Withdrawal
Encyclopedia
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol. In order to experience the symptoms of withdrawal, one must have first developed a physical/mental dependence (often referred to as chemical dependency). This happens after consuming one or more of these substances for a certain period of time, which is both dose dependent and varies based upon the drug consumed. For example, prolonged use of an anti-depressant is most likely to cause a much different reaction when discontinued than the repeated use of an opioid, such as heroin. In fact, the route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well. Generally, a person will start to feel worse and worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs (benzodiazepines, alcohol) can be fatal and therefore the abrupt discontinuation of any type of drug is not recommended. The term "cold turkey
" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations.
code) of withdrawal syndrome
include:
F16.1 is the ICD-10 code for withdrawal from hallucinogens (such as LSD
), but this is not currently a recognized disorder.
The term "withdrawal" can sometimes be used to describe the results of discontinuing prescription medicine, as in SSRI discontinuation syndrome
, though the term rebound effect
is also used to characterize these conditions.
Although withdrawal symptoms are often associated with the use of recreational drugs
, many drugs have a profound effect on the user when stopped. When withdrawal from any medication occurs it can be harmful or even fatal; hence prescription warning labels explicitly saying not to discontinue the drug without doctor approval.
The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition, disease, chronic pain, or sleep deprivation, conditions that drug abusers often suffer as a secondary consequence of the drug. Many drugs (including alcohol) suppress appetite while simultaneously consuming any money that might have been spent on food. When the drug is removed, the discomforts return in force and are sometimes confused with addiction withdrawal symptoms, which they quite properly are not.
is very complex and still questioned within the scientific community. While neurologists have discovered that addiction encompasses several areas of the brain, the amygdala, Prefrontal Cortex, and the nucleus accumbens
are specifically responsible for the pleasurable feelings one may experience when using a mind or mood-altering substance. Within the nucleus accumbens is the neurotransmitter dopamine
, so while specific mechanisms vary, nearly every drug either stimulates dopamine release or enhances its activity, directly or indirectly. Sustained use of the drug results in less and less stimulation of the nucleus accumbens until eventually it produces no euphoria at all. Discontinuation of the drug then produces a withdrawal syndrome characterized by dysphoria
— the opposite of euphoria — as nucleus accumbens activity declines below normal levels.
Withdrawal symptoms can vary significantly among individuals, but there are some commonalities. Subnormal activity in the nucleus accumbens is often characterized by depression
, anxiety
and craving, and if extreme can drive the individual to continue the drug despite significant harm — the definition of addiction
— or even to suicide. In general, the longer the half-life of the drug, the longer the acute abstinence syndrome is likely to last. However, with drugs with a longer half-life, the acute abstinence syndrome will be much milder than that of those with shorter half-lives.
However, addiction is to be carefully distinguished from physical dependence. Addiction is a psychological compulsion to use a drug despite harm that often persists long after all physical withdrawal symptoms have abated. On the other hand, the mere presence of even profound physical dependence does not necessarily denote addiction, e.g., in a patient using large doses of opioids to control chronic pain under medical supervision.
As the symptoms vary, some people are, for example, able to quit smoking "cold turkey
" (i.e., immediately, without any tapering off) while others may never find success despite repeated efforts. However, the length and the degree of an addiction can be indicative of the severity of withdrawal.
Withdrawal is a more serious medical issue for some substances than for others. While nicotine
withdrawal, for instance, is usually managed without medical intervention, attempting to give up a benzodiazepine
or alcohol
dependency can result in seizures and worse if not carried out properly. An instantaneous full stop to a long, constant alcohol use can lead to delirium tremens
, which may be fatal.
