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DOI: 10.1055/a-2443-1189
Strategies and Management for Psychiatric Drug Withdrawal: A Systematic Review of Case Reports and Series
- Abstract
- Introduction
- Methods
- Search Strategy
- Eligibility Criteria
- Data Extraction and Synthesis
- Results
- Discussion
- References
Abstract
In recent years, an increasing number of case reports on psychiatric drug withdrawal have emerged, offering detailed clinical insights and valuable real-world evidence on the withdrawal process. The objective of this review was to evaluate the strategies and management for withdrawing psychiatric drugs, as detailed in case reports and series. A systematic review of case reports and series published between 2013 and 2023 was conducted to capture the latest trends in psychiatric drug withdrawal. Cases were identified following the PRISMA guidelines by searching electronic databases Medline and Scopus. Finally, 47 case reports and series were included. The primary reason for drug withdrawal was attributed to the emergence of adverse events, followed by medication dependence or abuse, and clinical decision-making or symptom resolution. Gradual reduction of doses was implemented through various management approaches as the primary strategy for drug withdrawal, and drug substitution emerged as the second most employed strategy. Also, patients were mostly undergoing polypharmacy. Favorable treatment outcomes were reported in the majority of cases, suggesting that psychiatric drug withdrawal is feasible – though quite challenging in some situations. However, the remarkably low number of unsuccessful cases may create a misleading impression of the significant difficulty associated with withdrawing psychiatric drugs.
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Keywords
drug tapering - dose reduction - drug therapy - psychoactive drug - drug withdrawal symptomsIntroduction
Deprescribing involves a planned and monitored strategy to reduce or withdraw medications that may harm patients or offer limited ongoing benefits, with the primary goal of enhancing their quality of life by minimizing medication-related burdens or risks [1] [2]. Reports of withdrawal symptoms associated with psychiatric drugs, including both physical and mental manifestations, date back to as early as 1950 [3].
Approximately 54% of patients with serious mental illness experience withdrawal symptoms upon the abrupt or gradual discontinuation of psychiatric drugs [4] [5]. Considerable attention has been focused on discussing how psychoactive drugs induce abnormal neuroadaptation, establishing a new homeostatic balance in which the nervous system accommodates the changes produced by the drug. These adaptations involve changes in postsynaptic receptor and autoreceptor sensitivity, neurotransmitter release and synthesis, as well as various molecular and genetic mechanisms across different brain systems. When the drug is reduced or discontinued, the disruption of homeostasis leads to withdrawal symptoms [6] [7] [8] [9] [10]. However, the exact link between neuroadaptive changes and specific withdrawal effects remains unclear [11].
The results of neuroadaptation are evident through the onset and persistence of withdrawal symptoms. For instance, it has been reported that patients often experience antidepressant withdrawal effects for several months or even longer [12]. Similarly, motor symptoms associated with antipsychotics can persist for months or more following withdrawal [13]. In other words, these adaptations do not immediately resolve upon cessation of the drug but endure for a certain period [9] [14].
When conducting drug withdrawal, a carefully structured tapering regimen should be implemented based on shared decision-making, with ongoing patient monitoring, support, and follow-up [15]. Even when complete withdrawal is not feasible, patients can still benefit from dose reduction, as lower doses help minimize adverse events and improve quality of life [10].
In recent years, an increasing number of case reports concerning the withdrawal of psychiatric drugs have emerged. Case reports provide detailed clinical information and valuable insights into the drug withdrawal process, emphasizing real-world evidence. The objective of this review was to systematically evaluate the strategies and management for withdrawing psychiatric drugs, as detailed in case reports and series. Furthermore, we examined several key factors, including the rationale behind treatment withdrawal, duration of medication use, psychiatric polypharmacy, and treatment outcomes.
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Methods
This systematic review followed the PRISMA guidelines [16]. The study protocol was registered on Prospero (CRD42024527241).
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Search Strategy
Electronic databases (Medline and Scopus) were systematically searched. The literature review covered the period from 2013 to 2023 to capture the latest trends in the withdrawal of psychiatric drugs, with the search conducted in March 2024.
A comprehensive search aimed to identify case reports and series detailing and discussing a specific strategy for withdrawal of psychiatric drugs was performed utilizing the following terms: (“Psychiatric Drugs” or “Psychotropics” or “Psychoactive” or “Antidepressant” or “Antipsychotic” or “Benzodiazepine” or “Z-drug” or “Anticonvulsant”) AND (“Drug Discontinuation” or “Dose Reduction” or “Drug Tapering” or “Drug Withdrawal”) AND (“Case Report” or “Case Series” or “Case”).
Additionally, a supplementary search involved examining the references of the identified articles to uncover any potential publications not captured in the electronic search.
