Review, Feb/20: Discontinuing psychotropic drug treatment

[[La...]]

"Discontinuing psychotropic drug treatment"

 

https://www.ncbi.nlm.nih.gov/pubmed/32070450

 

Abstract

 

Interruption of ongoing treatment with benzodiazepines, antidepressants, antipsychotics and mood stabilisers including lithium can be followed by clinically significant withdrawal reactions within hours or days, as well as later increases in relapses or recurrences of the illness being treated. Such observations support the view that stopping treatment is not equivalent to being untreated. With lithium, antipsychotics and antidepressants, there is consistent evidence that abrupt or rapid discontinuation is followed by earlier clinical worsening than with more gradual removal of treatment. Moreover, treatment discontinuation can complicate interpretation of responses to changes in treatment, including in clinical practice and in experimental treatment trials. Notably, terminating preceding treatments can lead to both discontinuation and carry-over effects that can have an impact on the interpretation of observed outcomes.

 

Full Document:

 

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/249FF79A648ABD3A77675A337C9043F4/S205647242000006Xa.pdf/discontinuing_psychotropic_drug_treatment.pdf 

 

Excerpt:

 

Pharmacodynamic mechanisms underlying discontinuation syndromes

 

Mechanisms underlying early reactions to withdrawal of various psychotropic agents, and particularly later relapses or recurrences, remain uncertain. It is likely that complex pharmacodynamic adaptations to long-term drug treatment are involved.6,8,9 Long-term exposure to antidepressant, antipsychotic, anxiolytic, mood stabilising and other psychotropic drugs leads to neuropharmacological adaptations that include changes in postsynaptic receptor and auto-receptor sensitivity, neurotransmitter synthesis and release, and various downstream molecular and genetic mechanisms in multiple brain systems.8,9 Agents with long elimination half-lives appear to carry lower risk of withdrawal effects, including fluoxetine among antidepressants and long-acting antipsychotics.6 Effects of adaptative changes during prolonged drug exposure evidently become manifest as clinically apparent neurobehavioural responses when treatment is removed. Restoring the withdrawn medicine, even temporarily and at lower doses, sometimes may reduce the clinical manifestations of withdrawal reactions.6

 

 

[[Fi...]]

In short: According to this article, Everyone does NOT heal after w/d & cessation of benzos & other psychotropic drug use. Am I correct?

[[La...]]

The focus isn't really on whether people "heal" or not. Rather, it's on the speed of discontinuation, the misinterpretation of effects following rapid discontinuation, the effects on women who stop their meds abruptly when they become pregnant, as well the effects of starting/stopping/changing medications on trial outcomes and in treatment.  The focus isn't so much on benzos in this paper, although they are mentioned (as are all the psychotropics).

 

They note that the withdrawal syndromes are "clinically significant" and even suggest that "Treatment-discontinuation syndromes for psychotropic medicines may be worth considering for inclusion as distinct disorders in standard international diagnostic systems including DSM and ICD."

 

They're also recommending further study of the discontinuation of psychotropic medications (see the last line of the full paper).

 

 

[[Li...]]

Am I missing something here?  This appears to be an editorial discussing the implications of a recent report about discontinuing long-term lithium treatment.  Only one of the references cited (see below) pertains specifically to benzodiazepines, and it’s not a research study but rather a review of the literature on the use of medications to manage benzodiazepine withdrawal.

 

Fluyau D, Revadigar N, Monobianco BE. Challenges of the pharmacological management of benzodiazepine withdrawal, dependence, and discontinuation. Ther Adv Psychopharmacol 2018; 8: 147–168.

[[La...]]

Yes, I referred to this paper as a "review" rather than a "study". There are 22 references below the body of the copy, which mention various psychotropics, e.g. lithium, SSRIs, benzos (yep, just the one).