Additionally, benzodiazepines have clearly been shown to induce a withdrawal syndrome in some people that is often severe and protracted in course. Doctors Ashton and Lader are two separate internationally recognized contributors who researched and described this condition that is now referred to as protracted benzodiazepine withdrawal syndrome (PBWS). Noteworthy, some patients become physically dependent on a small duration and dose (therapeutically prescribed dosages) of benzodiazepines. Patients may develop physical and psychological adaptations that may manifest while taking the medications and/or up on cessation that may lead to a severe withdrawal and discontinuation syndrome (PBWS). There is no known cure for PBWS, except time (in some cases 4, 5, or perhaps 6 years or more is needed for the withdrawal symptoms to slowly fade from 'misery' to 'comfort'). Paxil (an antidepressant) and benzodiazepines share this unique phenomenon known as 'discontinuation syndrome'.
Although a distinguishing characteristic of a benzodiazepine is that the withdrawal effects clearly may protract in course for an inordinate amount of time, iatrogenic dependence (doctor induced) can be an overlooked phenomenon with benzodiazepines. When patients begin to complain and/or shown signs of tolerance, dependence, interdose withdrawal, withdrawal, or protracted withdrawal to tranquilizers such as benzodiazepines, the patient may be misdiagnosed with yet another physical or psychological classification or diagnoses. This is because a great majority of health care providers have minimal training in addictionology/chemical dependency, especially with recognizing the signs and symptoms related to benzodiazepine dependency en route to tranquilizer withdrawal. Doctors may become perplexed or frustrated with such patients and assign the patient with a diagnoses such as anxiety, psychosis, somatization disorder, or other diagnoses pertaining to the wide range of symptoms that tranquilizer dependent patients may complain about while on the medications or up on cessation of these medications.
Unfortunately, a sizeable minority of tranquilizer victims endure the withdrawal syndrome with minimal help from the medical community, while finding support from various organizations or internet support groups with individuals who have made their lives and stories available to help support others who are trying to recover. For those susceptible individuals who manifest with PBWS, recovering from benzodiazepine dependency is serious business requiring an understanding of the 'slow and waxing-waning nature of the withdrawal' as well as extreme patience.
An interesting side-note is that while physical dependence (and withdrawal on discontinuation) is virtually inevitable with the sustained use of certain classes of drugs, notably the opioid
s, psychological addiction is much less common. ((Hence the "cold turkey method.)) Most chronic pain patients, as mentioned earlier, are one example. There are also documented cases of soldiers who used heroin recreationally in Vietnam during the war, but who gave it up when they returned home (see Rat Park
for experiments on rats showing the same results). It is thought that the severity or otherwise of withdrawal is related to the person's preconceptions about withdrawal. In other words, people can prepare to withdraw by developing a rational set of beliefs about what they are likely to experience. Self-help
materials are available for this purpose.
, heart conditions
and many psychological or neurological conditions, like epilepsy
, hypertension
, schizophrenia
and psychosis
. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and polypharmacy, focus therapies where they are most effective, and prevent cost-related underuse of medications.
Sudden cessation of the use of an antidepressant
can deepen the feel of depression significantly (see "Rebound" below), and some specific antidepressants can cause a unique set of other symptoms as well when stopped abruptly.
Discontinuation of selective serotonin reuptake inhibitor
s (SSRIs), the most commonly prescribed class of antidepressants, (and the related class serotonin-norepinephrine reuptake inhibitor
s or SNRIs) is associated with a particular syndrome of physical and psychological symptoms known as SSRI discontinuation syndrome
. Effexor (venlafaxine)
and Paxil (paroxetine)
, both of which have relatively short half-lives in the body, are the some of the most likely of the antidepressants to cause withdrawals. The worst withdrawal symptoms from a prescription drug that are documented are from the drug Cymbalta (duloxetine)
which are sometimes referred to as "nightmare-ish" due to the ill effects and their prevalence. Prozac (fluoxetine)
, on the other hand, is the least likely of SSRI and SNRI
antidepressants to cause any withdrawal symptoms, due to its exceptionally long half-life.
