Benzodiazepine Dependence Presenting as Treatment-Resistant Anxiety in a 27-Year-Old Male with Generalized Anxiety Disorder: A Case Report from Pakistan

Background: 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.