This report summarizes pertinent biochemical, pharmacological and clinical information on the effects of abrupt cessation of benzodiazepine therapy. The need to discriminate between distress (anxiety) due to recurrences, rebound phenomena and withdrawal syndromes is emphasized. Although the longer-acting benzodiazepines are less likely to be followed by serious withdrawal reactions, abrupt cessation of drug administration in any dependent high-dose patient should be avoided.
References
1.
DeutschJ.A., WaltonN.Y.Diazepam maintenance of alcohol preference during alcohol withdrawal.Science1977; 198: 307–309.
2.
HollisterL.E., MotzenbeckerF.P., DeganR.O.Withdrawal reactions from chlordiazepoxide (Librium).Psychopharmacologia1961; 2: 63–68.
3.
ShaderR.I., GreenblattD.J.Clinical implications of benzodiazepines pharmacokinetics.Am J Psychiatry1977; 134: 652–656.
4.
DeAngelisL., TraversaU., VertuaR.Structure-activity relationships within the class of 1,4-benzodiazepines: presence of chlorine and central nervous system activities.Curr Ther Res1974; 16: 324–337.
5.
KaplanS.A., JackM.L., WeinfeldR.E., GloverW., WeissmanL., CotlerS.Biopharmaceutical and clinical pharmacokinetic profile of bromazepam.J Pharmacokinet Biopharm1976; 4: 1–16.
6.
CookL., DavidsonA.B.Effects of behaviourally active drugs in a conflict-punishment procedure in rats. In: GarattiniS. ed. The benzodiazepines.New York: Raven Press, 1973.
7.
RastogiR.B., LapierreY.D., SinghaiR.L.Effect of a new benzodiazepine, bromazepam, on locomotor performance and brain monoamine metabolism.J Neurol Transm1978; 42: 251–261.
8.
HaefelyW.E.Biological basis of the therapeutic effects of benzodiazepines. Communication at 1st International Symposium, Benzodiazepines Today and Tomorrow. Rio de Janeiro, September 1979.
9.
RastogiR.B.LapierreY.D., SinghaiR.L.Evidence for the role of norepinephrine and dopamine in rebound phenomenon seen during withdrawal after repeated exposure to benzodiazepines.J Psychiatr Res1976; 13: 65–75.
10.
MohlerH., OkadaT.Benzodiazepine receptor: demonstration in the central nervous system.Science1977; 198: 849–851.
11.
HollisterL.E.Withdrawal from benzodiazepam therapy.JAMA1977; 237: 1432.
LapierreY.D., TremblayA., GagnonA., MonpremierP., KumaranayakeV.A therapeutic and discontinuation study of clobazam and diazepam in anxiety neurosis.In Preparation.
14.
HannaS.M.A case of oxazepam (Serenid D) dependence.Br J Psychiatry1972; 120: 443–445.
15.
MendelsonG.Withdrawal reactions after oxazepam.Lancet1978; II: 565.
16.
AgrawalP.Diazepam addiction: a case report.Can Psychiatr Assoc J1978; 23: 35–37.
17.
FoxR.Abuse of benzodiazepines.Lancet1978; II: 681–682.
18.
PreskornS.H., DennerL.J.Benzodiazepines and withdrawal psychosis: report of three cases.JAMA1977; 237: 36–38.
19.
MoireS.J., SellersE.M.Use of drugs with dependence liability.Can Med Assoc J1979; 121: 717–723, 22 Sept.