, amphetamines, and other stimulants experience. Occasionally light users of opiates that would otherwise not experience much in the way of withdrawals will notice some rebound depression as well. Extended use of drugs that increase the amount of serotonin
or other neurotransmitters in the brain can cause some receptors
to 'turn off' temporarily or become desensitized, so, when the amount of the neurotransmitter available in the synapse
returns to an otherwise normal state, there are fewer receptors to attach to, causing feelings of depression until the brain re-adjusts.
Other drugs that commonly cause rebound are:
With these drugs, the only way to relieve the rebound symptoms is to stop the medication causing them and weather the symptoms for a few days; if the original cause for the symptoms is no longer present, the rebound effects will go away on their own.
s and amphetamines.
Cold turkey
"Cold turkey" describes the actions of a person who abruptly gives up a habit or addiction rather than gradually easing the process through gradual reduction or by using replacement medication....
" is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations.
Substances
Examples (and ICD-10ICD-10
The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...
code) of withdrawal syndrome
Withdrawal syndrome
A withdrawal syndrome, also called a discontinuation syndrome, occurs when a person suddenly stops taking or reduces the dosage of some types of medications...
include:
- F10.1 alcohol withdrawal syndromeAlcohol withdrawal syndrome-Protracted withdrawal:A protracted alcohol withdrawal syndrome occurs in many alcoholics where withdrawal symptoms continue beyond the acute withdrawal stage but usually at a subacute level of intensity and gradually decreasing with severity over time. This syndrome is also sometimes referred to...
(which can lead to delirium tremensDelirium tremensDelirium tremens is an acute episode of delirium that is usually caused by withdrawal from alcohol, first described in 1813...
) - F11.1 opioids, including methadone withdrawal
- F12.1 cannabis withdrawalCannabis withdrawalCannabis withdrawal is a form of withdrawal associated with the substance cannabis. It is included in the proposed revision of DSM-5.At one time cannabis was considered a drug that had no withdrawal symptoms because users did not display symptoms similar to those withdrawing from alcohol or opiates...
- F13.1 benzodiazepine withdrawal syndromeBenzodiazepine withdrawal syndromeBenzodiazepine withdrawal syndrome—often abbreviated to benzo withdrawal—is the cluster of symptoms which appear when a person who has taken benzodiazepines long term and has developed benzodiazepine dependence stops taking benzodiazepine drug or during dosage reductions...
- F14.1 cocaineCocaineCocaine is a crystalline tropane alkaloid that is obtained from the leaves of the coca plant. The name comes from "coca" in addition to the alkaloid suffix -ine, forming cocaine. It is a stimulant of the central nervous system, an appetite suppressant, and a topical anesthetic...
withdrawal - F15.1 caffeine withdrawal
- F17.1 nicotine withdrawalNicotine withdrawalNicotine withdrawal is a term used to describe the effects felt by a person who is nicotine dependent and suddenly stops or significantly reduces his/her nicotine intake. Since smoking cigarettes is the most popular form of nicotine use, the effects of nicotine withdrawal have been most commonly...
F16.1 is the ICD-10 code for withdrawal from hallucinogens (such as LSD
LSD
Lysergic acid diethylamide, abbreviated LSD or LSD-25, also known as lysergide and colloquially as acid, is a semisynthetic psychedelic drug of the ergoline family, well known for its psychological effects which can include altered thinking processes, closed and open eye visuals, synaesthesia, an...
), but this is not currently a recognized disorder.
The term "withdrawal" can sometimes be used to describe the results of discontinuing prescription medicine, as in SSRI discontinuation syndrome
SSRI discontinuation syndrome
SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome, is a syndrome that can occur following the interruption, dose reduction, or discontinuation of SSRI or SNRI antidepressant medications...
, though the term rebound effect
Rebound effect
The rebound effect, or rebound phenomenon, is the tendency of some medications, when discontinued suddenly, to cause a return of the symptoms it relieved, and that, to a degree stronger than they were before treatment first began...
is also used to characterize these conditions.
