Withdrawing Benzodiazepines in Patients With Anxiety Disorders

Lader, Malcolm; Kyriacou, Andri

doi:10.1007/s11920-015-0642-5

Cited by 57 publications

(45 citation statements)

References 70 publications

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“…Benzodiazepine discontinuation is known to produce minor as well as major new withdrawal symptoms. Table 4 reports most frequent minor new withdrawal symptoms [37][38][39][40][41], among them sweating, tachycardia, nausea, visual changes, tremor, confusion, restlessness. Major withdrawal symptoms, such as seizure [42,43] and psychosis [43], are rare.…”

Section: New Withdrawal Symptoms After Benzodiazepine Discontinuationmentioning

confidence: 99%

“…Management of Benzodiazepine Discontinuation Slow tapering, often extending over a year or more, has been suggested to manage new withdrawal symptoms [78]. However, even a more flexible tapering at a rate that the patient can tolerate, typically in about 3-6 months, has shown to be appropriate [37]. Some authors suggested tapering from other BZDs such as lorazepam after substituting diazepam [79], according to Murphy and Tyrer [80] such substitution has shown little evidence to support its efficacy.…”

Section: Associated Clinical Manifestationsmentioning

confidence: 99%

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Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Cosci

Chouinard

2020

Psychother Psychosom

187

184

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Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015; 84 (2): 63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be shortlived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.

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Section: New Withdrawal Symptoms After Benzodiazepine Discontinuationmentioning

confidence: 99%

Section: Associated Clinical Manifestationsmentioning

confidence: 99%

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Cosci

Chouinard

2020

Psychother Psychosom

187

184

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“…The prevalence of mood and anxiety disorders including posttraumatic stress disorder (PTSD), panic disorder, and generalized anxiety disorders underscores the critical need for innovative treatment approaches for this class of disorders. The current primary treatment for these disorders produces a delayed onset of action with modest therapeutic benefits and significant adverse effects (3), while the chronic use of the fast-acting benzodiazepines treatment can cause potentially significant adverse effects (4–6). …”

Section: Introductionmentioning

confidence: 99%

Functional Redundancy Between Canonical Endocannabinoid Signaling Systems in the Modulation of Anxiety

Bedse

Hartley

Neale

et al. 2017

Biological Psychiatry

102

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Background Increasing the available repertoire of effective treatments for mood and anxiety disorders represents a critical unmet need. Pharmacological augmentation of endogenous cannabinoid (eCB) signaling has been suggested to represent a novel approach to the treatment of anxiety disorders; however, the functional interactions between two canonical eCB pathways mediated via anandamide (AEA) and 2-arachidonoylglycerol (2-AG) in the regulation of anxiety are not well understood. Methods We utilized pharmacological augmentation and depletion combined with behavioral and electrophysiological approaches to probe the role of 2-AG signaling in the modulation of stress-induced anxiety, and the functional redundancy between AEA and 2-AG signaling in the modulation of anxiety-like behaviors in mice. Results Selective 2-AG augmentation reduced anxiety in the light-dark box assay, and prevented stress-induced increases in anxiety associated with limbic AEA deficiency. In contrast, acute 2-AG depletion increased anxiety-like behaviors, which was normalized by selective pharmacological augmentation of AEA signaling and via direct CB1 receptor stimulation with tetrahydrocannabinol (THC). Electrophysiological studies revealed 2-AG modulation of amygdala glutamatergic transmission as a key synaptic correlate of the anxiolytic effects of 2-AG augmentation. Conclusions Although AEA and 2-AG likely subserve distinct physiological roles, a pharmacological and functional redundancy between these canonical eCB signaling pathways exists in the modulation of anxiety-like behaviors. These data support development of eCB-based treatment approaches for mood and anxiety disorders and suggest a potentially wider therapeutic overlap between AEA and 2-AG augmentation approaches than previously appreciated.

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“…There is synergism between these two respiratory depressants (National Institute on Drug Abuse, 2018), which has been implicated in the drug-related mortality increase seen by emergency departments in the United States (Gomes, Mamdani, Dhalla, Paterson, & Juurlink, 2011). As with opioids, BZDs are addictive (Lader & Kyriacou, 2016). Withdrawal symptoms can occur following abrupt cessation of the drug after only 3 to 4 weeks of regular use (Brett & Murnion, 2015).…”

Section: Benzodiazepinesmentioning

confidence: 99%