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withdrawal effects can...

...vary between people

...be both physical and emotional

...appear at different times

Chouinard and Cosci distinguish, from a synthesis of the scientific literature, 3 categories of symptoms : new symptoms and rebound symptoms, which can last up to 6 weeks, and persistent symptoms which last more than six weeks. New symptoms are symptoms that did not exist before the start of treatment whereas rebound symptoms may be reminiscent of symptoms for which treatment was prescribed, but with much more intensity (see …be mistaken for relapse below). The category of persistent symptoms includes new symptoms or rebound symptoms. You can consult their withdrawal symptoms chart here which lists all the symptoms reviewed by research, organized by drug class and symptom type.

For her part, based on an analysis of the Surviving antidepressants forum and the scientific literature, Adèle Framer refers to two categories , also used by other researchers (Moncrieff 2021; Horowitz, 2022): acute symptoms, which last up to 8 weeks, and post-acute symptoms (or prolonged withdrawal syndrome), which last longer than 8 weeks.

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Cosci, Fiammetta, and Guy Chouinard. 2020. “Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications.” Psychotherapy and Psychosomatics 89(5):283-306. must: 10.1159/000506868 .

Framer, Adele. 2021. “What I Have Learned from Helping Thousands of People Taper off Antidepressants and Other Psychotropic Medications.” Therapeutic Advances in Psychopharmacology 11:2045125321991274. must: 10.1177/2045125321991274 .

Moncrieff, Joanna, 2021, A Straight Talking Introduction to Psychiatric Drugs: The Truth about how they work and how to come off them, PCCS Books, Monmouth

Horowitz, Mark Abie, and David Taylor. 2022. “How to Reduce and Stop Psychiatric Medication.” European Neuropsychopharmacology 55:4‑7. must: 10.1016/j.euroneuro.2021.10.001 .

...be mistaken for a relapse

In an article on psychiatric drug withdrawal effects, Cosci and Chouinard define rebound symptoms as "the return of the symptoms for which the drug was originally prescribed, with greater intensity than initially" (Cosci and Chouinard, 2020). For example, someone who has been prescribed benzodiazepines for symptoms of anxiety may experience anxiety, but more intensely, upon withdrawal. In the same way, a person who has been prescribed a drug for insomnia could experience insomnia again, but more intensely at the time of withdrawal. These rebound effects, however, are not related to anxiety or insomnia attributed to a mental health problem, but they are part of the effects of withdrawal on the body and mind. They are therefore temporary. This is why we distinguish the rebound effects, linked to withdrawal, from a relapse. Upon withdrawal, the body and brain go through a series of adaptations and must “relearn” to function without the drug. Rebound symptoms are primarily adaptive physiological effects of the body and brain associated with withdrawal.

...require a period of adaptation

Stopping a drug also means giving your brain time to relearn how to function without the drug or, as research says, to adapt or re-adapt to functioning without the drug. Here is what Mark Horowitz, a researcher, says about these adaptations.

“Long-term use of psychotropic medications can lead to lasting adaptations – seen in the persistence of tardive dyskinesia after stopping antipsychotics (Horowitz et al., 2021). The long-lasting effects of other classes of psychiatric drugs have received relatively little attention, but there is no reason to believe that the brain or body can return to its pre-drug state within weeks of taking the drug after years or decades of drug exposure (Reidenberg, 2011). The sometimes prolonged nature of withdrawal effects after discontinuation of benzodiazepines, antidepressants, antipsychotics, and other classes is consistent with the notion that the adaptations underlying these drugs may persist for months or years (Lerner et al. Klein, 2019). Patient reports of lasting effects are often dismissed because the drug is "out of the system." However, it is the drug adaptations that persist, causing the brain to register a lack of the anticipated intake of psychiatric drugs, which manifests as withdrawal effects. »

Horowitz, Mark Abie, and David Taylor. 2022. “How to Reduce and Stop Psychiatric Medication.” European Neuropsychopharmacology 55:4‑7. doi: 10.1016/j.euroneuro.2021.10.001 .

...relate to dependance

In research, a distinction is often made between dependence, addiction and tolerance, which can sometimes be confusing, even among some mental health professionals. Here is a possible definition of the three terms, to help you find your way around them.

According to some recent research, dependance would be associated with all psychiatric drugs. Dependence "refers to three different meanings: (i) physical dependence is an adaptive state that manifests as a class-specific withdrawal syndrome and can be produced by abrupt cessation, rapid reduction in dose, a reduction in the blood level of the drug and/or the administration of an antagonist; (ii) psychological dependence is a subjective feeling of craving for a specific psychoactive substance, either for its positive effects or to avoid the negative effects associated with its abstinence; and (iii) a substance use disorder category in previous editions of the Diagnostic and Statistical Manual of Mental Disorders, but not in DSM-5, published in 2013.”

In the case of psychiatric drugs, we can think that dependance refers rather to the first meaning of the term: the withdrawal of a drug leads to a series of symptoms which represent the adaptation of the body to the discontinuation or diminishing of a drug.

Some psychotropic drugs can lead to addiction . This is the case for example of benzodiazepines, opioids but also of certain psychostimulants. Addiction "is characterized by an inability to abstain permanently, impaired behavioural control, cravings, diminished recognition of significant problems with one's behaviours and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can lead to disability or premature death."

Tolerance is an “adaptive state in which exposure to a drug over time results in a decrease in one or more of its physiological effects”. This is the case, for example, with benzodiazepines.

Alicja Lerner, Michael Klein, Dependence, withdrawal and rebound of CNS drugs: an update and regulatory considerations for new drugs development, Brain Communications, Volume 1, Issue 1, 2019, https://doi.org/10.1093/braincomms/fcz025