Overview
The sustained use of many kinds of drugs causes adaptations within the body that tend to lessen the drug's original effects over time, a phenomenon known as drug tolerance. At this point, one is said to also have a physical dependency on the given chemical. This is the stage that withdrawal may be experienced upon discontinuation. Some of these symptoms are generally the opposite of the drug's direct effect on the body. Depending on the length of time a drug takes to leave the bloodstream elimination half-life, withdrawal symptoms can appear within a few hours to several days after discontinuation and may also occur in the form of cravings. A craving is the strong desire to obtain, and use a drug or other substance similar to other cravings one might experience for food and hunger.Although withdrawal symptoms are often associated with the use of recreational drugs
Recreational drug use
Recreational drug use is the use of a drug, usually psychoactive, with the intention of creating or enhancing recreational experience. Such use is controversial, however, often being considered to be also drug abuse, and it is often illegal...
, many drugs have a profound effect on the user when stopped. When withdrawal from any medication occurs it can be harmful or even fatal; hence prescription warning labels explicitly saying not to discontinue the drug without doctor approval.
The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition, disease, chronic pain, or sleep deprivation, conditions that drug abusers often suffer as a secondary consequence of the drug. Many drugs (including alcohol) suppress appetite while simultaneously consuming any money that might have been spent on food. When the drug is removed, the discomforts return in force and are sometimes confused with addiction withdrawal symptoms, which they quite properly are not.
Withdrawal from drugs of abuse
Central to the role of nearly all drugs that are commonly abused is the reward circuitry or the "pleasure center" of the brain. The science behind the production of a sense of euphoriaEuphoria (emotion)
Euphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of well-being, elation, happiness, ecstasy, excitement and joy...
is very complex and still questioned within the scientific community. While neurologists have discovered that addiction encompasses several areas of the brain, the amygdala, Prefrontal Cortex, and the nucleus accumbens
Nucleus accumbens
The nucleus accumbens , also known as the accumbens nucleus or as the nucleus accumbens septi , is a collection of neurons and forms the main part of the ventral striatum...
are specifically responsible for the pleasurable feelings one may experience when using a mind or mood-altering substance. Within the nucleus accumbens is the neurotransmitter dopamine
Dopamine
Dopamine is a catecholamine neurotransmitter present in a wide variety of animals, including both vertebrates and invertebrates. In the brain, this substituted phenethylamine functions as a neurotransmitter, activating the five known types of dopamine receptors—D1, D2, D3, D4, and D5—and their...
, so while specific mechanisms vary, nearly every drug either stimulates dopamine release or enhances its activity, directly or indirectly. Sustained use of the drug results in less and less stimulation of the nucleus accumbens until eventually it produces no euphoria at all. Discontinuation of the drug then produces a withdrawal syndrome characterized by dysphoria
Dysphoria
Dysphoria is medically recognized as a mental and emotional condition in which a person experiences intense feelings of depression, discontent and indifference to the world around them.Mood disorders can induce dysphoria, often with a heightened risk of suicide, especially in...
— the opposite of euphoria — as nucleus accumbens activity declines below normal levels.
Withdrawal symptoms can vary significantly among individuals, but there are some commonalities. Subnormal activity in the nucleus accumbens is often characterized by depression
Depression (mood)
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behaviour, feelings and physical well-being. Depressed people may feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, or restless...
, anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and craving, and if extreme can drive the individual to continue the drug despite significant harm — the definition of addiction
Substance use disorder
Substance use disorders include substance abuse and substance dependence. In DSM-IV, the conditions are formally diagnosed as one or the other, but it has been proposed that DSM-5 combine the two into a single condition called "Substance-use disorder"....
— or even to suicide. In general, the longer the half-life of the drug, the longer the acute abstinence syndrome is likely to last. However, with drugs with a longer half-life, the acute abstinence syndrome will be much milder than that of those with shorter half-lives.
