Immediate Warning

Benzodiazepine withdrawal can be dangerous and potentially life-threatening.
Abruptly stopping these medications—especially after regular or high-dose use—may trigger severe symptoms such as panic attacks, extreme anxiety, confusion, hallucinations, seizures, or heart palpitations.

If someone is experiencing withdrawal symptoms or has recently discontinued benzodiazepines suddenly, seek emergency medical care right away.
Never attempt to stop benzodiazepine use “cold turkey.” Safe discontinuation requires medical supervision, ideally through a physician-guided taper or a medically monitored detoxification program.

Understanding Benzodiazepines

Benzodiazepines (often called “benzos”) are a class of psychoactive medications primarily prescribed for their anxiolytic, sedative, anticonvulsant, and muscle-relaxant properties. They act as central nervous system (CNS) depressants, helping to calm overactive brain activity.

Mechanism of Action

Benzodiazepines work by enhancing the effect of gamma-aminobutyric acid (GABA)—a neurotransmitter that inhibits excessive neural firing and promotes relaxation. By binding to the GABA-A receptor complex, benzodiazepines increase GABA’s inhibitory influence, resulting in reduced anxiety, muscle relaxation, and sedation.¹

When used over time, however, the brain adapts to this externally enhanced inhibition. The GABA system becomes downregulated, and other excitatory neurotransmitters, such as glutamate, may increase to compensate. This neuroadaptation explains why abrupt discontinuation can lead to hyperexcitability of the nervous system, the foundation of benzodiazepine withdrawal syndrome.¹

Commonly Prescribed Benzodiazepines

• Alprazolam (Xanax®)

• Diazepam (Valium®)

• Lorazepam (Ativan®)

• Clonazepam (Klonopin®)

• Temazepam (Restoril®)

• Chlordiazepoxide (Librium®)

  
  

These medications are typically used for conditions such as generalized anxiety disorder, panic disorder, insomnia, muscle spasms, and seizure disorders. When prescribed and monitored appropriately, benzodiazepines can be effective short-term treatments—but long-term use often increases the risk of tolerance, dependence, and withdrawal.

Benzodiazepine Misuse and Dependence

While benzodiazepines have legitimate medical uses, they also have significant potential for misuse and addiction. The calming and euphoric effects can be reinforcing, leading individuals to take higher or more frequent doses than prescribed.

Dependence can develop in as little as a few weeks of regular use, particularly with potent or short-acting agents like alprazolam.² Chronic exposure results in both physiological (the user believes they need the medication to function or craves the medication).

Overprescription and Illicit Use

Over the past two decades, benzodiazepines have been widely prescribed, sometimes in combination with opioids or alcohol—both of which are also CNS depressants. This combination significantly increases the risk of respiratory depression, coma, and fatal overdose.
According to data from the National Institute on Drug Abuse (NIDA), benzodiazepines were involved in roughly 14% of opioid overdose deaths in the United States in 2021.³

Even in the absence of misuse, physical dependence can occur during routine treatment, meaning that withdrawal symptoms may emerge even when the medication was taken as directed.

Benzodiazepine Withdrawal: Symptoms and Timeline

When an individual who has developed physiological dependence abruptly reduces or discontinues benzodiazepine use, the central nervous system—suddenly deprived of GABAergic support—enters a state of overstimulation. The resulting withdrawal syndrome can range from mild anxiety to severe medical crises.

Common Withdrawal Symptoms

• Tremors or muscle twitching

• Anxiety, panic attacks, or restlessness

• Sweating, chills, or fever-like sensations

• Headaches and dizziness

• Nausea or vomiting

• Insomnia or vivid dreams

• Sensory hypersensitivity (light, sound, touch)

• Depersonalization or derealization

• Irritability, mood swings, or depression

• Difficulty concentrating or cognitive fog

• Heart palpitations or elevated blood pressure

Severe and Potentially Life-Threatening Symptoms

• Seizures (particularly with abrupt discontinuation)

• Hallucinations or psychotic episodes

• Severe confusion or delirium

• Suicidal thoughts or extreme agitation

These symptoms reflect the nervous system’s hyperactivity once GABAergic inhibition is suddenly withdrawn.⁷

Typical Withdrawal Timeline

The exact timeline varies depending on factors such as the specific drug, dosage, duration of use, and individual physiology. However, general patterns include:

It is important to note that withdrawal duration does not necessarily correlate with severity—even short-term users can experience serious reactions.^8,9,10

Risk and Mitigating Factors

Several variables influence both the likelihood and severity of benzodiazepine withdrawal:

1. Duration and Dosage of Use

   
   Longer periods of use and higher doses increase physiological dependence and make withdrawal more complex.

   
   

2. Pharmacologic Profile

   
   Short-acting benzodiazepines (e.g., alprazolam) produce faster-onset and more intense withdrawal than long-acting ones (e.g., diazepam), which leave the system more gradually.

   
   

3. Method of Discontinuation

   
   Abrupt cessation—especially after chronic use—is the most dangerous approach. Gradual dose tapering under medical supervision is strongly recommended.

   
   

4. Co-Use of Other Substances

   
   Concurrent use of alcohol, opioids, or other sedatives heightens dependence risk and complicates withdrawal management.

