Hey everybody, welcome back. This is Dr. B from Dr. B360 (@DrB360Official). Today, we’re tackling an essential and detailed topic: Benzodiazepine Withdrawals. Specifically, we’ll clearly differentiate between acute benzodiazepine withdrawal and chronic (protracted) benzodiazepine withdrawal, sometimes called Post-Acute Withdrawal Syndrome (PAWS).
Recognizing the differences between acute and chronic benzodiazepine withdrawals is critical because:
It impacts patient experience and health outcomes.
Helps bridge understanding between patients and healthcare providers.
Reduces fear, misinformation, and miscommunication surrounding withdrawal experiences.
Recently, I covered when anti-seizure medications are appropriate for benzodiazepine withdrawal. Today, we dig deeper into acute versus chronic withdrawal.
Acute benzodiazepine withdrawal is formally recognized in the medical community, especially among emergency physicians, and typically lasts no more than one week.
Early Symptoms (6-48 hours)
Increased anxiety (rebound anxiety)
Insomnia
Irritability, mood swings
Restlessness
Mild tremors or shaky hands
Sweating
Elevated heart rate and blood pressure
Muscle stiffness, sensitivity to light/sound
Nausea, loss of appetite
Peak Symptoms (48 hours – 1 week)
Severe anxiety, panic
Depersonalization, derealization
Hyperreflexia (exaggerated reflexes)
Visible tremors
Severe nausea, vomiting, dry heaving
Headaches, increased sweating and chills
Muscle twitching and jerks
Difficulty concentrating (“brain fog”)
Visual and perceptual distortions, general dysphoria
Severe or Complicated Symptoms (3-7 days)
Seizures (especially if withdrawal is abrupt or from high doses)
Hallucinations (auditory and visual)
Paranoia, delusions, disorientation
Delirium tremens (DTs), characterized by fever, severe agitation, hallucinations, and intense confusion
Note: Short-acting benzodiazepines (e.g., Xanax, Ativan) often intensify withdrawal symptoms, increasing seizure risk and severity.
Chronic benzodiazepine withdrawal (PAWS) remains less recognized and understood by the medical community but is increasingly acknowledged in clinical practice.
Neurological/Cognitive Symptoms
Persistent brain fog
Memory issues, poor concentration
Depersonalization/derealization
Brain zaps, head pressure, dizziness
Hypersensitivity to lights, sounds
Tinnitus (ringing ears)
Chronic akathisia (persistent inner restlessness)
Psychiatric Symptoms
Chronic anxiety, panic
Persistent depression, anhedonia (lack of pleasure)
Intrusive thoughts, obsessive-compulsive behaviors
Insomnia, emotional numbness or hyper-excitability
Autonomic Dysfunction
Temperature dysregulation (hot/cold flashes, sweating)
Heart palpitations, blood pressure fluctuations
Air hunger, shortness of breath
Gastrointestinal Symptoms
Persistent nausea, bloating, IBS-like symptoms
Constipation, diarrhea, acid reflux
Musculoskeletal Symptoms
Chronic muscle pain, stiffness
Twitching, burning, tingling sensations
Internal vibrations, shaking sensations
Fatigue, muscle jerks
Inflammatory and Flu-like Symptoms
Random flu-like discomfort, aches, mild fevers
Histamine intolerance, new allergies
Joint pain, stiffness (similar to autoimmune conditions)
Hormonal and Metabolic Symptoms
Adrenal surges, panic episodes
Cortisol imbalance (morning anxiety, fatigue)
Sexual dysfunction, blood sugar irregularities
Duration varies widely: weeks, months, or even years.
Triggers include stress, caffeine, alcohol, certain medications, poor sleep, and physical exertion.
Chronic withdrawal is real, though not yet officially recognized by major medical frameworks (ICD or DSM).
Long-term benzodiazepine use, particularly at high doses or short-acting varieties, significantly increases chronic withdrawal risk.
Similar withdrawal syndromes appear in patients discontinuing SSRIs and antipsychotics (psychotropic withdrawal symptom complex).
Understanding acute vs. chronic benzodiazepine withdrawals is crucial for patient care, communication with healthcare providers, and overall mental and physical health management. Awareness, validation, and patience are key in navigating these complex withdrawal processes.
Thank you for staying with this detailed discussion. If you found this helpful, please like, subscribe, and share.
See you next time!