However, addiction is to be carefully distinguished from physical dependence. Addiction is a psychological compulsion to use a drug despite harm that often persists long after all physical withdrawal symptoms have abated. On the other hand, the mere presence of even profound physical dependence does not necessarily denote addiction, e.g., in a patient using large doses of opioids to control chronic pain under medical supervision.
As the symptoms vary, some people are, for example, able to quit smoking "cold turkey
Cold turkey
"Cold turkey" describes the actions of a person who abruptly gives up a habit or addiction rather than gradually easing the process through gradual reduction or by using replacement medication....
" (i.e., immediately, without any tapering off) while others may never find success despite repeated efforts. However, the length and the degree of an addiction can be indicative of the severity of withdrawal.
Withdrawal is a more serious medical issue for some substances than for others. While nicotine
Nicotine
Nicotine is an alkaloid found in the nightshade family of plants that constitutes approximately 0.6–3.0% of the dry weight of tobacco, with biosynthesis taking place in the roots and accumulation occurring in the leaves...
withdrawal, for instance, is usually managed without medical intervention, attempting to give up a benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
or alcohol
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
dependency can result in seizures and worse if not carried out properly. An instantaneous full stop to a long, constant alcohol use can lead to delirium tremens
Delirium tremens
Delirium tremens is an acute episode of delirium that is usually caused by withdrawal from alcohol, first described in 1813...
, which may be fatal.
Additionally, benzodiazepines have clearly been shown to induce a withdrawal syndrome in some people that is often severe and protracted in course. Doctors Ashton and Lader are two separate internationally recognized contributors who researched and described this condition that is now referred to as protracted benzodiazepine withdrawal syndrome (PBWS). Noteworthy, some patients become physically dependent on a small duration and dose (therapeutically prescribed dosages) of benzodiazepines. Patients may develop physical and psychological adaptations that may manifest while taking the medications and/or up on cessation that may lead to a severe withdrawal and discontinuation syndrome (PBWS). There is no known cure for PBWS, except time (in some cases 4, 5, or perhaps 6 years or more is needed for the withdrawal symptoms to slowly fade from 'misery' to 'comfort'). Paxil (an antidepressant) and benzodiazepines share this unique phenomenon known as 'discontinuation syndrome'.
Although a distinguishing characteristic of a benzodiazepine is that the withdrawal effects clearly may protract in course for an inordinate amount of time, iatrogenic dependence (doctor induced) can be an overlooked phenomenon with benzodiazepines. When patients begin to complain and/or shown signs of tolerance, dependence, interdose withdrawal, withdrawal, or protracted withdrawal to tranquilizers such as benzodiazepines, the patient may be misdiagnosed with yet another physical or psychological classification or diagnoses. This is because a great majority of health care providers have minimal training in addictionology/chemical dependency, especially with recognizing the signs and symptoms related to benzodiazepine dependency en route to tranquilizer withdrawal. Doctors may become perplexed or frustrated with such patients and assign the patient with a diagnoses such as anxiety, psychosis, somatization disorder, or other diagnoses pertaining to the wide range of symptoms that tranquilizer dependent patients may complain about while on the medications or up on cessation of these medications.
Unfortunately, a sizeable minority of tranquilizer victims endure the withdrawal syndrome with minimal help from the medical community, while finding support from various organizations or internet support groups with individuals who have made their lives and stories available to help support others who are trying to recover. For those susceptible individuals who manifest with PBWS, recovering from benzodiazepine dependency is serious business requiring an understanding of the 'slow and waxing-waning nature of the withdrawal' as well as extreme patience.
