Panic Anxiety after Abrupt Discontinuation of Mianserin

Kuniyoshi, Masayuki; Arikawa, Katsuyoshi; Miura, Chishin; Inanaga, Kazutoyo

doi:10.1111/j.1440-1819.1989.tb02564.x

Cited by 3 publications

(8 citation statements)

References 10 publications

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“…Thus, this criterion would fit in 2 cases of the literature [7,10] as well as in the case described here. Withdrawal occurred after either abrupt discontinuation [4][5][6][7][8][9] or tapering [10]. Although gradual tapering over a long period has been suggested before discontinuing SSRIs [2], according to several studies [1,14,15] even with gradual tapering withdrawal symptoms still occur.…”

Section: Discussionmentioning

confidence: 99%

“…Although gradual tapering over a long period has been suggested before discontinuing SSRIs [2], according to several studies [1,14,15] even with gradual tapering withdrawal symptoms still occur. Withdrawal occurred both in case of monotherapy [6,7,9] and polypharmacotherapy [4,5,8,10]. Withdrawal is related to the discontinuation of a drug [1,2], despite the maintenance of other ones.…”

Section: Discussionmentioning

confidence: 99%

“…For SSRI and SNRI, the peak of onset of new symptoms and rebound withdrawal has been described 36-96 h after tapering/discontinuing [2] and the peak of onset of persistent postwithdrawal disorders has been described 24 h-6 weeks after tapering or discontinuing the drug [2]. Interestingly, 5 out of 7 cases of the literature were managed reintroducing the discontin-ued drug [4,5,[7][8][9], 1 case did not receive therapy [6], 1 case was treated with olanzapine [10] while X. received clonazepam. Unfortunately, the literature does not suggest guidelines to manage withdrawal after discontinuation or tapering of antidepressants.…”

Section: Discussionmentioning

confidence: 99%

“…Table 1 describes previously published papers (only case reports are available in the literature) on withdrawal symptoms occurred after NaSSA discontinuation. First, withdrawal symptoms after NaSSA discontinuation may occur both in males [5,7,10] and in females [4,6,8,9]. Second, withdrawal symptoms after NaSSA discontinuation might occur at an age ranging of 25 [8]-75 years [6].…”

Section: Case Reportmentioning

confidence: 99%

“…Only few papers (only case reports) referred to withdrawal symptoms induced by the discontinuation of antidepressants different from SSRIs and SNRIs. In 1989, withdrawal symptoms that occurred after the discontinuation of a noradrenergic and specific serotonergic antidepressant (NaSSA) were for the first time documented after abrupt discontinuation of mianserin [4]. Later on, 5 case reports described withdrawal symptoms after abrupt discontinuation of mirtazapine [5][6][7][8][9] and 1 case report referred to withdrawal after tapering and discontinuing mirtazapine [10].…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Withdrawal symptoms after discontinuation of a noradrenergic and specific serotonergic antidepressant: A case report and review of the literature

Cosci

2017

Personalized Medicine in Psychiatry

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Withdrawal symptoms after discontinuation of a noradrenergic and specific serotonergic antidepressant: A case report and review of the literature

Cosci

2017

Personalized Medicine in Psychiatry

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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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Withdrawal Symptoms Following Discontinuation of Vortioxetine—Retrospective Chart Review

et al. 2021

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The efficacy of vortioxetine has been proven in many studies, but data concerning discontinuation symptoms (DS) after vortioxetine withdrawal is scarce. The aim of our study is to systematically evaluate the prevalence, determinants, and clinical features of vortioxetine DS in a retrospective chart review. Data were obtained from medical records of 263 adult patients with depressive disorders who discontinued former vortioxetine treatment. DS were observed in eight (3%) patients after 71–375 days (median 272) of treatment. DS emerged after median three days following vortioxetine withdrawal and lasted for median seven days. The clinical presentation of DS involved: emotional lability (100% of patients), irritability (75%), sudden worsening of mood (75%), nervousness (37.5%), and agitation (37.5%). Median DESS score was four (range of four to six). DS were significantly more prevalent after accidental vs. planned discontinuation (adjusted p = 0.011) and were less frequent after switching to a different antidepressant vs. ceasing pharmacotherapy (adjusted p = 0.0165). DS appeared more often if patients discontinued therapy without medical consultation (adjusted p = 0.033). The occurrence of DS was not associated with the dose and way of drug discontinuation (sudden vs. gradual). In sum, our results show that clinicians should be aware that vortioxetine withdrawal is associated with the possibility of DS.

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Panic Anxiety after Abrupt Discontinuation of Mianserin

Cited by 3 publications

References 10 publications

Withdrawal symptoms after discontinuation of a noradrenergic and specific serotonergic antidepressant: A case report and review of the literature

Withdrawal symptoms after discontinuation of a noradrenergic and specific serotonergic antidepressant: A case report and review of the literature

Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications

Withdrawal Symptoms Following Discontinuation of Vortioxetine—Retrospective Chart Review

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