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Symptoms

Anxiety	Somatic symptoms of anxiety
Depressed mood	Depersonalisation, derealisation
Sleep disturbance	Hypersensitivity to touch, pain
Tremor, shakiness	Paranoid reaction
Headache	Muscular aches, pains, twitches
Convulsions

Management

• Usually manageable as an outpatient, with frequent supervision
• Inpatient care for high doses, previous seizures, psychosis
• Dose must be tapered, usually over several weeks depending on the initial dose, and titrated according to withdrawal symptoms
• Taper in steps of 2 mg diazepam equivalent daily (or slower, if not coping)
• Enquire about increased alcohol or nicotine consumption during withdrawal
• Watch for emergent depression, relationship difficulties
• Implement relaxation, cognitive techniques if these are not already in place
• Use self-help groups where available
• Educate patients about withdrawal
• Maintain close contact with patient during the withdrawal phase.

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