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Eligibility Criteria
The inclusion criteria consisted of the following: studies published in English, limited to case reports or case series, involving human subjects, adult population (age≥18 years), content directly relevant to the subject of the review, and adherence to the specified date limit. This review covered descriptive cases and series, focusing on patient symptoms, diagnosis, treatment, and outcomes.
Studies outside the scope of interest were excluded. Case reports that exclusively described clinical aspects of abrupt discontinuation due to severe adverse drug reactions (ADRs) or focused solely on patient narratives were also excluded.
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Data Extraction and Synthesis
The screening was conducted independently by two authors (JKE and EAK) based on the title and abstract, followed by a thorough examination of the full text. Any discrepancy was resolved by discussing with the research team. Cases were systematically reviewed and examined, focusing on study design, methodology, and results.
A previously designed form was used to extract and organize the data. The following data were collected: drug, study, reason for drug withdrawal, duration of medication use, withdrawal strategy, withdrawal management, psychiatric polypharmacy, and outcome.
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Results
A total of 563 references were identified, and 47 cases were included, each describing and discussing a specific strategy for the withdrawal of psychiatric drugs. [Fig. 1] presents a flow diagram illustrating the references retrieved during the review process.
These reports involved antidepressants (8 cases), anticonvulsants (2 cases), antipsychotics (19 cases), benzodiazepines (10 cases), opioids (2 cases), Z-drugs (2 cases), and also multiple drugs (4 cases). [Table 1] provides a concise overview of the studies.
|
Drug |
Study |
Reason for drug withdrawal |
Duration of medication use |
Withdrawal strategy |
Psychiatric polypharmacy |
Outcome |
|
|---|---|---|---|---|---|---|---|
|
Antidepressants |
Duloxetine |
Brogan et al., 2020 [17] |
Adverse event |
~ 6 years |
Gradual dose reduction |
Lorazepam, methylphenidate |
Discontinued |
|
Escitalopram |
Gallo et al., 2022 [18] |
Adverse event (sexual dysfunction) |
5 years |
Gradual dose reduction, extended dosing, hyperbolic dose reduction |
Lorazepam when needed |
Discontinued |
|
|
Fluoxetine |
Hamilton et al., 2018 [19] |
Adverse drug reaction (choreoathetosis) |
Not informed |
Abrupt discontinuation |
Lisdexamfetamine, melatonin, clonazepam, olanzapine |
Discontinued |
|
|
Nortriptyline |
Olsufka et al., 2018 [20] |
Adverse event (oral ulceration) |
8 weeks |
Gradual dose reduction |
No |
Discontinued |
|
|
Sertraline |
Kaufman et al., 2013 [21] |
Adverse event (gynecomastia) |
18 days |
Gradual dose reduction |
Duloxetine, alprazolam |
Discontinued |
|
|
Tianeptine |
Szczesniak et al., 2022 [22] |
Dependence (opioid-like effects) |
3 years |
Drug substitution |
No |
Substitute medication adopted |
|
|
Trazodone |
Arslan et al., 2015 [23] |
Adverse event (galactorrhea) |
1 week |
Gradual dose reduction |
Citalopram |
Discontinued |
|
|
Venlafaxine |
Zarowitz et al., 2023 [24] |
Clinical decision (patient’s age, duration of treatment, desire to streamline drug therapy) |
20 years |
Gradual dose reduction |
Trazodone |
Dose was reduced |
|
|
Anticonvulsants |
Gabapentin |
Deng et al., 2021 [25] |
Adverse event |
20 months |
Gradual dose reduction |
Fluoxetine, lisdexanfetamine |
Discontinued |
|
Pregabalin (7 cases) |
Langlumé et al., 2022 [26] |
Dependence |
a: 5 months |
Drug substitution |
a,c: None |
Medication abuse restarted (two patients relapsed). |
|
|
Antipsychotics |
Amisulpride |
Lo et al., 2017 [27] |
Adverse event (dyskinesia) |
6 months |
Gradual dose reduction |
No |
Dose was reduced |
|
Amilsulpride |
Yang et al., 2022 [28] |
Adverse event (akhatisia) |
~5 months |
Drug substitution |
Quetiapine, benztropine |
Substitute medication adopted |
|
|
Aripiprazole (a,b,c), Olanzapine (d) (4 cases) |
Suzuki et al., 2014 [29] |
Clinical decision |
