In susceptible patients, however, the short half-life may precipitate withdrawal symptoms similar to panic every time the patient tries to discontinue the medication. Thus, a vicious cycle is set up for the patient. A decline in sales may prompt drug manufacturers to extend indications for benzodiazepines to areas other than those already approved. The alcoholic in remission who presents with anxiety must be carefully evaluated as to the cause of the anxiety. Many times, the anxiety is related to a recent detoxification or possibly a manifestation of an underlying depression.
Depression often masquerades as anxiety.
A benzodiazepine will not help depression and may even worsen it. The earliest report of serious withdrawal reactions from chlorodiazepoxide, the first benzodiazepine on the market, appeared within months of the introduction of the medication.12 Many subsequent journal articles and presentations at meetings have confirmed the potential for prolonged and serious withdrawal states with benzodiazepines of various types. As Busto and his group reported, long-term use of benzodiazepines in therapeutic doses can lead to a definite withdrawal syndrome.13 High doses of benzodiazepines are not necessary for the complication, and withdrawal may occur after as little as 2 weeks of use.14 Withdrawal symptoms include, but are not limited to, anxiety, insomnia, headaches, irritability, fatigue, muscular twitches, spasms, tremors, and shakiness. Patients may also experience sweats, dizziness, and difficulty concentrating. Depression, nausea, and loss of appetite also may occur, as well as symptoms of depersonalization and derealization.