An interesting side-note is that while physical dependence (and withdrawal on discontinuation) is virtually inevitable with the sustained use of certain classes of drugs, notably the opioid
Opioid
An opioid is a psychoactive chemical that works by binding to opioid receptors, which are found principally in the central and peripheral nervous system and the gastrointestinal tract...
s, psychological addiction is much less common. ((Hence the "cold turkey method.)) Most chronic pain patients, as mentioned earlier, are one example. There are also documented cases of soldiers who used heroin recreationally in Vietnam during the war, but who gave it up when they returned home (see Rat Park
Rat Park
Rat Park was a study into drug addiction conducted in the late 1970s , by Canadian psychologist Bruce K. Alexander and his colleagues at Simon Fraser University in British Columbia, Canada....
for experiments on rats showing the same results). It is thought that the severity or otherwise of withdrawal is related to the person's preconceptions about withdrawal. In other words, people can prepare to withdraw by developing a rational set of beliefs about what they are likely to experience. Self-help
Self-help
Self-help, or self-improvement, is a self-guided improvement—economically, intellectually, or emotionally—often with a substantial psychological basis. There are many different self-help movements and each has its own focus, techniques, associated beliefs, proponents and in some cases, leaders...
materials are available for this purpose.
Withdrawal from prescription medicine
As mentioned earlier, many drugs should not be stopped abruptly without the advice and supervision of a physician, especially if the medication induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes, asthmaAsthma
Asthma is the common chronic inflammatory disease of the airways characterized by variable and recurring symptoms, reversible airflow obstruction, and bronchospasm. Symptoms include wheezing, coughing, chest tightness, and shortness of breath...
, heart conditions
Cardiovascular disease
Heart disease or cardiovascular disease are the class of diseases that involve the heart or blood vessels . While the term technically refers to any disease that affects the cardiovascular system , it is usually used to refer to those related to atherosclerosis...
and many psychological or neurological conditions, like epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
, schizophrenia
Schizophrenia
Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...
and psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and polypharmacy, focus therapies where they are most effective, and prevent cost-related underuse of medications.
Sudden cessation of the use of an antidepressant
Antidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
can deepen the feel of depression significantly (see "Rebound" below), and some specific antidepressants can cause a unique set of other symptoms as well when stopped abruptly.
Discontinuation of selective serotonin reuptake inhibitor
Selective serotonin reuptake inhibitor
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...
s (SSRIs), the most commonly prescribed class of antidepressants, (and the related class serotonin-norepinephrine reuptake inhibitor
Serotonin-norepinephrine reuptake inhibitor
Serotonin–norepinephrine reuptake inhibitors are a class of antidepressant drugs used in the treatment of major depression and other mood disorders...
s or SNRIs) is associated with a particular syndrome of physical and psychological symptoms known as SSRI discontinuation syndrome
SSRI discontinuation syndrome
SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome, is a syndrome that can occur following the interruption, dose reduction, or discontinuation of SSRI or SNRI antidepressant medications...
. Effexor (venlafaxine)
Venlafaxine
Venlafaxine is an antidepressant of the serotonin-norepinephrine reuptake inhibitor class. First introduced by Wyeth in 1993, now marketed by Pfizer, it is licensed for the treatment of major depressive disorder , as a treatment for generalized anxiety disorder, and comorbid indications in...
and Paxil (paroxetine)
Paroxetine
Paroxetine is an SSRI antidepressant. Marketing of the drug began in 1992 by the pharmaceutical company SmithKline Beecham, now GlaxoSmithKline...
, both of which have relatively short half-lives in the body, are the some of the most likely of the antidepressants to cause withdrawals. The worst withdrawal symptoms from a prescription drug that are documented are from the drug Cymbalta (duloxetine)
Duloxetine
Duloxetine is a serotonin-norepinephrine reuptake inhibitor manufactured and marketed by Eli Lilly. It is effective for major depressive disorder and has been shown to be as effective as venlafaxine for generalized anxiety disorder...
which are sometimes referred to as "nightmare-ish" due to the ill effects and their prevalence. Prozac (fluoxetine)
Fluoxetine
Fluoxetine is an antidepressant of the selective serotonin reuptake inhibitor class. It is manufactured and marketed by Eli Lilly and Company...
