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For other meanings, see Withdrawal (disambiguation).

Withdrawal, also known as withdrawal/abstinence syndrome, refers to the characteristic signs and symptoms that appear when a drug that causes physical dependence is regularly used for a long time and then suddenly discontinued or decreased in dosage. Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation The term can also, less formally, refer to symptoms that appear after discontinuing a drug or other substance (unable to cause true physical dependence) that one has become psychologically dependent upon. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as

Examples are:

Contents

Overview

The sustained use of many kinds of drugs causes reversible adaptations within the body that tend to lessen the drug's original effects over time, a phenomenon known as drug tolerance. Delirium tremens (colloquially the DTs, " the horrors " " the fear "" the shakes "" jazz hands "" Benzodiazepine withdrawal syndrome is caused by stopping benzodiazepines or during dosage reduction of Benzodiazepines. Methadone ( Dolophine Amidone Methadose Physeptone Heptadon and many others is a synthetic Opioid, used medically as an Analgesic, Antitussive SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome is a Withdrawal syndrome that can occur during or following the interruption Drug tolerance occurs when a subject's reaction to a Psychoactive drug (such as a painkiller or intoxicant decreases so that larger doses are required to achieve the same effect To have these adaptations to a drug is to have a physical dependency on it, for when the drug is suddenly discontinued or decreased, the adaptations do not immediately disappear. Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation Unopposed by the drug, the adaptations appear as withdrawal signs and symptoms that are generally the opposite of the drug's direct effects. Depending primarily on the drug's elimination half-life, withdrawal symptoms can appear within a few hours to several days after discontinuation. The biological half-life of a substance is the time it takes for a substance (drug radioactive nuclide or other to lose half of its pharmacologic physiologic or radiologic activity

The withdrawal symptoms associated with many recreational drugs are well-known. Recreational drug use is the use of Psychoactive drugs for Recreational purposes rather than for work, medical or spiritual purposes However, many drugs that do not generally cause euphoria, and are therefore not generally abused or thought of as addictive, also induce physical dependence with associated withdrawal. Examples include beta blockers, corticosteroids such as cortisone, many anticonvulsants and most antidepressants. Beta blockers (sometimes written as β-blocker) are a class of drugs used for various indications but particularly for the management of Cardiac arrhythmias Corticosteroids are a class of Steroid hormones that are produced in the Adrenal cortex. The anticonvulsants, also called antiepileptic drugs (abbreviated "AEDs" are a diverse group of pharmaceuticals used in the treatment of epileptic An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression Nevertheless, sudden withdrawal from these medications can be harmful or even fatal; this is why many prescription labels explicitly warn the patient not to discontinue the drug without doctor approval.

Withdrawal from drugs of abuse

Central to the role of nearly all drugs that are commonly abused to produce euphoria is the nucleus accumbens, the brain's "pleasure center". Euphoria is a medically recognized emotional state related to Pleasure and Happiness. The nucleus accumbens (NAcc also known as the accumbens nucleus or as the nucleus accumbens septi (Latin for nucleus leaning against the Septum Neurons in the nucleus accumbens use the neurotransmitter dopamine, so while specific mechanisms vary, nearly every drug of abuse either stimulates dopamine release or enhances its activity, directly or indirectly. Dopamine is a Hormone and Neurotransmitter occurring in a wide variety of animals including both vertebrates and invertebrates Sustained use of the drug results in less and less stimulation of the nucleus accumbens until eventually it produces no euphoria at all. Discontinuation of the drug then produces a withdrawal syndrome characterized by dysphoria — the opposite of euphoria — as nucleus accumbens activity declines below normal levels

Withdrawal symptoms can vary significantly among individuals, but there are some commonalities. Dysphoria (from Greek δύσφορος (dysphoros from δυσ- difficult and φέρω to bear is generally characterized as an unpleasant or uncomfortable mood such as sadness Subnormal activity in the nucleus accumbens is often characterized by depression, anxiety and craving, and if extreme can help drive the individual to continue the drug despite significant harm — the definition of addiction — or even to suicide

However, addiction is to be carefully distinguished from physical dependence. In the fields of Psychology and Psychiatry, the terms depression or depressed refer to both expected and pathologically chronic or severe Anxiety is a physiological and psychological state characterized by Cognitive, Somatic, Emotional and Behavioral components The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as Addiction is a psychological compulsion to use a drug despite harm that often persists long after all physical withdrawal symptoms have abated. On the other hand, the mere presence of even profound physical dependence does not necessarily denote addiction, e. g. , in a patient using large doses of opioids to control chronic pain under medical supervision.