Long-term use |
Gradual dose reduction |
a,b: None |
Discontinued |
|
|
Aripiprazole |
Karadag et al., 2015 [30] |
Adverse event (acute transient bilateral myopia) |
5 days |
Drug substitution |
No |
Substitute medication adopted |
|
|
Aripiprazole (7 cases) |
Selfani et al., 2017 [31] |
Adverse event (movement disorders: parkinsonism, tardive dyskinesia, akhatisia) |
A few months to 2 years |
Abrupt discontinuation |
a: Bupropione, paroxetine, quetiapine |
Discontinued or substitute medication adopted |
|
|
Blonanserin |
Kim et al., 2020 [32] |
Adverse event (refractory dry eye disease) |
5 years |
Gradual dose reduction |
No |
Discontinued |
|
|
Clozapine |
Arnoldy et al., 2014 [33] |
Adverse event (type 2 diabetes and obesity) |
14 years |
Gradual dose reduction |
No |
Substitute medication adopted |
|
|
Clozapine |
Yu, 2014 [34] |
Adverse event (poor metabolic profile) |
1 year |
Gradual dose reduction |
Amisulpride and valproate, which were titrated concomitantly to the discontinuation of the other drugs |
Dose was reduced |
|
|
Clozapine (3 cases) |
Uzun et al., 2020 [35] |
Adverse event (knee buckling, negative myoclonus) |
a,c:>2 months |
Gradual dose reduction |
a. No |
Dose was reduced |
|
|
Olanzapine |
Liuzzo et al., 2020 [36] |
Adverse event (oculogyric crisis) |
<1 year |
Gradual dose reduction |
No |
Dose was reduced |
|
|
Olanzapine |
Yogi et al., 2023 [37] |
Adverse event (oculogyric crises) |
1 month |
Gradual dose reduction |
Sodium valproate, lorazepam, haloperidol, promethazine |
Discontinued |
|
|
Paliperidone |
Suzuki et al., 2017 [38] |
Adverse event (extrapyramidal symptoms) |
Not informed |
Extended dosing |
No |
Dose was reduced |
|
|
Quetiapine |
Koch, 2015 [39] |
Resolution of symptoms |
1 year |
Gradual dose reduction |
Venlafaxine |
Discontinued |
|
|
Quetiapine |
Nakamura et al., 2016 [40] |
Adverse event (bradycardia and hypotension) |
~5 months |
Dose reduction |
Brotizolam |
Substitute medication adopted |
|
|
Risperidone |
Shanmugasundaram et al., 2019 [41] |
Adverse event (retrograde ejaculation) |
~1 month |
Drug substitution |
No |
Substitute medication adopted |
|
|
Risperidone |
Torrico et al., 2023 [42] |
Adverse event (sialorrhea) |
5 days |
Drug substitution |
No |
Substitute medication adopted |
|
|
Risperidone, Quetiapine |
Munshi et al., 2016 [43] |
Adverse drug reaction |
1 month |
Abrupt discontinuation, gradual dose reduction |
Lithium, clonazepam |
Discontinued |
|
|
Risperidone, Ziprasidone |
Segrec et al., 2016 [44] |
Resolution of symptoms |
3 days |
Gradual dose reduction |
Buprenorphine, lorazepam, diazepam, quetiapine |
Discontinued |
|
|
Ziprasidone |
Praharaj et al., 2014 [45] |
Adverse drug reaction |
A few days |
Dose reduction |
Sertraline, clonazepam |
Dose was reduced |
|
|
Benzodiazepines |
Alprazolam |
Fournier et al., 2021 [46] |
Dependence |
10 months |
Drug substitution, gradual dose reduction |
Lisdexanfetamine, sertraline, binge drinking, cannabis, nicotine, ecstasy, amphetamine, cocaine, codeine, LSD, psilocybin, inhalants, caffeine |
Discontinued |
|
Clonazepam |
Kacirova et al., 2016 [47] |
Dependence |
Not informed |
Gradual dose reduction |
Gabapentin, citalopram, sulpirid |
Dose was reduced |
|
|
Diazepam |
Coenen et al., 2017 [48] |
Dependence |
Not informed |
Gradual dose reduction |
Phenibut, which was substituted for baclofen |
Dose was reduced |
|
|
Etizolam |
Nishii et al., 2014 [49] |
Dependence |
2 years and 7 months |
Gradual dose reduction |
No |
Discontinued |
|
|
Lorazepam |
Luykx et al., 2013 [50] |
Resolution of symptoms |
~15 days |
Gradual dose reduction |
Fluoxetine, zopiclone, zolpidem, prazepam, which were tapered over 12 days |
Medication was reinstated (symptoms recurred after lorazepam tapering) |
|
|
Lorazepam (7 cases) |
Ali et al., 2017 [51] |
Resolution of symptoms |
Not informed |
Gradual dose reduction |
a,c,e: Risperidone, trihexyphenidyl |
Discontinued or |
|
|
Lorazepam |
Loscertales et al., 2017 [52] |
Dependence |
Long-term use |
Drug substitution |
Cannabis |
Dose was reduced |
|
|
Midazolam |
Ramazani et al., 2023 [53] |
Benzodiazepine abuse |
6 months |
Gradual dose reduction, drug substitution |
No |
