Third, persistent post-withdrawal disorders (Table 3) are a set of long-lasting, severe, potentially irreversible symptoms which entitle rebound primary symptoms or primary disorder at greater intensity and/or new withdrawal symptoms and/or new symptoms or disorders that were not present before treatment. Second, rebound symptoms (Table 2) are short-lasting, transient, reversible symptoms which represent a rapid return of the primary symptoms usually at a greater intensity than before treatment. New symptoms are usually the same, common to all psychotropic medications during withdrawal (e.g., nausea, headaches, sleep disturbances), but also specific and unique for a drug class (e.g., specific serotonin-related symptoms: flu-like symptoms, diarrhea, confusion). First, new withdrawal symptoms (Table 1) are usually short-lasting, transient, reversible symptoms, which are new to the patient. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.īased on the literature, Chouinard and Chouinard proposed in 2015 3 types of withdrawal syndromes for psychotropic medications: new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders (Tables 1- 3). Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived.
All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard, which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes.
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