Withdrawal from psychiatric drugs

How to withdraw from psychiatric drugs is discussed in chapter 15. 

Because of the withdrawal symptoms, it is often necessary to reduce neuroleptic drugs at a very slow rate. Sometimes withdrawal seems to become impossible. I describe the principles of safely withdrawing from psychiatric drugs in chapter 15. 

There are no foolproof methods or blueprints for withdrawing from psychiatric drugs. Unexpected hazards can arise at any time. The following guidelines are drawn from a combination of the author s clinical experience and the scientific literature but cannot possibly cover all of the potential hazards involved in withdrawing from psychiatric drugs. 

When health care providers decide to supervise withdrawal from psychiatric drugs, they must pay careful attention to the feelings or emotions of their patients or clients. Not only do patients deserve this respect and concern, their emotional reactions are the best gauge of how well the tapering process is going. Drug withdrawal requires a patient-centered approach. 

When withdrawing a patient from psychiatric drugs, the health care provider should stay in close touch with the individual, especially at the start of the taper and toward the end, the times that serious problems are most likely to surface. In my practice, I try to see the patient at least once per week throughout the withdrawal process. Early in the taper or at other times of concern, I may arrange for phone call contacts in between sessions. If necessary, I will also stay in touch with family members who are informed about the drug withdrawal. 

There are several key safety principles that should be observed during withdrawal from psychiatric drugs, especially if the drug exposure exceeds a few weeks or months or if the individual has serious preexisting... 

The new edition concludes with two entirely new chapters on treatment—one on how to safely withdraw from psychiatric drugs, and the other about psychosocial and educational approaches to very disturbed people, including 20 guidelines for therapy. I am pleased to include how-to treatment information in the book for the first time. 

The most important problem encountered with amphetamines is abuse and the development of dependence. The most rapid amfetamine epidemic occurred in Japan after World War II, where there had been little or no previous abuse (83). Although a high proportion of amfetamine users probably already have emotional and social difficulties, sustained abuse can result in serious psychiatric complications, ranging from severe personality disorders to chronic psychoses (84,85). Whereas signs of intense physical dependence are not thought to occur (SED-9, 9), withdrawal may be associated with intense depression (SED-9, 9) (86), and relapses in psychiatric disorders have often been noted. Some countries in which the problem became widespread banned amphetamines, and Australia restricted their use to narcolepsy and behavioral disorders in children. Amfetamine dependence developed into a serious problem in the USA (and to a lesser extent in the UK), where it followed the typical pattern of drug dependence (SED-9, 7,10). 

As with several other drugs, for example marijuana, PCP, and LSD, cocaine can precipitate panic disorder, which continues long after drug withdrawal (177). Among 280 patients in a methadone maintenance clinic, the prevalence of panic disorder increased from 1% to 6% over a decade (178). A marked rise in the frequency of cocaine abuse coincided with this outbreak. The authors suggested that episodes of panic occurring in cocaine users can result in hospitalization for either psychiatric or medical illnesses. 

Women were more often affected than men. There was no difference in the incidence or natnre of the disorder according to the type of interferon nsed. Whereas most patients who required psychotropic drugs were able to complete treatment, 10 had to discontinue interferon treatment because of severe psychiatric symptoms, five from group B and five from group C. Twelve patients stiU required psychiatric treatment for more than 6 months after interferon withdrawal. In addition, residual sjmp-toms (anxiety, insomnia, and mild hypothymia) were stiU present at the end of the survey in seven patients. Delayed recovery was mostly observed in patients in group C and in patients treated with interferon beta. 

Visual hallucinations lasting 3 to 4 hours occurred in a 17-year-oid boy who had been taking bupropion 450 mg daiiy for one month and zolpidem 5 to 10 mg daily for about 6 months, when he increased the zolpidem dose to 60 mg. Note that the recommended dose of zolpidem is 10 mg daily and that zolpidem itself can cause psychiatric adverse effects such as hallucinations. Therefore an interaction is not established. Bupropion is contraindicated during abrupt withdrawal from any drug known to be associated with seizures on withdrawal, particularly benzodiazepines and benzodiazepine-like drugs. ... 

Modified and reprinted with permission from American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed.r text revision. Washington, DC American Psychiatric Association, 2000 Sofuoglu M, Dudish-Poulsen S, Poling J, et al. The effect of individual cocaine withdrawal symptoms on outcomes in cocaine users. Addict Behav 2005,30 1 125-1134 and Patten SB, Barbui C. Drug-induced depression a systematic review to inform clinical practice. Psychoth Psychosom 2004 73 207-215. 

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