Substitute medication adopted |
|
|
Nitrazepam (a,b,e), Diazepam (c), Alprazolam (d) (5 cases) |
Shukla et al., 2014 [54] |
a,d,e: Benzodiazepine dependence |
a,c–e: Not informed |
a–c,e: Gradual dose reduction |
No |
Discontinued |
|
|
Oxazepam |
Mustonen et al., 2021 [55] |
Dependence |
Long-term use |
Gradual dose reduction, drug substitution |
Codeine |
Discontinued |
|
|
Opioids |
Hydrocodone |
Tchikrizov et al., 2022 [56] |
Dependence |
~1 year |
Drug substitution |
Ecstasy (occasional use) |
Substitute medication adopted |
|
Hydromorphone |
Crum et al., 2020 [57] |
Change of administration route |
~3 years |
Drug substitution |
No |
Discontinued |
|
|
Z-drugs |
Zolpidem |
Mashiana et al., 2021 [58] |
Dependence |
Not informed |
Drug substitution |
No |
Discontinued |
|
Zolpidem (7 cases) |
Orsolini et al., 2021 [59] |
Dependence/ misuse |
Not informed |
Drug substitution |
a: Sertraline, bupropione |
Discontinued |
|
|
Multiple drugs |
Clozapine, Lamotrigine, Alprazolam (a); Lithium, Olanzapine, Lamotrigine, Lorazepam (b); Risperidone, Divalproex (c); Divalproex (d); Oxcarbazepine (e) (5 cases) |
Gurevich et al., 2016 [60] |
Clinical decision (to examine the effect of an integrative approach in the absence of medications) |
Not informed |
Gradual dose reduction |
No |
Discontinued |
|
Lamotrigine, Quetiapine, Venlafaxine, Clonazepam, Codeine |
Brogan et al., 2019 [61] |
Adverse event (preparation for pregnancy) |
12 years |
Gradual dose reduction |
No |
Discontinued |
|
|
Lithium, Citalopram, Quetiapine, Zopiclone, Alprazolam |
Valtonen et al., 2020 [62] |
Adverse event (cognitive dysfunction) |
1.5 years (lithium) |
Gradual dose reduction, extended dosing |
No |
Discontinued |
|
|
Trazodone (a,d,e), Lorazepam (b), Zolpidem (c) (5 cases) |
Fung et al., 2019 [63] |
Not mentioned |
a: 10 years |
Gradual dose reduction |
No |
Discontinued |
|
Occurrences associated with adverse events were subclassified as an adverse drug reaction (ADR) when indicated by the study (studies that applied the Naranjo algorithm). For those not utilizing the algorithm, occurrences were classified merely as adverse events.
The primary reason for drug withdrawal was attributed to the emergence of adverse events, accounting for 53.2% of cases [17] [18] [19] [20] [21] [23] [25] [27] [28] [30] [31] [32] [33] [34] [35] [36] [37] [38] [40] [41] [42] [43] [45] [61] [62]. In 27.7% of cases, medication dependence or abuse prompted withdrawal [22] [26] [46] [47] [48] [49] [52] [53] [54] [55] [56] [58] [59], while clinical decision-making or symptom resolution accounted for 14.9% [24] [29] [39] [44] [50] [51] [60]. Other causes accounted for 4.2% of the cases [57] [63].
In 80.9% of the studies, a gradual reduction of doses was implemented as the primary strategy for drug withdrawal [17] [18] [19] [20] [21] [23] [24] [25] [26] [27] [29] [31] [32] [33] [34] [35] [36] [37] [39] [40] [43] [44] [45] [46] [47] [48] [49] [50] [51] [52] [53] [54] [55] [59] [60] [61] [62] [63]. Drug substitution emerged as the second most employed strategy, accounting for 40.4% of cases in the analyzed cases [22] [26] [28] [30] [31] [33] [35] [40] [41] [42] [46] [52] [53] [54] [55] [56] [57] [58] [59].
The majority of reported cases exhibited favorable treatment outcomes, whether it was successful withdrawal from the drug (55.3%) [17] [18] [19] [20] [21] [23] [24] [25] [29] [31] [32] [37] [39] [43] [44] [46] [49] [51] [54] [55] [57] [58] [59] [60] [61] [62] [63], treatment maintenance with reduced doses (23.4%) [27] [34] [35] [36] [38] [45] [47] [48] [51] [52], or treatment maintenance with the substitute drug (21.3%) [22] [28] [30] [31] [33] [40] [41] [42] [53] [56]. Cases with unfavorable outcomes accounted only for 4.3% [26] [50].
In 53.3% of cases, the patients were undergoing polypharmacy, as they were concurrently using other psychoactive drugs.
Favorable treatment outcomes were reported in the majority of cases, suggesting that psychiatric drug withdrawal is feasible - though quite challenging in some situations. However, the remarkably low number of unsuccessful case reports may create a misleading impression of the significant difficulty associated with psychiatric drug withdrawal.
