Discontinuation Syndrome with Psychotropics
Prescribers of psychotropic medications (antidepressants, antipsychotics and anxiolytics) have been aware of the risk of discontinuation syndrome. Often patients who have experienced the discontinuation syndrome will bring this up for discussion before recommencement of psychotropics but invariably this is a focus of discussion at the time of stopping or switching. A recent article in British Journal of Psychiatry by Leonardo Tondo, Ross J. Baldessarini raises concerns that this discontinuation syndrome could also precipitate relapse or recurrence of the underlying condition.
In my clinical practice discontinuation syndrome has been more pronounced with certain medications, such as Serotonin Nor-Adrenaline Re-uptake Inhibitors (SNRIs) or short-acting benzodiazepines. I concur with Ross J. Bladessarini's perspective that agents with long half-lives are less likely to cause withdrawal effects. He also highlights the impact of this issue as a confounding factor in clinical trials and suggests approaches that could mitigate against this.
However, in clinical practice, prescribers should be aware of this issue and offer psycho-education to the patient when the treatment is changed or withdrawn. In my opinion, an open discussion about this issue is essential even prior to commencement of psychotropics and should be part of seeking informed consent. In addition, a gradual dose reduction is likely to be the best strategy in minimising the risk of discontinuation syndrome.
References
- Tondo, L., & Baldessarini, R. (2020). Discontinuing psychotropic drug treatment. BJPsych Open, 6(2), E24. doi:10.1192/bjo.2020.6
- Fluyau D, Revadigar N, Monobianco BE. Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinu- ation. Ther Adv Psychopharmacol 2018; 8: 147–168.
- Rosenbaum JF, Fava M, Hoog SL, Ascroft RC, Krebs WB. Selective serotonin reuptake inhibitor discontinuation syndrome: randomized clinical trial. Biol Psychiatry 1998; 44: 77–87.