The antidepressant termination syndrome is a condition that can occur after interruption, dose reduction, or discontinuation of antidepressant drugs, including selective serotonin reuptake inhibitor (SSRI) or serotonin-norepinephrine reuptake inhibitor (SNRI). Symptoms may include flu-like symptoms and sleep, sensory, movement, mood, and mind disorders. In some cases, symptoms may be mild, short-lived, and cured without treatment. More severe cases may only be successfully treated with drug reintroduction, provided that reintroduction is performed in a timely manner. Symptoms, including tardif akathisia, and Post SSRI Sexual Disfunction (PSSD) can last for months to years.
Video Antidepressant discontinuation syndrome
Signs and symptoms
People who have had antidepressant withdrawal syndrome have been using antidepressants for at least four weeks and recently stopped taking the drug, either suddenly, after a rapid taper, or whenever the drug was reduced to a slow taper. Commonly reported symptoms include flu-like symptoms (nausea, vomiting, diarrhea, headache, sweating) and sleep disorders (insomnia, nightmares, persistent drowsiness). Sensory and movement disorders have also been reported, including imbalances, tremors, vertigo, dizziness, and experiences like electrical shock in the brain, often described by sufferers as "inflammation of the brain". Mood disorders such as dysphoria, anxiety, or agitation are also reported, such as cognitive disorders such as confusion and hyperarousal.
In cases related to the sudden discontinuation of MAO inhibitors, acute psychosis has been observed. More than fifty symptoms have been reported.
Most cases of termination syndrome may last between one and four weeks, are relatively mild, and heal by itself; in more severe cases, the symptoms can be severe or widespread. paroxetine ( Paxil ) and venlafaxine ( Effexor ) appear to be very difficult to discontinue, and prolonged withdrawal syndrome (post-acute-withdrawal syndrome, or PAWS) lasting 18 months. has been reported with Paxil .
The 2009 Advisory Committee for the FDA found that online anecdotal reports of the duloxetine-related (Cymbalta) termination syndrome (Cymbalta) included severe symptoms and exceeded the prevalence of paroxetine ( Paxil ) and venlafaxine ( Effexor ) reported more than 250% (although admittedly this may be influenced by duloxetine ( Cymbalta Duration
Symptoms may last for more than four weeks after the reduction or discontinuation of medication, but can heal in a day to recover the drug.
Maps Antidepressant discontinuation syndrome
Prevention and treatment
In some cases, the withdrawal syndrome (withdrawal) can be prevented by taking the drug as directed, and when stopping, do it gradually, although symptoms may appear at the time of reduction. When stopping antidepressants with a short half-life, switch to a drug with a longer half-life (eg fluoxetine ( Prozac ) or citalopram) and then taper, and eventually stop, the medication may decrease the severity of symptoms.
Treatment depends on the severity of the stopping reaction and whether or not further antidepressant treatment is required. In cases where further antidepressant treatment is prescribed, then the only recommended option may be to restart antidepressants. If antidepressants are no longer needed, treatment depends on the severity of the symptoms. If symptoms are severe discontinuation, or do not respond to symptomatic management, antidepressants can be recovered and then withdrawn more carefully, or by switching to drugs with longer half-lives, (such as Prozac ), and then reducing and stop the drug. In severe cases, hospitalization may be necessary.
Pregnancy and newborn
Antidepressants, including SSRIs, may cross the placenta and have the potential to affect the fetus and newborn, including the possibility of increased miscarriage, present a dilemma for pregnant women to decide whether to continue taking antidepressants altogether, or if they do, consider if reduction and discontinuation during pregnancy can have a protective effect for newborns.
Postpartum adaptation syndrome (PNAS) (originally called "neonatal behavior syndrome", "poor neonatal adaptation syndrome", or "neonatal withdrawal syndrome") was first recognized in 1973 in newborns of mothers taking antidepressants; Symptoms in infants include irritability, rapid breathing, hypothermia, and blood sugar problems. Symptoms usually develop from birth to the day after delivery and usually heal within a few days or weeks after delivery.
Research
The mechanism of antidepressant withdrawal syndrome has not been identified with certainty. The main hypothesis is that once the antidepressants are stopped, some are temporary, but in some cases, long-term deficiencies, in the brain of one or more mood-regulating mood neurotransmitters, such as serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid, and because neurotransmitters are interconnected systems, dysregulated one affects the other.
Culture and history
Symptoms of antidepressant cessation were first reported with imipramine, the first tricyclic antidepressant (TCA), in the late 1950s, and each new class of antidepressants had reported similar conditions, including monoamine oxidase inhibitors (MAOIs), SSRIs, and SNRIs. In 2001, at least 21 different antidepressants, including all major classes, were known to cause termination syndrome. The problem has been poorly learned, and most of the literature is case reports or small clinical studies; incidences are difficult to determine and controversial.
With the explosion of use and interest in SSRIs in the late 1980s and early 1990s, which focused mainly on Prozac, interest grew also in the termination syndrome. Some of the symptoms come from a discussion board where people with depression discuss their experiences with their illness and their medicines; "brain zaps" or "brain shivers" is one of the symptoms that arise through these sites.
Increased media attention and ongoing community concerns led to the formation of a group of experts on the safety of selective serotonin reuptake inhibitors in the UK, to evaluate all available studies prior to 2004. This group determined that the incidence of symptom withdrawal was between 5% and 49%, depending on the SSRI certain, length of time on drugs and sudden termination versus stages.
With a lack of definitions based on the consensus criteria for syndrome, panels met in Phoenix, Arizona in 1997 to form a design definition, which continued to be refined by other groups.
In the late 1990s, some researchers thought that the fact that symptoms appear when antidepressants are stopped may mean that antidepressants cause addiction, and some use the term "withdrawal syndrome" to describe symptoms. Some addictive substances cause physiological dependence, so discontinuation of drugs causes suffering. These theories are abandoned, because addiction leads to drug-seeking behavior, and people taking antidepressants do not exhibit drug-seeking behavior, except in cases where they suffer from termination syndrome, and drug resumption is their only chance to be relieved from their suffering.. Due to pressure from pharmaceutical companies that make anti-depressants, the term "withdrawal syndrome" is no longer used by drug makers, and thus, most physicians, with respect to antidepressants, to avoid confusion with problems arising from addiction or addiction from others. drugs.
2013 class action lawsuit
In 2013, the class action suit filed, Jennifer L Saavedra v. Eli Lilly and Company , filed against Eli Lilly who claimed that the Cymbalta label removed important information about "brain zaps" and other symptoms after discontinuation. Eli Lilly moved for dismissal per "learned doctrinal learning" when the doctors prescribing the drug were warned of potential problems and were intermediate medical assessments between Lilly and the patient; in December 2013, Lilly's movement to dismiss was denied.
See also
- Benzodiazepine withdrawal syndrome
- Neuropharmacology
- Neuropsychopharmacology
- Neurotoxicology
- Pharmacology
- Psychoactive drugs
References
External links
Source of the article : Wikipedia
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