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Discussion
Adverse events were the primary reason for drug withdrawal in the cases studied. Reported adverse events included a variety of problems such as cognitive dysfunction, movement disorders, sexual dysfunctions, and metabolic disorders, among others [17] [18] [19] [20] [21] [23] [25] [27] [28] [30] [31] [32] [33] [34] [35] [36] [37] [38] [40] [41] [42] [43] [45] [61] [62].
Patients often ask to come off the medication, typically due to adverse events. However, the withdrawal process demands substantial effort, requiring patients to fully engage and remain vigilant for any withdrawal symptoms or the resurgence of their condition. Hence, self-monitoring becomes essential for effectively managing symptoms and achieving a successful withdrawal [15].
Gradual dose reduction was identified through various management approaches as the most commonly used strategy for psychiatric drug withdrawal. In two cases, multiple strategies were employed for a single patient, reflecting efforts to withdraw the drug effectively [18] [40]. One of the cases employed hyperbolic dose reduction [18]. Hyperbolic taper involves reducing the dose in progressively smaller steps, particularly during the final doses. Recent studies suggest that this strategy results in a linear reduction in receptor occupancy, potentially mitigating withdrawal symptoms [6] [9] [13].
During this review study, we have noted a tendency in research articles to generalize certain terms. Frequently, publications refer to any drug utilized in a psychiatric context as a ‘psychotropic drug,’ rather than distinguishing it from a ‘psychoactive drug.’
Psychoactive drugs alter central nervous system functions, affecting behavior, mood, and cognition. Psychotropic drugs similarly influence these functions and are additionally characterized by potent reinforcing properties, making them prone to self-administration [64]. While all psychotropic drugs are psychoactive, the reverse is not always true.
‘Dependence’ and ‘addiction’ are occasionally used interchangeably as well. Physical dependence involves physiological adaptation to central nervous system medications, leading to rebound effects upon abrupt cessation, independent of reinforcing effects but related to homeostasis. ‘Addiction’ includes compulsive behavior, craving, impaired control over drug intake, and physical dependence. Not all psychiatric drugs induce addiction, but they all cause neurobiological adaptations that may lead to discomfort upon reduction or discontinuation [9].
Similarly, ‘abstinence syndrome’ and ‘withdrawal syndrome’ have been used to describe symptoms when drug use stops after physical dependence develops. However, ‘Abstinence syndrome’ encompasses not only physical but psychological and behavioral aspects of drug abstention, including challenges, cravings, and triggers for relapse during recovery.
Therefore, antidepressants, antipsychotics, and mood stabilizers (e. g., lithium and anticonvulsants) are categorized as psychoactive drugs due to their non-reinforcing nature and lack of addiction potential. Stopping these medications can result in withdrawal syndrome. In contrast, benzodiazepines, Z-drugs, opioids, methylphenidate, and drugs of abuse, are classified as psychotropic drugs because they possess reinforcing properties and can lead to addiction. They also may cause tolerance to develop. Ceasing these drugs can result in abstinence syndrome.
Withdrawal symptoms can be severe and prolonged – with variations in severity and duration among patients when withdrawing psychiatric drugs. Adjusting drug withdrawal based on the patient’s tolerance level implies difficulties in establishing a standardized approach. Thus, monitoring during the process is essential [8].
Informed consent and shared decision-making are important at all stages of pharmacotherapy, including discussions of benefits, risks, and withdrawal challenges [65] [66]. Essential support for withdrawal involves elements such as helplines, counseling groups, and personalized plans [67].
Focusing on case studies entails limitations regarding sample size and variability in the reported cases. We were unable to identify a consistent pattern or trend between drug exposure and the complexity of the withdrawal process among the cases. High heterogeneity, due to variability in clinical characteristics and methods, limits the ability to detect patterns [68]. Results may be biased, as only unusual or successful cases might be reported. Also, none of the identified cases regarded withdrawal symptoms as the primary focus.
Therefore, our findings should be supplemented by studies using different designs to gain a more comprehensive understanding of psychiatric drug withdrawal. Additionally, the exclusion of cases involving people with lived experience is a limitation that future research should address.
Further research into neurobiological adaptation and its implications is required, as the persistence of withdrawal symptoms mainly depends on the system’s return to a pre-drug state [9] [14]. The great “aha!” is finding out what to do during this transitional period.
This systematic review concluded that the primary strategy for withdrawing psychiatric drugs involves the gradual reduction of doses, typically initiated by the emergence of adverse events in patients undergoing polypharmacy.
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Conflict of Interest
The authors declare that they have no conflict of interest.
