Iatrogenic Comorbidity in Childhood and Adolescence: New Insights from the Use of Antidepressant Drugs
Open accessAbstract
The term "iatrogenic comorbidity" refers to unfavorable modifications in the course of an illness, with regard to its characteristics and responsiveness, which may be related to previous treatments. Some iatrogenic adverse events arising from either pharmacotherapy or psychotherapy cannot be subsumed under the traditional rubric of adverse effects and require careful evaluation. Children and adolescents are generally more likely to experience adverse health consequences after drug treatment. The use of antidepressant drugs in this age group may cause potential long-term detrimental effects, such as mood elevation that does not subside when drugs are discontinued and may predispose to the development of a bipolar disorder. The concept of iatrogenic comorbidity in children and adolescents has heuristic value in weighing potential benefits and risks associated particularly with psychotropic treatments.
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Discontinuation of SSRI may trigger complex phenomena, such as hypomania or mania and persistent postwithdrawal disorders.
“Third, discontinuation of SSRI may trigger complex phenomena, which may or may not be related to the onset of withdrawal symptomatology, such as hypomania or mania [85,88] and persistent postwithdrawal disorders [62] .”
From Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review (2015) · cites this paper as [62]
Less common paroxetine withdrawal reactions were 'electric-shock' sensation, visual and auditory hallucination, nocturnal enuresis, pruritus, and emesis.
“Less common reactions were 'electric-shock' sensation [9,59,61,62] , visual and auditory hallucination [63] , nocturnal enuresis [64] , pruritus [65] , and emesis [6] .”
From Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review (2015) · cites this paper as [62]
Citation [6] is attached specifically to emesis. Section 2.1 discusses withdrawal reactions generally, and section 4.1 describes withdrawal after citalopram, but neither identifies emesis as a paroxetine withdrawal reaction. Searches for emesis, vomiting, and paroxetine found no passage addressing that point. (LLM, conf=0.76)
Experimental — accuracy not yet measuredBelaise et al. described 3 cases of persistent post-withdrawal disorders induced by paroxetine.
“Belaise et al. [62] described 3 cases of what they defined as 'persistent post-withdrawal disorders induced by paroxetine'.”
From Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review (2015) · cites this paper as [62]
Section 2.2 discusses persistent symptoms after SSRI withdrawal, and §4.1 describes one case involving citalopram. Searches for Belaise, paroxetine, and three paroxetine cases found no passage in our copy addressing the specific claim. Page numbers were not available in the indexed passages. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThere are anecdotal reports on the use of clonazepam and other benzodiazepines or mood stabilizers for SSRI withdrawal.
“There are anecdotal reports on the use of clonazepam and other benzodiazepines or mood stabilizers, which, however, need to be properly tested [15,50,59,62,72] .”
From Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review (2015) · cites this paper as [62]
Section 4.1 describes alprazolam being prescribed alongside citalopram, then tapered before citalopram; it does not describe its use to treat SSRI withdrawal. Section 4.3 discusses withdrawal from both antidepressants and benzodiazepines, but the passages found for clonazepam, mood stabilizers, and withdrawal treatment do not report anecdotal use of those drugs for SSRI withdrawal. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measuredThe evidence for withdrawal after lithium decrease or discontinuation is weak and ambiguous.
“The evidence for withdrawal after lithium decrease or discontinuation is weak and ambiguous.”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [173]
Section 2.1 mentions cognitive impairments with lithium and reports withdrawal reactions across psychotropic drugs, but does not assess the evidence for withdrawal specifically after lithium dose reduction or discontinuation. A search for lithium found no passage characterizing that evidence as weak or ambiguous; page numbers were unavailable in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Studies with appropriate methodology failed to confirm that early manic and depressive recurrences after lithium discontinuation are rebound symptoms.
“Early manic and depressive recurrences after lithium discontinuation may suggest rebound symptoms, but studies carried out with appropriate methodology failed to confirm it [173].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [173]
Section 2.1 mentions lithium only in connection with cognitive impairment and a general statement about psychotropic-drug withdrawal. Searches for lithium discontinuation, rebound symptoms, and methodological studies found no passage addressing whether early manic or depressive recurrences are rebound symptoms. (LLM, conf=0.75)
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Self-citation
- Authors
- Offidani, E., Fava, G. A., & Sonino, N.
- Affiliations
- Weill Cornell Medicine (US)
- University at Buffalo, State University of New York (US)
- University of Padua (IT)
- Corresponding author
- Fava, Giovanni A.
- Venue
- CNS Drugs
- Published
- 2014-07-01
- Volume
- 28
- Issue
- 9
- Pages
- 769-774
- ISSN
- 1172-7047 (ISSN-L)
- 1179-1934
- OpenAlex
- W2075316199
- Cited by
- 23
- References
- 36
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 3 · 2019: 2 · 2018: 3 · 2017: 2 · 2016: 4 · 2015: 1 · 2014: 1
- FWCI
- 1.94
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- CNS Drugs (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Padua Research Archive (University of Padova) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- antidepressants, childhood depression, adolescent depression, adverse drug reactions, bipolar disorder, mood improvement, treatment discontinuation
- MeSH terms
- Adolescent, Antidepressive Agents, Anxiety Disorders, Child, Female, Humans, Iatrogenic Disease, Male, Risk, Comorbidity, Mood Disorders
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