Sudden discontinuation of which of the following drugs can cause agitation, anxiety and insomnia?
First, I should recall drugs that can cause withdrawal symptoms when stopped abruptly. Common ones include benzodiazepines, barbiturates, and maybe some antidepressants. Let's break it down.
Benzodiazepines are known for causing withdrawal symptoms like agitation, anxiety, and insomnia. They work by enhancing GABA activity. Sudden discontinuation can lead to a rebound effect because the body has adapted to the drug. The GABA system becomes less sensitive, so when the drug is stopped, the person experiences the opposite effects—agitation and anxiety.
Other drugs like beta-blockers can cause rebound hypertension, but that's not the symptoms here. Antidepressants like SSRIs might cause discontinuation syndrome with symptoms like dizziness, fatigue, but not typically the acute symptoms mentioned. Antipsychotics can cause withdrawal delirium, but again, different symptoms.
So the correct answer is likely a benzodiazepine. The options might be drugs like diazepam, alprazolam, etc. The wrong options could include beta-blockers, SSRIs, or antipsychotics. Each of these incorrect options would have different withdrawal symptoms. For example, beta-blockers cause rebound tachycardia, SSRIs have a different set of symptoms, and antipsychotics might lead to withdrawal delirium or extrapyramidal symptoms.
The clinical pearl here is that benzodiazepines require gradual tapering to prevent withdrawal symptoms. This is a high-yield fact for exams like NEET PG or USMLE. Students often confuse the withdrawal symptoms of different drug classes, so emphasizing the key points about benzodiazepines is important.
**Core Concept**
Sudden discontinuation of **benzodiazepines** can lead to withdrawal symptoms like agitation, anxiety, and insomnia due to **GABAergic receptor hypersensitivity**. These drugs enhance GABA activity, and abrupt cessation results in a rebound excitation of the central nervous system.
**Why the Correct Answer is Right**
Benzodiazepines (e.g., alprazolam, diazepam) act on **GABA-A receptors**, potentiating inhibitory neurotransmission. Chronic use causes downregulation of GABA receptors. Sudden withdrawal leads to **rebound kindling**, where the CNS becomes hyperexcitable, manifesting as insomnia, anxiety, and autonomic hyperactivity. Tapering is essential to prevent this.
**Why Each Wrong Option is Incorrect**
**Option A:** Beta-blockers (e.g., propranolol) cause **rebound tachycardia/hypertension**, not psychiatric symptoms.
**Option B:** SSRIs (e.g., sertraline) induce **discontinuation syndrome** with dizziness and flu-like symptoms, not acute agitation.
**Option C:** Antipsychotics (e.g., haloperidol) may cause **withdrawal delirium**, but symptoms are distinct (confusion, dystonia).
**Clinical Pearl / High-Yield Fact**
Always taper benzodiazepines gradually to avoid withdrawal. Remember **"BZD bounce"**: anxiety