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- 32 Kim JE, Jung JW. Refractory dry eye disease associated with Meige’s syndrome induced by long-term use of an atypical antipsychotic. BMC Ophthalmol 2020; 20: 474
- 33 Arnoldy R, Curtis J, Samaras K. The effects of antipsychotic switching on diabetes in chronic schizophrenia. Diabet Med 2014; 31: e16-e19
- 34 Yu CH. Reversal of weight gain with concurrent normalization of fasting glucose and marked reduction in triglyceride after clozapine dose-reduction and simplification of other psychotropics in chronic schizophrenia: A case report. Psychiatr Danub 2014; 26: 190-192
- 35 Uzun Ö, Bolu A, Taşçi AB. et al. Knee buckling (negative myoclonus) associated with clozapine: Reports on 3 cases. Clin Neuropharmacol 2020; 43: 26-27
- 36 Liuzzo K, Stutzman D, Murphy J. Olanzapine-induced withdrawal oculogyric crisis in an adolescent with a neurodevelopmental disorder. J Pediatr Pharmacol Ther 2020; 25: 455-458
- 37 Yogi TN, Bhusal A, Limbu S. et al. Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: A case report. Ann Med Surg (Lond) 2023; 85: 5255-5258
- 38 Suzuki H, Hibino H, Inoue Y. et al. One patient with schizophrenia showed reduced drug-induced extrapyramidal symptoms as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day. SAGE Open Med Case Rep 2017; 5: 2050313X17742836
- 39 Koch HJ. Severe quetiapine withdrawal syndrome with nausea and vomiting in a 65-year-old patient with psychotic depression. Therapie 2015; 70: 537-538
- 40 Nakamura M, Seki M, Sato Y. et al. Quetiapine-induced bradycardia and hypotension in the elderly-A case report. Innov Clin Neurosci 2016; 13: 34-36
- 41 Shanmugasundaram N, Nivedhya J, Karthik MS. et al. Risperidone-induced retrograde ejaculation and lurasidone may be the alternative. Ind Psychiatry J 2019; 28: 152-154
- 42 Torrico T, Kahlon A. Pathophysiology and management of risperidone-induced sialorrhea: Case report. Front Psychiatry 2023; 14: 1185750
- 43 Munshi S, Mukherjee S, Saha I. et al. Pedal edema associated with atypical antipsychotics. Indian J Pharmacol 2016; 48: 88-90
- 44 Segrec N, Kastelic A, Pregelj P. Pentedrone-induced acute psychosis in a patient with opioid addiction: A case report. Heroin Addict Relat Clin Probl 2016; 18: 53-56
- 45 Praharaj SK, Jana AK, Sarkhel S. et al. Acute dystonia, akathisia, and parkinsonism induced by ziprasidone. Am J Ther 2014; 21: e38-e40
- 46 Fournier C, Jamoulle O, Chadi A. et al. Severe benzodiazepine use disorder in a 16-year-old adolescent: A rapid and safe inpatient taper. Pediatrics 2021; 147: e20201085
- 47 Kacirova I, Grundmann M, Silhan P. et al. A case report of clonazepam dependence: Utilization of therapeutic drug monitoring during withdrawal period. Medicine (Baltimore) 2016; 95: e2881
- 48 Coenen NCB, Dijkstra BAG, Batalla A. et al. Detoxification of a patient with comorbid dependence on phenibut and benzodiazepines by tapering with baclofen: Case report. J Clin Psychopharmacol 2019; 39: 511-514
- 49 Nishii S, Hori H, Kishimoto T. et al. A successful case of dose reduction in etizolam dependence using fine granules: A case report. Int Med Case Rep J 2014; 7: 121-122
- 50 Luykx JJ, Post EH, van der Erf M. et al. Agitation after minor trauma: Combativeness as a cardinal catatonic feature. BMJ Case Rep 2013; 2013: bcr2012008217
- 51 Ali SF, Gowda GS, Jaisoorya TS. et al. Resurgence of catatonia following tapering or stoppage of lorazepam - A case series and implications. Asian J Psychiatr 2017; 28: 102-105
- 52 Loscertales HR, Wentzky V, Dürsteler K. et al. Successful withdrawal from high-dose benzodiazepine in a young patient through electronic monitoring of polypharmacy: A case report in an ambulatory setting. Ther Adv Psychopharmacol 2017; 7: 181-187
- 53 Ramazani Y, Nemati A, Moshiri M. et al. Treatment of high dose of intravenous midazolam abuse: A case report. Int Clin Psychopharmacol 2024; 39: 206-210
- 54 Shukla L, Kandasamy A, Kesavan M. et al. Baclofen in the short-term maintenance treatment of benzodiazepine dependence. J Neurosci Rural Pract 2014; 5: S53-S54
- 55 Mustonen A, Leijala J, Aronranta J. et al. Withdrawal from long-term use of unusually high-dose oxazepam. Case Rep Psychiatry 2021; 2021: 2140723
- 56 Tchikrizov V, Richert AC, Bhardwaj SB. Case of buprenorphine-associated central sleep apnea resolving with dose reduction. J Opioid Manag 2022; 18: 391-394
