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Cited by 164Treatment of Major DepressionElectroconvulsive Therapy StudiesPharmacovigilance and Adverse Drug Reactions

New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

Open access
Chouinard, Guy, Chouinard, Virginie-Anne·2015·Psychotherapy and Psychosomatics
DOI 10.1159/000371865
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Abstract

inal symptoms at the same intensity as before treatment, entailing a return of the same episode and a new episode of illness, respectively [6, 9] . When treatment with a CNS drug is discontinued, patients can experience classic new withdrawal symptoms, rebound and/or persistent postwithdrawal disorders, or relapse/recurrence of the original illness [6, 9, 14] . New and rebound symptoms can occur for up to 6 weeks after drug withdrawal, depending on the drug elimination half-life [2, 3] , while persistent postwithdrawal or tardive disorders associated with longlasting receptor changes may persist for more than 6 weeks after drug discontinuation. Initial withdrawal symptoms from CNS drugs have been reported to be more frequent and severe when high-potency drugs and drugs with a short elimination half-life have been used [9, 10] . CNS drugs with a shorter elimination half-life and rapid onset of action also carry a higher risk of dependency and high-dose use [9, 10] . Withdrawal symptoms can be relatively short-lasting, lasting for a few hours to a few weeks with complete recovery, while others may persist and last for several months [1, 15, 16] . Fava et al. [1] have proposed using the terminology ‘withdrawal syndrome’ to replace the term ‘discontinuation syndrome’, which has been most often used to describe SSRI withdrawal. They have recommended the Selective serotonin reuptake inhibitors (SSRIs) are widely used in clinical practice, and have advanced the treatment of depressi…

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Claims the paper makes

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  • Findingown data

    In a 50-year-old woman with social phobia treated with citalopram 20 mg/day for 5 years for an MDE, tapering and discontinuation of citalopram produced new withdrawal symptoms (sweating, agitation, nausea) for 2 weeks.

    “After the discontinuation of citalopram, she reported new symptoms, such as sweating, agitation, and nausea, for 2 weeks.”
    Quote in the paperSubstantial claim
  • Findingown data

    The same patient developed an MDE with melancholic features (deep anhedonia, depressed mood with diurnal variation, loss of energy, guilt, and suicidal thoughts) that she had never had before.

    “However, she also developed MDE with melancholic features accompanied by deep anhedonia, depressed mood with diurnal variation, loss of energy, guilt, and suicidal thoughts, which she had never had before.”
    Quote in the paperSubstantial claim
  • Premisecitation

    Some initial new withdrawal symptoms common to all CNS drug classes include nausea, headaches, tremor, sleep disturbances, decreased concentration, anxiety, irritability, agitation, aggression, depression, or dysphoria.

    “Some initial new withdrawal symptoms common to all CNS drug classes include nausea, headaches, tremor, sleep disturbances, decreased concentration, anxiety, irritability, agitation, aggression, depression, or dysphoria.”
    Quote in the paperSubstantial claim
  • Premisecitation
    § New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

    Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness.

    “Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness [1,2,7] .”
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  • Premisecitation

    High potency and short and intermediate half-life compounds tend to carry greater risks for withdrawal symptoms, in addition to drug dependence.

    “High potency and short and intermediate half-life compounds tend to carry greater risks for withdrawal symptoms, in addition to drug dependence [6,9,10] .”
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  • May combine two claims. 29
  • Classified as probably not a substantial claim. 14

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    Findingown data

    In that patient, the melancholic depression persisted for an additional week while other withdrawal symptoms disappeared.

    “The patient was observed for an additional week, and while other withdrawal symptoms disappeared, the melancholic depression persisted.”
    Quote in the paperSubstantial claim

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    Findingown data

    Case 1 illustrates a persistent postwithdrawal disorder with generalized anxiety disorder, which responded to CBT and clonazepam, but without complete recovery, still requiring clonazepam despite completion of CBT.

    “This case illustrates a persistent postwithdrawal disorder with GAD, which responded to CBT and clonazepam, but without complete recovery, still requiring clonazepam despite the completion of the CBT.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: The three types of withdrawal (new withdrawal symptoms, rebound, and persistent postwithdrawal disorders) are distinct and can be reliably differentiated from relapse or recurrence of the original illness using the proposed criteria.

  • May combine two claims.

    Findingown data

    Case 2 illustrates a persistent postwithdrawal cyclothymic disorder that developed after paroxetine discontinuation and lasted 3 years, with remission but without complete recovery.

