Table 1.
Published reports of benzodiazepine withdrawal catatonia
| Study | Age | Gender | Psychiatric/neurologic diagnoses | Benzodiazepine use | Diazepam equivalents (per 24 h) | Duration of use | Time until symptoms | Psychotic symptoms | Autonomic symptoms | Successful treatment | Time to response | Scale Used for Diagnosis | DSM-V Criteria Met |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Hauser et al.32 | 29 | M | Complex partial seizures | Clorazepate 45 mg daily | 30 mg | Not specified | 3 days | Yes (hallucinations) | No | Diazepam, clorazepate | 15 min | No | Yes |
| 30 | F | Complex partial seizures, depression | Clonazepam 4 mg daily | 80 mg | Not specified | 3 days | Yes (hallucinations, delusions) | No | Lorazepam | Immidiate | No | Yes | |
| Rapport and Covington33 | 70 | F | Not specified | Diazepam 30 mg daily, alprazolam (dose unknown) | 30 mg (for diazepam) | Diazepam: 4 years alprazolam: 6 months | 7 days | Yes (hallucinations, delusions) | No | Lorazepam | “Minutes” | No | Yes |
| Rosebush and Mazurek34 | 88 | M | Nil | Clonazepam 1.5 mg daily | 30 mg | 15 years | 5 days | Yes (hallucinations) | Yes (tachycardia) | Lorazepam | 45 min | No | Yes |
| 70 | M | Major depressive disorder with psychosis | Alprazolam 2 mg daily | 40 mg | 6 months | 4 days | No | Yes (elevated blood pressure) | Lorazepam | 1 h | No | Yes | |
| 66 | F | Bipolar disorder, alcohol abuse, benzodiazepine abuse | Oxazepam (dosage unknown), temazepam (dosage unknown), lorazepam 4 mg daily (started for a 2-week course) | 40 mg (for lorazepam) | 10 years | 7 days after lorazepam decrease from 4 mg to 1 mg daily | No | Yes (elevated blood pressure, tachycardia, diaphoresis) | Lorazepam | 30 min | No | No | |
| 53 | F | Nil | Diazepam 40−60 mg daily | 40−60 mg (mean = 50 mg) | 15 years | 2 days | No | No | Lorazepam | Not specified | No | Yes | |
| 63 | F | Major depressive disorder, anxiety disorder | Diazepam 30 mg daily | 30 mg | 20 years | 3 days | No | No | Lorazepam | 1 h | No | Yes | |
| Carroll35 | 42 | F | Major depressive disorder, panic disorder | Lorazepam 1 mg TID (taking up to 7 mg daily), meprobamate 400 mg TID (taking up to 2400 mg daily) | 30−70 mg (for lorazepam) (mean = 50 mg) | Not specified | 7 days | Yes (hallucinations) | No | Lorazepam, diazepam | Not specified | No | Yes |
| Glover et al.36 | 62 | M | Schizophrenia | Lorazepam 0.5 mg BID | 10 mg | Not specified | 2 days | Active psychosis prior to benzodiazepam discontinuation and onset of catatonia | No | Lorazepam | 2 h | No | Yes |
| Deuschle and Lederbogen37 | 51 | M | Chronic fatigue and insomnia | Bromazepam 18 mg daily | 30−36 mg (mean = 33 mg) | 9 years | 5 days | Yes (hallucinations, delusions) | No | Lorazepam | 4 h | No | Yes |
| Carroll et al.38 | 61 | M | Anxiety disorder | Diazepam 5 mg TID | 15 mg | Not specified | Not specified | Yes (delusions) | Yes (elevated blood pressure, tachycardia) | Lorazepam | 1 h | Yes (BFCRS) | Yes |
| Brown and Freeman39 | 60 | M | Post-traumatic stress disorder, major depressive disorder, anxiety disorder—not otherwise specified | Clonazepam 2 mg TID | 120 mg | Not specified | 7 days | No | Yes (fever, elevated blood pressure, tachycardia, diaphoresis) | Lorazepam, clonazepam | “Immediate” | No | Yes |
| Lauterbach et al.40 | 39 | M | Neurosyphilis | Temazepam 30 mg daily, lorazepam 1−3 mg PRN | 15 mg (for temazepam), 10−30 mg (for lorazepam) (mean = 20 mg) | Temazepam: 34 days, lorazepam: 3 days | 5 days after temazepam discontinuation, 2 days after last lorazepam dose | Active psychosis prior to benzodiazepam discontinuation and onset of catatonia | No | Lorazepam | 48 h | No | Yes |
| Carroll et al.41 | 64 | F | Dysthymia | Lorazepam 5 mg daily | 50 mg | 6 months | “Immediately” | No | No | Lorazepam | “Hours” | No | No |
| Parameswaran et al.42 | 73 | F | Nil | Temazepam 40 mg daily | 20 mg | 40 years | 4 days after dose decrease to 20 mg | No | No | Midazolam | “Rapid” | No | Yes |
| Amos43 | 59 | F | Depression, anxiety | Lorazepam, 4 mg daily | 40 mg | Not specified | 3 days | No | Yes (fever, tachycardia) | Lorazepam | 5 min | Yes (BFCRS) | Yes |
| Wang et al.44 | 39 | F | Schizophrenia | Lorazepam 2 mg daily | 20 mg | Not specified | 2 days | Yes (hallucinations, delusions) | No | Lorazepam | Not specified | Yes (BFCRS) | Yes |
| Sivakumar et al.45 | 57 | M | Depression | Lorazepam 2 mg daily | 20 mg | 7 years | 2 days | No | No | Lorazepam | Not specified | Yes (BFCRS) | Yes |
| Saddawi-Konefka et al.46 | 78 | F | Depression, anxiety | Alprazolam 0.5 mg TID | 30 mg | 40 years | 4 days | No | No | Lorazepam | 15 min | No | Yes |
| 77 | F | Depression, anxiety, panic disorder | Chlordiazepoxide (dose unknown) | Dose unknown | 15 years+ | 3 days | No | No | Lorazepam | 1 day | No | Yes | |
| Holoyda and Xiong47 | 31 | M | Insomnia, anxiety | Alprazolam 3 mg daily | 60 mg | 2 years | 3 days | Yes (hallucinations, thought disorder) | Yes (elevated blood pressure) | Lorazepam | 15 min | Yes (BFCRS) | Yes |
| Oldham and Desan28 | 62 | F | Major depressive disorder, unspecified anxiety disorder, minor neurocognitive disorder, fibromyalgia | Clonazepam 1 mg daily | 20 mg | 2 years | 8 days | No | No | Clonazepam | “Hours” | Yes (BFCRS) | Yes |
| Peng et al.48 | 61 | F | Anxiety | Lorazepam 2 mg daily | 20 mg | Not specified | 3 days | No | Yes (elevated blood pressure, tachycardia) | Midazolam, lorazepam | “Minutes” | No | No |