
Chronic exposure to benzodiazepines causes physical adaptations in the brain that counteract the drug's effects. This is known as a tolerance and physical dependence. When the drug is removed or dosage reduced in an individual physically dependent on benzodiazepines, numerous withdrawal symptoms both physical and psychological may appear and will remain present until the body reverses the physical dependence by making adaptions to the drug-free environment and thus returning the brain to normal function.Generally, the higher the dose and the longer a benzodiazepine is used and the more rapidly a benzodiazepine is discontinued, the more likely severe withdrawal symptoms will occur. However, severe withdrawal symptoms can still occur during gradual dose reduction or from relatively low doses.
In certain selected patient groups the occurrence of withdrawal symptoms is as high as 100%, whereas in unselected patient groups more than 50% of subjects are able to discontinue benzodiazepines with mild or even no withdrawal symptoms at all. Withdrawal symptoms may persist for weeks or months after cessation of benzodiazepines. In a smaller subset of patients withdrawal symptoms may continue at a sub a cute level for many months or even a year or more. Long term use of benzodiazepines may lead to withdrawal like symptoms emerging despite a constant therapeutic dose. Correctly attributing previously misdiagnosed withdrawal symptoms such as anxiety to the withdrawal effects of benzodiazepines, individualised taper strategies according to withdrawal severity, the addition of alternative strategies such as reassurance and referral to benzodiazepine withdrawal support groups increase the success rate of withdrawal. Withdrawal symptoms can resemble psychiatric symptoms which doctors often interpret as evidence for the need of benzodiazepines which in turn leads to withdrawal failure and reinstatement of benzodiazepines, often to higher doses.