may not develop for more than 1 week, peak in  intensity during the second week, and de-
crease markedly during the third or fourth week. There may be additional longer-term
symptoms at a much lower level of inte nsity that persist for several months.
The longer the substance has been taken and the higher the dosages used, the more likely
it is that there will be severe withdrawal. However, withdrawal has been reported with as little
as 15 mg of diazepam (or its eq uivalent in other benzodiazepines) when taken daily for several
months. Doses of approximately 40 mg of diazepa m (or its equivalent) daily are more likely to
produce clinically relevant withdrawal symptoms, and even higher doses (e.g., 100 mg of di-
azepam) are more likely to be followed by withdrawal seizures or delirium. Sedative, hyp-
notic, or anxiolytic withdrawal delirium is ch aracterized by disturbances in consciousness and
cognition, with visual, tactile, or auditory ha llucinations. When present, sedative, hypnotic, or
anxiolytic withdrawal delirium should be diagnosed instead of withdrawal.
Prevalence 
The prevalence of sedative, hypnotic, or anxiolytic withdrawal is unclear. 
Diagnostic Markers
Seizures and autonomic instability in the setting of a history of prolonged exposure to sed-
ative, hypnotic, or anxiolytic medications su ggest a high likelihood of sedative, hypnotic,
or anxiolytic withdrawal. 
Differential Diagnosis
Other medical disorders. The symptoms of sedative, hypnotic, or anxiolytic with-
drawal may be mimicked by other medical cond itions (e.g., hypoglyc emia, diabetic keto-