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Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications
- Source :
- Psychotherapy and Psychosomatics. 89:283-306
- Publication Year :
- 2020
- Publisher :
- S. Karger AG, 2020.
-
Abstract
- Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. 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 [Psychother Psychosom. 2015;84(2):63–71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. 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. 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. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. 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. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. 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.
- Subjects :
- medicine.medical_specialty
SEROTONIN REUPTAKE INHIBITOR
cognitive-behavioral therapy
rebound insomnia
Serotonin noradrenaline reuptake inhibitor
medicine.drug_class
medicine.medical_treatment
Serotonin reuptake inhibitor
Nonbenzodiazepine
Antidepressant
GENERALIZED ANXIETY DISORDER
Discontinuation
Lithium
Antipsychotic
DOUBLE-BLIND
03 medical and health sciences
DOSE BENZODIAZEPINE USE
0302 clinical medicine
Mood stabilizers
Internal medicine
medicine
Humans
long-term treatment
030212 general & internal medicine
DOPAMINE SUPERSENSITIVITY PSYCHOSIS
Applied Psychology
Randomized Controlled Trials as Topic
Psychotropic Drugs
TREATMENT-RESISTANT SCHIZOPHRENIA
Benzodiazepine
selective serotonin reuptake inhibitor
tolerance
withdrawal
ATYPICAL ANTIPSYCHOTICS
business.industry
Mental Disorders
Lorazepam
General Medicine
Substance Withdrawal Syndrome
030227 psychiatry
Psychiatry and Mental health
Clinical Psychology
Alprazolam
business
medicine.drug
Subjects
Details
- ISSN :
- 14230348 and 00333190
- Volume :
- 89
- Database :
- OpenAIRE
- Journal :
- Psychotherapy and Psychosomatics
- Accession number :
- edsair.doi.dedup.....c1cb02df340f210cda5fcc080ad51ef4