   
   

5. Individual Health Factors

   
   Age, liver function, metabolic rate, and the presence of co-occurring psychiatric or medical conditions (e.g., anxiety disorders, depression, or epilepsy) can all impact symptom presentation and severity.¹¹

Treatment and Recovery

Medical Management of Acute Withdrawal

Individuals showing severe or unpredictable withdrawal symptoms should present to an emergency department. Acute management often includes¹²:

• Benzodiazepine taper substitution (switching to a longer-acting agent like diazepam or clonazepam, then tapering slowly)

• Anticonvulsant therapy to prevent or treat seizures

• Beta-blockers or antihypertensives to manage autonomic hyperactivity (e.g., elevated heart rate, sweating, blood pressure)

• Psychiatric evaluation if hallucinations, psychosis, or suicidal ideation occur

  
  

Medical detoxification programs can provide 24-hour monitoring, ensuring stabilization and prevention of complications.¹²

Outpatient and Inpatient Detoxification

Individuals presenting to either an outpatient or inpatient detoxification may work with a clinical team to create a gradual, individualized taper rather than immediate cessation. This minimizes benzodiazepine withdrawal intensity and allows for gradual neurochemical adaptation.¹³

• Outpatient detox may be suitable for individuals with mild to moderate dependence and strong social support.

• Inpatient or residential programs are indicated for severe dependence, co-occurring psychiatric conditions, or lack of a stable home environment.

Psychological and Supportive Therapies

Withdrawal management is not solely pharmacologic. Psychological support plays a vital role¹³:

• Cognitive-behavioral therapy (CBT) to address anxiety, insomnia, and dependence-related behaviors

• Mindfulness-based stress reduction and relaxation training

• Peer and family support, including participation in recovery groups or counseling sessions

Post-Acute Recovery

Even after acute symptoms subside, some individuals experience lingering anxiety, depression, or cognitive symptoms. Comprehensive recovery often includes continued therapy, gradual lifestyle adjustment, and medical follow-up to monitor relapse risk and emotional stability.¹³

When to Seek Professional Help

Anyone considering discontinuation of benzodiazepines—whether prescribed or misused—should first consult a physician or addiction specialist. Warning signs that require immediate attention include:

• Severe anxiety or agitation

• Confusion or hallucinations

• Uncontrolled shaking or seizures

• Suicidal thoughts

• Irregular heartbeat or high blood pressure

  
  

Early intervention can prevent medical emergencies and improve recovery outcomes.

Conclusion

Benzodiazepine withdrawal is a complex and potentially dangerous physiological process rooted in neurochemical adaptation. While dependence can occur even under medical supervision, safe recovery is entirely possible through structured tapering and professional support.  Medical oversight, patience, and a comprehensive treatment plan remain the cornerstones of successful benzodiazepine discontinuation.

If you or someone you know is struggling with benzodiazepine dependence or withdrawal, contact a healthcare provider or call the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357) for confidential, 24-hour assistance.

References

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2. Ait-Daoud N, Hamby AS, Sharma S, Blevins D. A Review of Alprazolam Use, Misuse, and Withdrawal. J Addict Med 2018; 12:4.

3. CDC WONDER. Multiple Cause of Death 1999-2021. Centers for Disease Control and Prevention, National Center on Health Statistics. Released January 2023. Accessed January 2023.

4. Rickels K, Schweizer E, Case WG, Greenblatt DJ. Long-term therapeutic use of benzodiazepines. I. Effects of abrupt discontinuation. Arch Gen Psychiatry 1990; 47:899.

5. Petursson H, Lader MH. Withdrawal from long-term benzodiazepine treatment. Br Med J (Clin Res Ed) 1981; 283:643.

6. Tyrer P, Murphy S, Riley P. The Benzodiazepine Withdrawal Symptom Questionnaire. J Affect Disord 1990; 19:53.

7. Schöpf J. Withdrawal phenomena after long-term administration of benzodiazepines. A review of recent investigations. Pharmacopsychiatria 1983; 16:1.

8. Basińska-Szafrańska A. Delayed crises following benzodiazepine withdrawal: deficient adaptive mechanisms or simple pharmacokinetics? Detoxification assisted by serum-benzodiazepine elimination tracking. Eur J Clin Pharmacol 2022; 78:101.

9. HOLLISTER LE, MOTZENBECKER FP, DEGAN RO. Withdrawal reactions from chlordiazepoxide ("Librium"). Psychopharmacologia 1961; 2:63.

10. Pétursson H. The benzodiazepine withdrawal syndrome. Addiction 1994; 89:1455.

11. Zawilska JB, Wojcieszak J. An expanding world of new psychoactive substances-designer benzodiazepines. Neurotoxicology 2019; 73:8.

12. Kang AM. Benzodiazepine withdrawal. In: UpToDate, Connor RF (Ed), Wolters Kluwer. Accessed October 22, 2025. https://www.uptodate.com/contents/benzodiazepine-withdrawal.

13. Park TW. Benzodiazepine use disorder. In: UpToDate, Connor RF (Ed), Wolters Kluwer. Accessed October 22, 2025. https://www.uptodate.com/contents/benzodiazepine-use-disorder.