Discontinuation of psychotropic treatment: prediction of consequences (pharmacological approach)
Predicting conditions caused by psychotropic drugs discontinuation is an important part of adequate pharmacotherapy, on the one hand, and a problem of fundamental psychopharmacology, on the other. This is due to the fact that this is not covered either in the recommendations of drug manufacturers or in the regulatory documents of the Ministry of Health of the Russian Federation. At the same time, every practicing psychiatrist faces the problems of “withdrawals” and their possible consequences, arising either due to poor compliance of patients, or due to switching drugs, replacement of add-on medications, etc. Given clinical pharmacology data and drugs’ pharmacodynamics, it is obvious that different groups of psychotropic drugs may differ in the “severity of consequences” and the degree of risk of the patient’s condition worsening when the treatment is discontinued. The article discusses the potential dangers and pathological variants of the neurophysiological processes developing as the result of discontinuation of treatment with the main classes of psychotropic drugs: antipsychotics, antidepressants, anxiolytics, anticonvulsants. A distinction is made between such phenomena as “withdrawal syndrome” and “rebound phenomenon”, the development of which might be associated with the dose and duration of administration of different psychotropic drugs.