Benzodiazepine Dependence

Abstract

This review concentrates on papers published 1983–1988 on the topic of benzodiazepine dependence. A number of related syndromes may follow discontinuation of benzodiazepine use. Rebound is the worsening of insomnia, anxiety or tension above pretreatment levels, particularly noticeable on discontinuation of short-acting benzodiazepines. Tapering the dose is advisable. Normal-dose dependence is characterized by a wide range of symptoms even after gradual discontinuation. Perceptual symptoms are characteristic. The syndrome is more severe in patients attempting to discontinue lorazepam than those stopping diazepam and more fail to discontinue. Alprazolam is also presenting especial difficulties and may not be fully cross-tolerant with other benzodiazepines. The management of withdrawal centres on the use of flexible withdrawal schedules together with unstinting psychological support. High-dose dependence and abuse are uncommon but increasing, particularly among polydrug abusers. The clinical and research implications of these studies are discussed.