In severe cases, the withdrawal reaction or protracted withdrawal may exacerbate or resemble serious psychiatric and medical conditions, such as mania, schizophrenia, agitated depression, panic disorder, generalised anxiety disorder, and complex partial seizures and, especially at high doses, seizure disorders.[22] Failure to recognize discontinuation symptoms can lead to false evidence for the need to take benzodiazepines, which in turn leads to withdrawal failure and reinstatement of benzodiazepines, often to higher doses. Pre-existing disorder or other causes typically do not improve, whereas symptoms of protracted withdrawal gradually improve over the ensuing months.[22] For this reason at least six months should have elapsed after benzodiazepines cessation before re-evaluating the symptoms and updating a diagnosis.[citation needed]
Symptoms may lack a psychological cause and can fluctuate in intensity with periods of good and bad days until eventual recovery.[90][91]
Withdrawal effects caused by sedative-hypnotics discontinuation, such as benzodiazepines, barbiturates, or alcohol, can cause serious medical complications. They are cited to be more hazardous to withdraw from than opioids.[26] Users typically receive little advice and support for discontinuation.[27] Some withdrawal symptoms are identical to the symptoms for which the medication was originally prescribed,[21] 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.[28] 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.[29]
Daytime reemergence and rebound withdrawal symptoms, sometimes confused with 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, but at a more intense level than before; whereas 'interdose withdrawal' is when a prior dosage of drug wears off and beginnings of an entirely new cycle of withdrawal sets in, the symptoms of which dissipate upon taking the next dosage but afterwhich yet another entirely new cycle of withdrawal begins when that dosage wears off, a new onset of withdrawal between each dosage thus called 'interdose withdrawal' and if not properly treated can recur indefinitely in a vicious circle (for which consider a benzo with a long half life (e.g. Valium) so the drug does not wear off between doses).[30] Withdrawal symptoms may appear for the first time during dose reduction, and include insomnia, anxiety, distress, weight loss, dizziness, night sweats, shakes, muscle twitches, aphasia, panic attacks, depression, derealization, paranoia, etc., and are more commonly associated with short-acting benzodiazepines discontinuation, like triazolam.[22][31] Daytime symptoms can occur after a few days to a few weeks of administration of nightly benzodiazepine use[32][33] or z-drugs such as zopiclone;[34] withdrawal-related insomnia rebounds worse than baseline[35][36] even when benzodiazepines are used intermittently.[37]
The following symptoms may emerge during gradual or abrupt dosage reduction:
Akathisia&Agitation and Anxiety,[25] possible terror and panic attacks[1][38]&Blurred vision[38]&Chest pain[38]&Depersonalization[39]&Depression (can be severe),[40] possible suicidal ideation&Derealisation (feelings of unreality)[41]&Dilated pupils[22]&Dizziness[38]&Dry mouth[38]&Dysphoria[42][43]&Elevation in blood pressure[44]&Fatigue and weakness[38]&Gastrointestinal disturbance (including nausea, diarrhea, vomiting)[45][46][46][47]&Hearing disturbance[38]&Headache[1]&Hot and cold spells[38]&Hyperosmia[48]&Hypertension[49]&Hypnagogic hallucinations[17]&Hypochondriasis[38]&Increased sensitivity to touch[41]&Increased urinary frequency[38]&Insomnia[45]&Impaired memory and concentration[1][38]&Loss of appetite and weight loss[50]&Mild to moderate Aphasia[48]&Mood swings[38]&Muscular spasms, cramps, discomfort or fasciculations[51]&Nightmares[45]&Obsessive compulsive disorder[52][53]&Paraesthesia[38][41][48][5][54]&Paranoia[48]&Perspiration[1]&Photophobia[48]&Postural hypotension[45]&REM sleep rebound[55]&Restless legs syndrome[24]&Stiffness[38]&Taste and smell disturbances[38]&Tachycardia[56]&Tinnitus[57]&Tremor[58][59]&Visual disturbances[41
Rapid discontinuation may result in a more serious syndrome
Catatonia, which may result in death[60][61][62]&Confusion[25]&Convulsions,[25] which may result in death[63][64]&Coma[65] (rare)&Delirium tremens[66][67][67]&Hyperthermia[45]&Mania[68][69]&Neuroleptic malignant syndrome-like event[70][71] (rare)&Organic brain syndrome[72]&Post-traumatic stress disorder[24]&Psychosis[73][74]&Suicidal ideation[75] or suicide[2][3]&Violence and aggression[38][76
As withdrawal progresses, patients often find their physical and mental health improves with improved mood and improved cognition.