Panic attacks and major depression after discontinuation of long-term diazepam abuse

A case is described of a patient with a history of several years of diazepam abuse (in the last 24 months at dosages of 120 mg/d). A tapering schedule was carried out during a 12-day stay in the hospital in which the diazepam dosage was reduced by a fixed quantity every day, corresponding to about ten percent of the initial dosage. Five days after discharge from the hospital the patient experienced panic attacks, for the first time, which continued until 13 days after discharge. By the 40th day, the patient was experiencing a major depressive episode, which improved after administration of clomipramine therapy. We suggest that a relatively quick withdrawal schedule (ten percent per day) is probably inadequate in preventing withdrawal reactions to long-acting benzodiazepines taken in high doses for an extended period of time.