, on the other hand, is the least likely of SSRI and SNRI
SNRI
SNRI may refer to:* Serotonin–norepinephrine reuptake inhibitor* Strategic Naval Research Institute...
antidepressants to cause any withdrawal symptoms, due to its exceptionally long half-life.
Rebound
Many substances can cause rebound effects (significant return of the original symptom in absence of the original cause) when discontinued, regardless of their tendency to cause other withdrawal symptoms. Rebound depression is common among users of any antidepressant who stop the drug abruptly, whose states are sometimes worse than the original before taking medication. This is somewhat similar (though generally less intense and more drawn out) to the 'crash' that users of ecstasyMethylenedioxymethamphetamine
MDMA is an entactogenic drug of the phenethylamine and amphetamine class of drugs. In popular culture, MDMA has become widely known as "ecstasy" , usually referring to its street pill form, although this term may also include the presence of possible adulterants...
, amphetamines, and other stimulants experience. Occasionally light users of opiates that would otherwise not experience much in the way of withdrawals will notice some rebound depression as well. Extended use of drugs that increase the amount of serotonin
Serotonin
Serotonin or 5-hydroxytryptamine is a monoamine neurotransmitter. Biochemically derived from tryptophan, serotonin is primarily found in the gastrointestinal tract, platelets, and in the central nervous system of animals including humans...
or other neurotransmitters in the brain can cause some receptors
Receptor (biochemistry)
In biochemistry, a receptor is a molecule found on the surface of a cell, which receives specific chemical signals from neighbouring cells or the wider environment within an organism...
to 'turn off' temporarily or become desensitized, so, when the amount of the neurotransmitter available in the synapse
Synapse
In the nervous system, a synapse is a structure that permits a neuron to pass an electrical or chemical signal to another cell...
returns to an otherwise normal state, there are fewer receptors to attach to, causing feelings of depression until the brain re-adjusts.
Other drugs that commonly cause rebound are:
- Nasal decongestants, such as Afrin (oxymetazolineOxymetazolineOxymetazoline is a selective alpha-1 agonist and partial alpha-2 agonist topical decongestant, used in the form of Oxymetazoline hydrochloride, in products such as Afrin, Dristan, Nasivin, Logicin, Vicks Sinex, Visine L.R., Sudafed OM, and Zicam. It was developed from Xylometazoline at E.Merck...
) and Otrivin (xylometazolineXylometazolineXylometazoline is a drug which is used as a topical nasal decongestant. It is applied directly into the nose, either as a spray or as drops....
), which can cause rebound congestion if used for more than a few days - Many analgesics including Advil, Motrin (ibuprofenIbuprofenIbuprofen is a nonsteroidal anti-inflammatory drug used for relief of symptoms of arthritis, fever, as an analgesic , especially where there is an inflammatory component, and dysmenorrhea....
), Aspirin (acetylsalicylic acid), Tylenol (acetaminophen or paracetamol), and some prescription but non-narcoticNarcoticThe term narcotic originally referred medically to any psychoactive compound with any sleep-inducing properties. In the United States of America it has since become associated with opioids, commonly morphine and heroin and their derivatives, such as hydrocodone. The term is, today, imprecisely...
painkillers, which can cause rebound headacheHeadacheA headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck. The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the...
s when taken for extended periods of time. - Sedatives and benzodiazepines, which can cause rebound insomnia when used regularly as sleep aids.
With these drugs, the only way to relieve the rebound symptoms is to stop the medication causing them and weather the symptoms for a few days; if the original cause for the symptoms is no longer present, the rebound effects will go away on their own.
Pseudoabstinence
Pseudoabstinence is a term used by some authors to describe signs of withdrawal although the dose remains constant. Such signs may arise in use of benzodiazepineBenzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
s and amphetamines.