Chouinard, 2015 New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

[Altostrata]

Psychother Psychosom 2015;84:63-71

(DOI:10.1159/000371865)

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

Chouinard G.^{a, b} · Chouinard V.-A.^c

 

Abstract at http://www.karger.com/Article/FullText/371865 Fulltext PDF (117 Kb)

 

Selective serotonin reuptake inhibitors (SSRIs) are widely used in clinical practice, and have advanced the treatment of depression and other mental disorders. However, more studies are needed on the effects of decreasing and discontinuing these medications after their long-term use [1]. Withdrawal symptoms may occur with all SSRIs and serotonin-noradrenaline reuptake inhibitors (SNRIs) [1], similarly to other CNS drugs, including benzodiazepines [2,3,4] and antipsychotics [5,6]. Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness [1,2,7]. When discontinuing or decreasing SSRIs, withdrawal symptoms must be identified to avoid prolonging treatment or giving unnecessarily high doses [6,8].

 

Different types of syndromes have been described with the withdrawal from SSRIs and other CNS drug classes, including benzodiazepines, antipsychotics, antidepressants, opiates, barbiturates, and alcohol: (1) new withdrawal symptoms (classic withdrawal symptoms from CNS drugs) [1,4,5,6,9,10,11,12], (2) rebound [2,6,9,13,14,15,16], and (3) persistent postwithdrawal disorders [7,17,18] (table 1). These types of withdrawal need to be differentiated from relapse and recurrence of the original illness.....

[westcoast]

I'm glad to see this.

[Altostrata]

Chouinard has a long-time interest in withdrawal syndrome.

[Rhiannon]

Yep, I am glad to see this too. Sure hope a few people read it.

[westcoast]

It gives us some ammo against psychiatrists who don't believe in withdrawal syndromes. Probably should keep a laminated copy in my purse!

[JayPea]

Thank you for this. I just learned that a family member has been rx'd  Contrave for weigh loss- it contains bupriprion.  Such a bummer....

[KarenB]

Think I'll print this out too, though I found it difficult to understand all of it.  My favourite part:

 

"...Clinicians should understand why it is difficult to decrease a given drug treatment for a patient, for example, due to the presence of a persistent postwithdrawal disorder. Giving low doses of SSRIs and decreasing the lengths of SSRI maintenance treatment by using adjunct treatments, such as CBT, should be considered whenever possible to try to minimize long-term receptor changes. After 2 years of maintenance treatment, many types of persistent postwithdrawal disorders may be observed. We recommend re-evaluation of overall treatment and management after 2 years of continuous SSRI use, considering the possible use of other therapies, whether as adjunct or alternative treatment."

 

Good to show doctor, husband and counselor.  They all think I just need more, or for longer...

[mammaP]

I am glad to see this too, and think I will print it off along with some others that might help doctors to understand and finally accept withdrawal syndrome. 

[westcoast]

JayPea, how did she do on the Contrave?

 

 

[westcoast]

I found a study on meth withdrawal. I can't figure out why it was done.

 

Background: Methamphetamine dependence has become a significant problem, but methamphetamine withdrawal symptoms have not been well studied.  (Because there aren't any?)

 

Results:

Methamphetamine withdrawal symptoms*, mood, and anxiety symptoms all resolve fairly quickly within 2 weeks of cessation of methamphetamine. Sleep was disrupted over the course of the 4-week study. No clinically significant alterations in blood pressure or heart rate were identified. This study did not demonstrate any alterations in cognitive function over the 4 weeks of the residential stay.

 

[Amphetamine withdrawal is described as lasting up to two weeks and includes "total sleep length that increased for several weeks."]     

 

[No, this: "The duration of amphetamine withdrawal is generally considered to be much longer than cocaine withdrawal, reportedly lasting from 5 days to more than 2 weeks."  ]   

 

Conclusions: This pilot study points toward the need for a double-blind, placebo-controlled amphetamine withdrawal paradigm in humans where changes in sleep, cognitive function, and withdrawal measures can be explored more fully.

 

Scientific Significance: This study extends the literature by pointing toward a methamphetamine withdrawal syndrome that includes alterations in measures of sleep quality and refreshed sleep, early improvement in depression and anxiety symptoms, most striking during the first week, but persisting into the second week.

 

*(i) drug craving; (ii) dysphoric** mood; (iii) loss of pleasure; (iv) loss of interest in activities previously enjoyed; (v) anxiety; (vi) slowing in movement; (vii) agitation; (viii) decreased energy or fatigue; (ix) increased appetite or eating too much; (x) decreased appetite; (xi) vivid or unpleasant dreams; (xii) sleeping too much; and (xiii) insomnia

 

**Dysphoria (from Greek: δύσφορος (dysphoros), δυσ-, difficult, and φέρειν, to bear) is a profound state of unease or dissatisfaction. In a psychiatric context, dysphoria may accompany depression, anxiety, or agitation.

 

Full text:

https://www.researchgate.net/publication/49740875_Characterizing_methamphetamine_withdrawal_in_recently_abstinent_methamphetamine_users_A_pilot_field_study

 

The American Journal of Drug and Alcohol Abuse, 37:131–136, 2011 Copyright © Informa Healthcare USA, Inc.

 

ISSN: 0095-2990 print / 1097-9891 online

 

DOI: 10.3109/00952990.2010.543998

 

Characterizing methamphetamine withdrawal in recently abstinent methamphetamine users: a pilot field study

 

Michael J. Mancino, M.D.1, Brooks W. Gentry, M.D.2, Zachary Feldman, M.S.1, John Mendelson, M.D., Ph.D.3 and Alison Oliveto, Ph.D.1

 

1Department of Psychiatry, Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA, 2Department of Anesthesia, University of Arkansas for Medical Sciences, Little Rock, AR, USA, 3Department of Internal Medicine, Drug Dependence Research Laboratory, Langley Porter Institute, University of California at San Francisco, San Francisco, CA, USA

[andy013]

I was going to post this study but I searched and it's already here. I think this is the first time I've seen any paper talk about "persistent postwithdrawal disorders" for SSRIs. Most of the time when I see withdrawal mentioned it is referring to an acute period that lasts days or weeks. Lets hope one day it is common knowledge that these drugs can cause such lasting harm.