As the symptoms vary, some people are, for example, able to quit smoking "cold turkey" (i. " Cold Turkey " is a song written by John Lennon, and recorded by The Plastic Ono Band. e. , immediately, without any tapering off) while others may never find success despite repeated efforts. However, the length and the degree of an addiction can be indicative of the severity of withdrawal

Withdrawal is a more serious medical issue for some substances than for others. The term " addiction " is used in many contexts to describe an obsession compulsion or excessive Physical dependence or psychological dependence such as While nicotine withdrawal, for instance, is usually managed without medical intervention, attempting to give up a benzodiazepine or alcohol dependency can result in seizures and worse if not carried out properly. Nicotine is an Alkaloid found in the Nightshade family of plants ( Solanaceae) which constitutes approximately 0 The benzodiazepines (pronounced, often abbreviated to "benzos") are a class of Psychoactive drugs with varying Hypnotic Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation An epileptic seizure is caused by excessive and/or hypersynchronous electrical Neuronal activity and is usually self-limiting An instantaneous full stop to a long, constant alcohol use can lead to delirium tremens, which may be fatal. Delirium tremens (colloquially the DTs, " the horrors " " the fear "" the shakes "" jazz hands ""

An interesting side-note is that while physical dependence (and withdrawal on discontinuation) is virtually inevitable with the sustained use of certain classes of drugs, notably the opioids, psychological addiction is much less common. An opioid is a chemical Substance that has a Morphine -like action in the body Most chronic pain patients, as mentioned earlier, are one example. There are also documented cases of soldiers who used heroin recreationally in Vietnam during the war, but who gave it up when they returned home (see Rat Park for experiments on rats showing the same results). Heroin ( INN: diacetylmorphine, BAN: diamorphine) is a semi-synthetic opioid synthesized from Morphine, a derivative Rat Park was a study into Drug addiction conducted in the 1970s by Canadian psychologist Bruce K It is thought that the severity or otherwise of withdrawal is related to the person's preconceptions about withdrawal. In other words, people can prepare to withdraw by developing a rational set of beliefs about what they are likely to experience. Self-help materials are available for this purpose. Self-help or self-improvement refers to self-guided improvement—economically intellectually or emotionally—most frequently with a substantial psychological or spiritual

Withdrawal from prescription medicine

As mentioned earlier, many drugs should not be stopped abruptly[1] without the advice and supervision of a physician, especially if the medication induces dependence or if the condition they are being used to treat is potentially dangerous and likely to return once medication is stopped, such as diabetes, asthma, heart conditions and many psychological or neurological conditions, like epilepsy, hypertension, schizophrenia and psychosis. Diabetes mellitus (ˌdaɪəˈbiːtiːz or /ˌdaɪəˈbiːtəs/ /məˈlaɪtəs/ or /ˈmɛlətəs/ often referred to simply as diabetes ( Ancient Greek: grc Asthma is a chronic Condition involving the Respiratory system in which the airways occasionally constrict become inflamed, and are Cardiovascular disease or cardiovascular diseases refers to the class of diseases that involve the Heart or Blood vessels ( arteries and Epilepsy is a common chronic Neurological disorder that is characterized by recurrent unprovoked seizures. Hypertension, also referred to as high blood pressure, HTN or HPN, is a medical condition in which the Blood pressure is chronically elevated Schizophrenia ( from the Greek roots schizein (σχίζειν "to split" and phrēn Psychosis (from the Greek ψυχή "psyche" for mind or soul and -οσις "-osis" for abnormal condition with adjective psychotic To be safe, consult a doctor before discontinuing any prescription medication.

Sudden cessation of the use of an antidepressant can deepen the feel of depression significantly (see "Rebound" below), and some specific antidepressants can cause a unique set of other symptoms as well when stopped abruptly. An antidepressant is a Psychiatric medication used for alleviating major depression or Dysthymia ('milder' depression

Discontinuation of selective serotonin reuptake inhibitors (SSRIs), the most commonly prescribed class of antidepressants, (and the related class serotonin-norepinephrine reuptake inhibitors or SNRIs) is associated with a particular syndrome of physical and psychological symptoms known as SSRI discontinuation syndrome. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders Serotonin-norepinephrine reuptake inhibitors (SNRIs are a class of Antidepressant used in the treatment of major depression and other mood disorders SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome is a Withdrawal syndrome that can occur during or following the interruption Effexor (venlafaxine) and Paxil (paroxetine), both of which have relatively short half-lives in the body, are the most likely of the antidepressants to cause withdrawals. Venlafaxine (Effexor Efexor is an Antidepressant of the Serotonin-norepinephrine reuptake inhibitor (SNRI class first introduced by Wyeth in 1993 Paroxetine (trade names Seroxat, Paxil, Parotin, Aropax, Xetanor, ParoMerck, Rexetin) is a Selective serotonin The biological half-life of a substance is the time it takes for a substance (drug radioactive nuclide or other to lose half of its pharmacologic physiologic or radiologic activity Prozac (fluoxetine), on the other hand, is the least likely of SSRI and SNRI antidepressants to cause any withdrawal symptoms, due to its exceptionally long half-life. Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders

