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Discontinuation Syndromes of Psychiatric Drugs


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This is a relatively new paper by Fiammetta Cosci and Guy Chouinard which describes withdrawal from various psychiatric drugs. If your physician doesn't believe you, you can print this paper to bring with you, or e-mail him the PDF.
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Is this the take-away message patients who are discontinuing benzodiazepines wish to convey to prescribers? From the abstract ...

 

“All these drugs [psychotropic medications] may induce withdrawal syndromes and re-bound 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.”

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Is this the take-away message patients who are discontinuing benzodiazepines wish to convey to prescribers? From the abstract ...

 

“All these drugs [psychotropic medications] may induce withdrawal syndromes and re-bound 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.”

 

 

 

Yes but in the paper:

 

Persistent Post-Withdrawal Disorders after Benzodiazepine Discontinuation

 

The literature on persistent post-withdrawal disorders after long-term benzodiazepine use and discontinuation is hardly existent. Notwithstanding this, anxiety, depression, psychosis, cognitive impairment, insomnia, sensory phenomena (i.e., tinnitus, tingling, numbness, paresthesia, deep or burning pain in limbs, feeling of inner trembling or vibration, strange skin sensations), motor phenomena (i.e., muscle pain, weakness, painful cramps, tremor, jerks, spasms, shaking attacks), and gastrointestinal disturbances (patients complain of food intolerance and gaseous abdominal distension) have been described. Length of treatment and high potency with short to intermediate elimination half-life seem important to favor the occurrence of persistent post-withdrawal disorders. It has been observed that withdrawal symptoms after discontinuation of low-dose benzodiazepine may take 6–12 months to subside completely and in some cases they persist for years.

 

The thing is, for long-term SSRI users it can be absolutely impossible to discontinue the drug, no matter how slow the taper. In fact changing the dose either up, or down can have disasterous consequences. And besides, antidepressants are "non-addictive" so physicians are prone to believing there's no antidepressant withdrawal.

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Id say it probs applies to anything that has “agonist or antagonist” attached to its name.. -Subject to who and when...

Ie. it all sounds very opiate to me, but more in a “damage” or altered neurology context rather than actual WD.. I guess its all a bit of a numbers game (of those affected in such a way)..

 

-Just a thought.. -mornink.. :)

 

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[9b...]

Id say it probs applies to anything that has “agonist or antagonist” attached to its name.. -Subject to who and when...

Ie. it all sounds very opiate to me, but more in a “damage” or altered neurology context rather than actual WD.. I guess its all a bit of a numbers game (of those affected in such a way)..

 

-Just a thought.. -mornink.. :)

Well, "discontinuation syndrome" was invented by BigPharma in order to market psychiatric drugs as "non-addictive". However, I think it's actually more fitting terminology than "withdrawal". Withdrawal implies that once the drug is out of your system you're fine, which really isn't the case with psychiatric drugs.
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The instructions for each benzodiazepine say that they can cause brain damage - extrapyramidal symptoms (damage to the basal ganglia): tardive dystonia, akathisia and tremor.
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