Can withdrawal after long-term benzodiazepine or Z-drug use persist for weeks and affect cognition and mood?

Long-term exposure to benzodiazepines—and less certainly Z-drugs—can produce symptoms that extend well beyond the conventionally acute withdrawal period. In a 77-year-old, new cognitive or emotional deterioration over weeks merits prompt clinical assessment rather than being attributed to withdrawal alone.

Clinical course and effectiveness of the claim

• The 2025 ASAM-led guideline recognizes protracted benzodiazepine-withdrawal symptoms lasting months and, in some individuals, years after discontinuation.
• A scoping review of 46 cessation studies found symptoms continuing or emerging beyond 4 weeks in 27 studies; 28 studies reported protracted symptom signals including anxiety, mood disturbance, insomnia, impaired memory, concentration, attention, processing speed, and psychomotor function.
• Therefore, deterioration developing across several weeks remains temporally compatible with a withdrawal-related course after long-term benzodiazepine use. This is not a universal trajectory: older-adult taper studies have also found subtle cognitive improvement or fewer depressive symptoms at follow-up, with anxiety often not worsening.
• The corresponding evidence for Z-drugs is less robust. Standard-dose zolpidem discontinuation usually produces short-lived rebound insomnia, whereas more severe withdrawal reports largely involve prolonged high-dose use or abrupt cessation.

Mechanistic interpretation

• Chronic benzodiazepine exposure is associated with compensatory adaptation in inhibitory GABAergic and excitatory glutamatergic systems.
• Reducing or stopping the drug may leave relatively diminished inhibition and central nervous-system hyperexcitability, a biologically plausible explanation for persistent anxiety, sleep disruption, emotional lability, and cognitive complaints after the drug has cleared.

Clinical implications

• Timing is compatible with withdrawal neuroadaptation but does not establish individual causation. Recurrence of anxiety or insomnia, depression, sleep deprivation, medical illness, and concurrent medicines can produce similar changes.
• Avoid abrupt discontinuation when dependence is likely. Symptom-monitored, individualized tapering—often initial reductions of 5–10% every 2–4 weeks—plus assessment for alternative causes is appropriate.

Bottom line

• Persistent or delayed cognitive and emotional symptoms can fit protracted benzodiazepine withdrawal and its proposed neuroadaptation, but require careful clinical evaluation rather than presumptive attribution.