    “Subsequently, he developed significant cyclothymic disorder, with greatly increased reactivity to environmental stimuli and anxious distress, which lasted for 3 years.”
    • Also stated in: § Case 2: Persistent Postwithdrawal Cyclothymic Disorder A 37-year-old man was treated for panic disorder with agoraphobia with paroxetine 20 mg/day for 7 years.Panic disorder and agoraphobia persisted despite treatment, and any attempt to reduce paroxetine was unsuccessful.He could only leave the house to go to work, and limited his activities to what he could not refuse for work, declining any other outings for leisure, including out-of-town opportunities.When the patient sought a new consultation, he was first treated for agoraphobia with CBT.A specialized psychologist guided him with homework exposure, consisting of 10 sessions every other week.His agoraphobia improved, and a paroxetine taper was then initiated.It was first tapered to 10 mg nightly, which immediately resulted in nervousness, headache, tension, and diarrhea.After 1 week of this paroxetine dose reduction, the patient was switched to fluoxetine 20 mg/day, which resulted in new withdrawal symptoms.After 2 months, these new symptoms improved, and fluoxetine was tapered to 10 mg/day for 1 week and then discontinued.Subsequently, he developed significant cyclothymic disorder, with greatly increased reactivity to environmental stimuli and anxious distress, which lasted for 3 years.It is important to note that he had no previous history of mood disorder.He was prescribed clonazepam without a decrease in his symptoms.Three years after the discontinuation of paroxetine, the patient started to improve, and the postwithdrawal cyclothymic disorder remitted, but without complete recovery. · plain
      “Three years after the discontinuation of paroxetine, the patient started to improve, and the postwithdrawal cyclothymic disorder remitted, but without complete recovery.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The three types of withdrawal (new withdrawal symptoms, rebound, and persistent postwithdrawal disorders) are distinct and can be reliably differentiated from relapse or recurrence of the original illness using the proposed criteria.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    In that patient, after 2 years, attempts to taper nortriptyline and clonazepam (one at a time) were unsuccessful.

    “After 2 years, she is still on nortriptyline 100 mg/day and clonazepam 0.5 mg three times a day.Any attempt to taper both drugs (one at the time) has been unsuccessful.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Other new withdrawal symptoms more specific to a certain class of CNS drugs include lacrimation, rhinorrhea, and sneezing for opiates, paroxysmal sweats for alcohol, and increased appetite for nicotine.

    “Other new withdrawal symptoms that may be more specific to a certain class of CNS drugs include lacrimation, rhinorrhea, and sneezing for opiates, paroxysmal sweats for alcohol, and increased appetite for nicotine [10,23,24] .”
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    Premisecitation

    Major complications of withdrawal may occur, such as seizures, suicide and psychoses, and in cases of barbiturate or alcohol abuse, even death.

    “However, major complications of withdrawal may occur, such as seizures, suicide and psychoses [10] , and, in cases of barbiturate or alcohol abuse, even death [25] .”
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    Premisecitation
    § New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

    Different types of withdrawal syndromes described with SSRIs and other CNS drug classes include new withdrawal symptoms, rebound, and persistent postwithdrawal disorders.

    “Different types of syndromes have been described with the withdrawal from SSRIs and other CNS drug classes, including benzodiazepines, antipsychotics, antidepressants, opiates, barbiturates, and alcohol: (1) new withdrawal symptoms (classic withdrawal symptoms from CNS drugs) [1,[4][5][6][9][10][11][12] , (2) rebound [2,6,9,[13][14][15][16] , and (3) persistent postwithdrawal disorders [7,17,18] (”
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    Premisecitation
    § New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

    Fava et al.'s systematic review of SSRI withdrawal analyzed 23 studies (15 randomized controlled studies, 4 open trials, 4 retrospective investigations) and 38 case reports, and found both early and late onset, and short and long duration of withdrawal symptoms.

    “Recently, Fava et al. [1] have conducted the first systematic review of SSRI withdrawal.The authors analyzed 23 studies (15 randomized controlled studies, 4 open trials, 4 retrospective investigations) and 38 case reports of SSRI withdrawal, and found both early and late onset, and short and long duration of withdrawal symptoms.”
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    Interpretationnone given
    § New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal

    SSRI withdrawal symptoms occur when the drug's pharmacological effects diminish after drug decrease or discontinuation, indicating an underlying pharmacological mechanism comparable to that of other CNS drug withdrawal symptoms.

    “SSRI withdrawal symptoms occur when the drug's pharmacological effects diminish after drug decrease or discontinuation, which indicates an underlying pharmacological mechanism comparable to that of other CNS drug withdrawal symptoms.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    These withdrawal symptoms are typically transient, reversible and usually last less than 6 weeks, depending on the drug elimination half-life.