Rebound

Many substances can cause rebound effects (significant return of the original symptom in absence of the original cause) when discontinued, regardless of their tendency to cause other withdrawal symptoms. Rebound depression is common among users of any antidepressant who stop the drug abruptly, whose states are sometimes worse than the original before taking medication. Major depressive disorder, also known as major depression, unipolar depression, unipolar disorder, clinical depression, or simply depression This is somewhat similar (though generally less intense and more drawn out) than the 'crash' that users of ecstasy, amphetamines, and other stimulants experience. MDMA ( 34-methylenedioxy- N -methylamphetamine) most commonly known today by the street name Ecstasy (often abbreviated E, X, Amphetamine, and related drugs such as Methamphetamine are a group of drugs that act by increasing levels of Norepinephrine, Serotonin, and Dopamine Stimulant drugs are Drugs that temporarily increase alertness and awareness Occasionally light users of opiates that would otherwise not experience much in the way of withdrawals will notice some rebound depression as well. For other uses see Opiate (disambiguation, or for the class of drugs see Opioid. Extended use of drugs that increase the amount of serotonin or other neurotransmitters in the brain can cause some receptors to 'turn off' temporarily or become desensitized, so, when the amount of the neurotransmitter available in the synapse returns to an otherwise normal state, there are fewer receptors to attach to, causing feelings of depression until the brain re-adjusts. Serotonin (ˌsɛrəˈtoʊnən ( 5-hydroxytryptamine, or 5-HT) is a Monoamine Neurotransmitter synthesized in serotonergic Neurons See Chemical synapse for an introduction to concepts and terminology used in this article In Biochemistry, a receptor is a Protein molecule embedded in either the Plasma membrane or Cytoplasm of a cell to which a mobile signaling Chemical synapses are specialized junctions through which Neurons signal to each other and to non-neuronal cells such as those in Muscles or Glands

Other drugs that commonly cause rebound are:

With these drugs, the only way to relieve the rebound symptoms is to stop the medication causing them and weather the symptoms for a few days; if the original cause for the symptoms is no longer present, the rebound effects will go away on their own.

Neonatal abstinence syndrome

Neonatal abstinence syndrome (NAS) is a withdrawal syndrome of infants, caused by administration of drugs. There are two types of NAS, prenatal and postnatal. Prenatal NAS is caused by substance abuse by the mother, while postnatal NAS is caused by discontinuation of drugs directly to the infant. [2]

The drugs involved are e. g. opioids, selective serotonin reuptake inhibitors (SSRIs) and alcoholic beverages. An opioid is a chemical Substance that has a Morphine -like action in the body Selective serotonin reuptake inhibitors ( SSRIs) are a class of Antidepressants used in the treatment of depression, Anxiety disorders [2]

Pseudoabstinence

Pseudoabstinence is used by some authors[3] to describe signs of withdrawal although the dose remains constant. Such signs may arise in use of benzodiazepines[3] and amphetamine. Amphetamine, and related drugs such as Methamphetamine are a group of drugs that act by increasing levels of Norepinephrine, Serotonin, and Dopamine

See also

References

  1. ^ (2002) in Peter Lehmann: Coming off Psychiatric Drugs. Physical dependence (or drug dependence) refers to a state resulting from habitual use of a drug where negative physical Withdrawal symptoms result from abrupt discontinuation Drug tolerance occurs when a subject's reaction to a Psychoactive drug (such as a painkiller or intoxicant decreases so that larger doses are required to achieve the same effect A hangover ( veisalgia) describes the sum of unpleasant physiological effects following heavy consumption of drugs particularly Alcoholic beverages The most commonly Germany: Peter Lehmann Publishing. 1-891408-98-4.  
  2. ^ a b emedicine.com - Neonatal Abstinence Syndrome Author: Jaques Belik, MD
  3. ^ a b [www. iuphar. org/case-studies/czelderlybz. doc Confusion in the third age]

External links

Dictionary

withdrawal

-noun

  1. Receiving from someone's care what one has earlier entrusted to them. Usually refers to money.
  2. A method of birth control which consists of removing the penis from the vagina before ejaculation.
  3. A type of metabolic shock the body undergoes when a substance, usually a toxin such as heroin, to which a patient is addicted is withheld. Sometimes used with the substance as modifier
  4. An act of withdrawing.
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