- 57 Crum IT, Meyer Karre VM, Balasanova AA. Transitioning from intrathecal hydromorphone to sublingual buprenorphine-naloxone through microdosing: A case report. A A Pract 2020; 14: e01316
- 58 Mashiana MK, Irfanullah Z, Khawaja HI. et al. Case of seizures with sudden discontinuation of zolpidem. Prim Care Companion CNS Disord 2021; 23: 21cr02960
- 59 Orsolini L, Chiappini S, Grandinetti P. et al. ‘Z-trip’? A comprehensive overview and a case-series of zolpidem misuse. Clin Psychopharmacol Neurosci 2021; 19: 367-387
- 60 Gurevich MI, Robinson CL. An individualized approach to treatment-resistant bipolar disorder: A case series. Explore (NY) 2016; 12: 237-245
- 61 Brogan K, Siefert A. Successful discontinuation of chronic polypsychotropic regimen and resolution of withdrawal syndrome through nutrition and lifestyle interventions: A case report. Adv Mind Body Med 2019; 33: 22-30
- 62 Valtonen J, Karrasch M. Polypharmacy-induced cognitive dysfunction and discontinuation of psychotropic medication: A neuropsychological case report. Ther Adv Psychopharmacol 2020; 10: 2045125320905734
- 63 Fung CH, Martin JL, Alessi C. et al. Hypnotic discontinuation using a blinded (masked) tapering approach: A case series. Front Psychiatry 2019; 10: 717
- 64 Carmona-Huerta J, Castiello-de Obeso S, Ramírez-Palomino J. et al. Polypharmacy in a hospitalized psychiatric population: Risk estimation and damage quantification. BMC Psychiatry 2019; 19: 78
- 65 Read J. How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addict Behav 2020; 102: 106157
- 66 Read J. How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication?. J Ment Health 2022; 1-9
- 67 Taylor S, Annand F, Burkinshaw P. et al. Dependence and withdrawal associated with some prescribed medicines: An evidence review. London: Public Health England; 2019
- 68 Henssler J, Schmidt Y, Schmidt U. et al. Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. Lancet Psychiatry 2024; 11: 526-535
Correspondence
Publication History
Received: 11 July 2024
Accepted: 03 October 2024
Article published online:
12 November 2024
© 2024. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
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- 33 Arnoldy R, Curtis J, Samaras K. The effects of antipsychotic switching on diabetes in chronic schizophrenia. Diabet Med 2014; 31: e16-e19
- 34 Yu CH. Reversal of weight gain with concurrent normalization of fasting glucose and marked reduction in triglyceride after clozapine dose-reduction and simplification of other psychotropics in chronic schizophrenia: A case report. Psychiatr Danub 2014; 26: 190-192
- 35 Uzun Ö, Bolu A, Taşçi AB. et al. Knee buckling (negative myoclonus) associated with clozapine: Reports on 3 cases. Clin Neuropharmacol 2020; 43: 26-27
- 36 Liuzzo K, Stutzman D, Murphy J. Olanzapine-induced withdrawal oculogyric crisis in an adolescent with a neurodevelopmental disorder. J Pediatr Pharmacol Ther 2020; 25: 455-458
- 37 Yogi TN, Bhusal A, Limbu S. et al. Olanzapine-induced oculogyric crisis in a patient with mania without psychotic symptoms: A case report. Ann Med Surg (Lond) 2023; 85: 5255-5258
- 38 Suzuki H, Hibino H, Inoue Y. et al. One patient with schizophrenia showed reduced drug-induced extrapyramidal symptoms as a result of an alternative regimen of treatment with paliperidone 3 and 6 mg every other day. SAGE Open Med Case Rep 2017; 5: 2050313X17742836
- 39 Koch HJ. Severe quetiapine withdrawal syndrome with nausea and vomiting in a 65-year-old patient with psychotic depression. Therapie 2015; 70: 537-538
- 40 Nakamura M, Seki M, Sato Y. et al. Quetiapine-induced bradycardia and hypotension in the elderly-A case report. Innov Clin Neurosci 2016; 13: 34-36
- 41 Shanmugasundaram N, Nivedhya J, Karthik MS. et al. Risperidone-induced retrograde ejaculation and lurasidone may be the alternative. Ind Psychiatry J 2019; 28: 152-154
- 42 Torrico T, Kahlon A. Pathophysiology and management of risperidone-induced sialorrhea: Case report. Front Psychiatry 2023; 14: 1185750
- 43 Munshi S, Mukherjee S, Saha I. et al. Pedal edema associated with atypical antipsychotics. Indian J Pharmacol 2016; 48: 88-90
- 44 Segrec N, Kastelic A, Pregelj P. Pentedrone-induced acute psychosis in a patient with opioid addiction: A case report. Heroin Addict Relat Clin Probl 2016; 18: 53-56
