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User:Kmcmiche/Antidepressant discontinuation syndrome

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Lead

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Approximately 20–50% of people who suddenly stop an antidepressant develop an antidepressant discontinuation syndrome.[1][2][3] The condition is generally not serious,[1] though about half of people with symptoms describe them as severe.[3] Many restart antidepressants due to the severity of the symptoms.[3]

Antidepressant discontinuation syndrome is a relatively new phenomenon, with its discovery in the 1950s. There is still little research on this syndrome; most of the research is conflicting or consists only of clinical trials. There has been a class action lawsuit in 2013, but the motion was dismissed. [4]


Signs and symptoms

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People with antidepressant discontinuation syndrome have been on an antidepressant for at least four weeks and have recently stopped taking the medication, whether abruptly, after a fast taper, or each time the medication is reduced on a slow taper.[5] Commonly reported symptoms include flu-like symptoms (nausea, vomiting, diarrhea, headaches, sweating) and sleep disturbances (insomnia, nightmares, constant sleepiness). Sensory and movement disturbances have also been reported, including imbalance, tremors, vertigo, dizziness, and electric-shock-like experiences in the brain, often described by people who have them as brain zaps. These "brain zaps" have been described as an electric shock felt in the skull, potentially triggered by lateral eye movement, and at times accompanied by vertigo, pain, or dissociative symptoms. Some individuals consider it as a pleasant experience akin to an orgasm, however it is more often reported as an unpleasant experience that interferes with daily function.[6] Mood disturbances such as dysphoria, anxiety, or agitation are also reported, as are cognitive disturbances such as confusion and hyperarousal. In cases associated with sudden discontinuation of MAO inhibitors, acute psychosis has been observed.[5][7][8] Over fifty symptoms have been reported.[9] The SNRI venlafaxine has been reported to have a higher incidence in withdrawal symptoms after discontinuation when compared to other SNRIs.[10] Venlafaxine has also been implicated to create withdrawal symptoms irregardless of dosage.[11] Venlafaxine has been implicated in causing the most severe withdrawal symptoms after cessation of use, possibly due to its short half-life.[12]

To simplfy identifying the principal signs and symptoms, the mnemonic FINISH may be used:

  • Flu-like symptoms
  • Insomnia
  • Nausea
  • Imbalance
  • Sensory disturbances, including “brain zaps”
  • Hyperarousal[13][14]

A 2009 Advisory Committee to the FDA found that online anecdotal reports of discontinuation syndrome related to duloxetine included severe symptoms and exceeded prevalence of both paroxetine and venlafaxine reports by over 250% (although acknowledged this may have been influenced by duloxetine being a much newer drug).[15] It also found that the safety information provided by the manufacturer not only neglected important information about managing discontinuation syndrome, but also explicitly advised against opening capsules, a practice required to gradually taper dosage.[15]

Mechanism

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The underlying reason for its occurrence is unclear, though the syndrome appears similar to withdrawal from other psychotropic drugs such as benzodiazepines. There is evidence that antidepressant discontinuation syndrome may be related to the half-life of SSRIs.[16] Antidepressants with a lower half-life, such as Venlafaxine, have been implicated in higher incidences of withdrawal symptoms and more severe withdrawal symptoms.[17] There may be a link between lower 5-hydroxytryptamine receptor availability and symptoms of antidepressant discontinuation syndrome.[16][18]

