International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 5, Issue 2 | Case Report | Open Access DOI
Qasim Zia*
Qasim Zia1#*, Amana Qayum2#, Omer Ismail Khalid3, Muhammad Zaki ud Din4, Junaid Iqbal5, Muhammad Sheeraz6, Hafiz Raees Imtiaz Sindhu7, Muhammad Nabeegh Khan8, Muhammad Salman Khan9
1Ibne Seina Hospital & Research Institute, MMDC, Multan
2Sofia Medical University, Bulgaria
3Arrahma Hospital for Mental Health, Multan
4Ibne Seina Hospital & Research Institute, MMDC, Multan
5Ibne Seina Hospital & Research Institute, MMDC, Multan
6Nishtar Medical University, Multan
7Saeed Medicare Hospital, Mian Channu
8Nishtar Medical University, Multan
9Ibne Seina Hospital & Research Institute, MMDC, Multan
#First Authorship holders
Fulltext PDFBackground: Benzodiazepines are widely used for the acute management of anxiety due to rapid onset of action, but prolonged or unsupervised use carries substantial risk of tolerance, physiological dependence, and withdrawal. Rebound symptoms may closely mimic treatment-resistant anxiety, especially in patients with pre-existing generalized anxiety disorder (GAD). In regions with lax prescription oversight, such as Pakistan, benzodiazepine misuse is a growing clinical concern.
Case Presentation: We report a 27-year-old male with a previous diagnosis of GAD, medication-free for one year, who presented with dizziness, panic-like episodes, and anxiety. Initial treatment with alprazolam for two months resulted in dependence, evidenced by panic attacks and autonomic symptoms when doses were missed. He was subsequently trialed on paroxetine for three weeks, followed by venlafaxine, with adjunctive quetiapine at night and clonazepam. With this regimen and structured monitoring, the patient achieved stabilization.
Conclusion: This case illustrates how benzodiazepine dependence can masquerade as treatment-resistant anxiety in patients with GAD. Comprehensive assessment, recognition of withdrawal and rebound phenomena, careful pharmacological strategy, and incorporation of psychotherapy are essential for achieving clinical stability.
Benzodiazepine dependence; Generalized anxiety disorder; Treatment-resistant anxiety; Venlafaxine; Clonazepam; Quetiapine; Pakistan
Qasim Zia, Amana Qayum, Omer Ismail Khalid, Muhammad Zaki ud Din, Junaid Iqbal, Muhammad Sheeraz, Hafiz Raees Imtiaz Sindhu, Muhammad Nabeegh Khan, Muhammad Salman Khan. Benzodiazepine Dependence Presenting as Treatment-Resistant Anxiety in a 27-Year-Old Male with Generalized Anxiety Disorder: A Case Report from Pakistan. Int Clinc Med Case Rep Jour. 2026;5(2):1-6.