Iatrogenic Comorbidity in Childhood and Adolescence: New Insights from the Use of Antidepressant Drugs

Offidani, Emanuela; Fava, Giovanni A.; Sonino, Nicoletta

doi:10.1007/s40263-014-0184-0

Cited by 16 publications

(11 citation statements)

References 26 publications

(32 reference statements)

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“…There is danger in that patients presenting withdrawal syndromes are at risk of being misdiagnosed, mistreated, and entering the cascade iatrogenesis, which is the front door for chronicity. This is true also in clinical practice in children and adolescents in which withdrawal syndromes can occur, much more caution is needed, and there is almost no literature [202].…”

Section: Discussionmentioning

confidence: 99%

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Cosci

Chouinard

2020

Psychother Psychosom

164

184

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Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015; 84 (2): 63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound 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 shortlived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.

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Section: Discussionmentioning

confidence: 99%

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Cosci

Chouinard

2020

Psychother Psychosom

164

184

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“…The term iatrogenic comorbidity refers to the lasting effects that previous treatments may entail (e.g., mood instability and high reactivity to environmental stimuli in persistent postwithdrawal disorders), well beyond their time of administration [89,90]. …”

Section: Discussionmentioning

confidence: 99%

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

Self Cite

341

383

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Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'.

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“…Withdrawal symptoms do not necessarily wane after drug discontinuation and may build into a persistent postwithdrawal disorder [53]. These symptoms may constitute an iatrogenic comorbidity that affects the course of illness and the response to subsequent treatments [13]. The discontinuation of antidepressant drugs such as selective serotonin reuptake inhibitors, duloxetine and venlafaxine constitutes a major clinical challenge [53].…”

Section: Emerging Perspectivesmentioning

confidence: 99%

“…The CBT/WBT combination was effective in reducing the risk of relapse, a finding that was quite exceptional in the literature concerned with children and adolescents with major depression. Unfortunately, unlike our original study [9], medication was also continued in the CBT/WBT group, despite the problems that are related to long-term treatment with antidepressant drugs in that patient population [13]. …”

mentioning

confidence: 99%

Well-Being Therapy: Current Indications and Emerging Perspectives

Fava

2016

Psychother Psychosom

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Iatrogenic Comorbidity in Childhood and Adolescence: New Insights from the Use of Antidepressant Drugs

Cited by 16 publications

References 26 publications

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Well-Being Therapy: Current Indications and Emerging Perspectives

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