  1. ^ a b Warner, CH; Bobo, W; Warner, C; Reid, S; Rachal, J (1 August 2006). "Antidepressant discontinuation syndrome". American Family Physician. 74 (3): 449–56. PMID 16913164.
  2. ^ Gabriel, M; Sharma, V (29 May 2017). "Antidepressant discontinuation syndrome". Canadian Medical Association Journal. 189 (21): E747. doi:10.1503/cmaj.160991. PMC 5449237. PMID 28554948.
  3. ^ a b c Davies, J; Read, J (4 September 2018). "A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?". Addictive Behaviors. 97: 111–121. doi:10.1016/j.addbeh.2018.08.027. PMID 30292574.
  4. ^ "Saavedra v. Eli Lilly & Co., CASE NO. 2:12-cv-9366-SVW (MANx) | Casetext Search + Citator". casetext.com. Retrieved 2024-04-06.
  5. ^ a b Warner, CH; Bobo, W; Warner, C; Reid, S; Rachal, J (1 August 2006). "Antidepressant discontinuation syndrome". American Family Physician. 74 (3): 449–56. PMID 16913164.
  6. ^ Papp, Alexander; Onton, Julie A. (2018-12-20). "Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation". The Primary Care Companion for CNS Disorders. 20 (6). doi:10.4088/PCC.18m02311. ISSN 2155-7780. PMID 30605268. S2CID 58577252.
  7. ^ Haddad, Peter M.; Anderson, Ian M. (October 2007). "Recognising and managing antidepressant discontinuation symptoms". Advances in Psychiatric Treatment. 13 (6): 447–57. doi:10.1192/apt.bp.105.001966.
  8. ^ Renoir T (2013). "Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: a review of the clinical evidence and the possible mechanisms involved". Front Pharmacol. 4: 45. doi:10.3389/fphar.2013.00045. PMC 3627130. PMID 23596418.
  9. ^ Haddad PM, Dursun SM (2008). "Neurological complications of psychiatric drugs: clinical features and management". Hum Psychopharmacol. 23 (Suppl 1): 15–26. doi:10.1002/hup.918. PMID 18098217.
  10. ^ Fava, Giovanni A.; Benasi, Giada; Lucente, Marcella; Offidani, Emanuela; Cosci, Fiammetta; Guidi, Jenny (2018). "Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review". Psychotherapy and Psychosomatics. 87 (4): 195–203. doi:10.1159/000491524. ISSN 1423-0348. PMID 30016772.
  11. ^ Campagne, Daniel M. (2005-07-06). "Venlafaxine and serious withdrawal symptoms: warning to drivers". MedGenMed: Medscape General Medicine. 7 (3): 22. ISSN 1531-0132. PMC 1681629. PMID 16369248.
  12. ^ Hosenbocus, Sheik; Chahal, Raj (2011-02). "SSRIs and SNRIs: A review of the Discontinuation Syndrome in Children and Adolescents". Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal De l'Academie Canadienne De Psychiatrie De L'enfant Et De L'adolescent. 20 (1): 60–67. ISSN 2293-6122. PMC 3024727. PMID 21286371. {{cite journal}}: Check date values in: |date= (help)
  13. ^ Rizcalla, Mireille; Kowalkovski, Bryan; Prozialeck, Walter A. (2020-02-20). "Antidepressant Discontinuation Syndrome: A Common but Underappreciated Clinical Problem". Journal of Osteopathic Medicine.
  14. ^ Bhat, Venkat; Kennedy, Sidney (2017-07-01). "Recognition and management of antidepressant discontinuation syndrome". Journal of Psychiatry & Neuroscience. doi:10.1503/jpn.170022. PMC 5487275. PMID 28639936.
  15. ^ a b "Cymbalta (Duloxetine) Discontinuation Syndrome: Issues of Scope, Severity, Duration & Management" (PDF). U.S. Food and Drug Administration (FDA). 9 June 2009. Retrieved 17 October 2016.
  16. ^ a b Renoir, Thibault (2013). "Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: a review of the clinical evidence and the possible mechanisms involved". Frontiers in Pharmacology. 4: 45. doi:10.3389/fphar.2013.00045. ISSN 1663-9812. PMC 3627130. PMID 23596418.{{cite journal}}: CS1 maint: unflagged free DOI (link)
  17. ^ Gastaldon, Chiara; Schoretsanitis, Georgios; Arzenton, Elena; Raschi, Emanuel; Papola, Davide; Ostuzzi, Giovanni; Moretti, Ugo; Seifritz, Erich; Kane, John M.; Trifirò, Gianluca; Barbui, Corrado (2022-12-01). "Withdrawal Syndrome Following Discontinuation of 28 Antidepressants: Pharmacovigilance Analysis of 31,688 Reports from the WHO Spontaneous Reporting Database". Drug Safety. 45 (12): 1539–1549. doi:10.1007/s40264-022-01246-4. ISSN 1179-1942. PMC 9676852. PMID 36400895.{{cite journal}}: CS1 maint: PMC format (link)
  18. ^ Blier, Pierre; Tremblay, Philippe (2006). "Physiologic mechanisms underlying the antidepressant discontinuation syndrome". The Journal of Clinical Psychiatry. 67 Suppl 4: 8–13. ISSN 0160-6689. PMID 16683857.


Peer-evaluation feedback:

I will be updating my article further by changing a few things from my peer-evaluations. Firstly, user MPHILLI stated that they did not see where my contribution fit into the article, and I will not be changing that as I believe that it further expands on the SNRI venlafaxine. I do agree with the user that the Mechanism and Research sections need more information, and as such, I will be looking into finding that information in the coming week. While this user pointed out that the most recent article was in 2018 and said they needed to be more recent, it is with my understanding that citations within the last ten years are considered recent and up to date. However, I will look for more recent studies for the information already cited. User Callalily4 stated that the sentence I have added is "jarring" in the place that it is, however I do not agree with that. The user suggested moving it to the Duration section, but I do not believe that is the correct place to put it. I may move it down to the next paragraph, or I may start a new paragraph as a previous user did for duloxetine to expand on venlafaxine more. User Jalyn547 asked why I deleted such a large paragraph from the original article, and I would like to expand on that. I am not suggesting deleting that paragraph, and I completely understand why it looks that way. I accidentally bolded the entire section of text when I added it to my sandbox, so it appeared that I contributed that portion. However, I did not, so I wanted to make it easier to see the sentence I added for the peer-evaluations. I completely agree with this user's suggestion to move the Culture and history section towards the top before the Signs and symptoms section. Moving those sections may make the article flow more smoothly. I do not plan to take anything out from the Lead section, as I believe it introduces the article well. As for the redundancy of the symptoms, I may make a chart or image that lists them out to add a figure to the article. User Nicolemicha suggested adding a brief historical part to the Lead section, and I will be changing that as the Lead section should reflect the contents of the article. I also agree with the user's suggestion of expanding the information on venlafaxine to make the article more understandable to the reader. Finally, user Crimson Kai did not add a peer-evaluation that I can see on my end.


Instructor Feedback:

I applaud your efforts to make a large contribution to your article. As submitted, I don't know how this contribution will fit with the existing text in the article. I would encourage you to bring over portions of the existing article and place your edits where you would propose they go. This will help others to see how your edits will "mesh" and overlay with the existing text. There are a few grammatical concerns in the text above, and I would encourage you to paste your edits in Microsoft Word or use a resource like QuillBot prior to publishing. I like the fact that you have included a number of wikilinks to existing articles! I am concerned that, while you have cited an example of peer-reviewed secondary literature published in 2018, this one source is supposed to support a very large section of text. I would encourage you to include additional citations for such a large addition. Finally, I do wonder if some information might be better organized with bullets or lists (e.g., symptoms) as opposed to placing in paragraph style. I would know better if I could see how it overlays with the existing text. Please let me know if you have questions/concerns about any of the feedback provided.

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