- 45 Praharaj SK, Jana AK, Sarkhel S. et al. Acute dystonia, akathisia, and parkinsonism induced by ziprasidone. Am J Ther 2014; 21: e38-e40
- 46 Fournier C, Jamoulle O, Chadi A. et al. Severe benzodiazepine use disorder in a 16-year-old adolescent: A rapid and safe inpatient taper. Pediatrics 2021; 147: e20201085
- 47 Kacirova I, Grundmann M, Silhan P. et al. A case report of clonazepam dependence: Utilization of therapeutic drug monitoring during withdrawal period. Medicine (Baltimore) 2016; 95: e2881
- 48 Coenen NCB, Dijkstra BAG, Batalla A. et al. Detoxification of a patient with comorbid dependence on phenibut and benzodiazepines by tapering with baclofen: Case report. J Clin Psychopharmacol 2019; 39: 511-514
- 49 Nishii S, Hori H, Kishimoto T. et al. A successful case of dose reduction in etizolam dependence using fine granules: A case report. Int Med Case Rep J 2014; 7: 121-122
- 50 Luykx JJ, Post EH, van der Erf M. et al. Agitation after minor trauma: Combativeness as a cardinal catatonic feature. BMJ Case Rep 2013; 2013: bcr2012008217
- 51 Ali SF, Gowda GS, Jaisoorya TS. et al. Resurgence of catatonia following tapering or stoppage of lorazepam - A case series and implications. Asian J Psychiatr 2017; 28: 102-105
- 52 Loscertales HR, Wentzky V, Dürsteler K. et al. Successful withdrawal from high-dose benzodiazepine in a young patient through electronic monitoring of polypharmacy: A case report in an ambulatory setting. Ther Adv Psychopharmacol 2017; 7: 181-187
- 53 Ramazani Y, Nemati A, Moshiri M. et al. Treatment of high dose of intravenous midazolam abuse: A case report. Int Clin Psychopharmacol 2024; 39: 206-210
- 54 Shukla L, Kandasamy A, Kesavan M. et al. Baclofen in the short-term maintenance treatment of benzodiazepine dependence. J Neurosci Rural Pract 2014; 5: S53-S54
- 55 Mustonen A, Leijala J, Aronranta J. et al. Withdrawal from long-term use of unusually high-dose oxazepam. Case Rep Psychiatry 2021; 2021: 2140723
- 56 Tchikrizov V, Richert AC, Bhardwaj SB. Case of buprenorphine-associated central sleep apnea resolving with dose reduction. J Opioid Manag 2022; 18: 391-394
- 57 Crum IT, Meyer Karre VM, Balasanova AA. Transitioning from intrathecal hydromorphone to sublingual buprenorphine-naloxone through microdosing: A case report. A A Pract 2020; 14: e01316
- 58 Mashiana MK, Irfanullah Z, Khawaja HI. et al. Case of seizures with sudden discontinuation of zolpidem. Prim Care Companion CNS Disord 2021; 23: 21cr02960
- 59 Orsolini L, Chiappini S, Grandinetti P. et al. ‘Z-trip’? A comprehensive overview and a case-series of zolpidem misuse. Clin Psychopharmacol Neurosci 2021; 19: 367-387
- 60 Gurevich MI, Robinson CL. An individualized approach to treatment-resistant bipolar disorder: A case series. Explore (NY) 2016; 12: 237-245
- 61 Brogan K, Siefert A. Successful discontinuation of chronic polypsychotropic regimen and resolution of withdrawal syndrome through nutrition and lifestyle interventions: A case report. Adv Mind Body Med 2019; 33: 22-30
- 62 Valtonen J, Karrasch M. Polypharmacy-induced cognitive dysfunction and discontinuation of psychotropic medication: A neuropsychological case report. Ther Adv Psychopharmacol 2020; 10: 2045125320905734
- 63 Fung CH, Martin JL, Alessi C. et al. Hypnotic discontinuation using a blinded (masked) tapering approach: A case series. Front Psychiatry 2019; 10: 717
- 64 Carmona-Huerta J, Castiello-de Obeso S, Ramírez-Palomino J. et al. Polypharmacy in a hospitalized psychiatric population: Risk estimation and damage quantification. BMC Psychiatry 2019; 19: 78
- 65 Read J. How common and severe are six withdrawal effects from, and addiction to, antidepressants? The experiences of a large international sample of patients. Addict Behav 2020; 102: 106157
- 66 Read J. How important are informed consent, informed choice, and patient-doctor relationships, when prescribing antipsychotic medication?. J Ment Health 2022; 1-9
- 67 Taylor S, Annand F, Burkinshaw P. et al. Dependence and withdrawal associated with some prescribed medicines: An evidence review. London: Public Health England; 2019
- 68 Henssler J, Schmidt Y, Schmidt U. et al. Incidence of antidepressant discontinuation symptoms: A systematic review and meta-analysis. Lancet Psychiatry 2024; 11: 526-535