    “These symptoms are typically transient, reversible and usually last <6 weeks, depending on the drug elimination half-life [2,[9][10][11] .”
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    Premisecitation

    New SSRI withdrawal symptoms usually reach a peak of onset between 36 and 96 h after SSRI reduction or discontinuation, and are reversible, lasting from a few hours up to 6 weeks.

    “They usually reach a peak of onset between 36 and 96 h after SSRI reduction or discontinuation, and are reversible, lasting from a few hours up to 6 weeks [1,12,22] .”
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    Premisecitation

    New withdrawal symptoms reported with SSRIs include a wide range of symptoms, both physical and psychological, and are found throughout different systems in the body.

    “New withdrawal symptoms reported with SSRIs include a wide range of symptoms, both physical and psychological [1] , and are found throughout different systems in the body ( table 2 ).”
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    Premisereasoning

    Different classes of CNS drugs may share common withdrawal symptoms, but may also have their own specific withdrawal symptoms.

    “Different classes of CNS drugs may share common withdrawal symptoms, but may also have their own specific withdrawal symptoms.”
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    Premisecitation

    Tardive dyskinesia and supersensitivity psychosis are well-known postwithdrawal disorders (also called supersensitivity syndromes).

    “Tardive dyskinesia and supersensitivity psychosis are well-known postwithdrawal disorders (also called supersensitivity syndromes) [7,17,18] .”
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    Premisecitation

    Rebound insomnia was demonstrated in individuals with insomnia upon withdrawal of short and intermediate half-life benzodiazepines, and early morning insomnia with rapidly eliminated benzodiazepines.

    “These reports were followed by the demonstration of rebound insomnia in individuals with insomnia upon withdrawal of short and intermediate half-life benzodiazepines [13] and early morning insomnia with rapidly eliminated benzodiazepines [32] .”
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  • Classified as probably not a substantial claim.

    Premisenone given

    Due to the lack of classification for SSRI withdrawal, rebound symptoms in SSRI withdrawal have not been described as such in the literature.

    “Due to the lack of classification for SSRI withdrawal, rebound symptoms in SSRI withdrawal have not been described as such in the literature.”
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    Premisecitation

    Data from controlled trials, case reports, and online patient reports show that paroxetine is most likely to be associated with new withdrawal symptoms, and fluoxetine the least.

    “Data from controlled trials [15,20,29] , case reports [16] , and online patient reports [26] show that paroxetine is most likely to be associated with new withdrawal symptoms, and fluoxetine the least.”
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    Premisenone given

    It has been clearly demonstrated with benzodiazepines that patients often respond rapidly to the reinstitution of the drug, which may lead to a false sense of efficacy and need for the drug.

    “It has been clearly demonstrated with benzodiazepines that patients often respond rapidly to the reinstitution of the drug, which may lead to a false sense of efficacy and need for the drug.”
    Quote in the paperSubstantial claim

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    Interpretationreasoning

    In the Rosenbaum et al. and the other study, drug interruption was short (5-8 days), and it is unlikely that rebound with fluoxetine would be seen; as fluoxetine has a long half-life, it is also less likely to cause rebound.

    “In this study and the study by Rosenbaum et al. [20] , the drug interruption was short (5-8 days), and it is unlikely that rebound with fluoxetine would be seen.However, as fluoxetine has a long half-life, it is also less likely to cause rebound.”
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    Premisecitation

    In Rosenbaum et al.'s study, patients taking paroxetine and sertraline developed worsened depressive symptoms on the Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale after treatment interruption, and returned to baseline depression measurements after reinstitution of treatment.

    “In this study, patients taking paroxetine and sertraline developed worsened depressive symptoms on the Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale after treatment interruption, and returned to baseline depression measurements after reinstitution of the treatment.”
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    Premisecitation

    Rebound anxiety and rebound panic were reported with abrupt benzodiazepine discontinuation.

    “Rebound anxiety [2,14] and rebound panic [15] were then reported with abrupt benzodiazepine discontinuation [9] .”
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    Premisecitation

    CNS drug rebound was first reported as REM rebound, consisting of an increase in REM sleep following abrupt withdrawal of barbiturates and nonbenzodiazepine hypnotics.

    “CNS drug rebound was first reported as REM rebound, consisting of an increase in REM sleep following abrupt withdrawal of barbiturates and nonbenzodiazepine hypnotics [30,31] .”
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    Premisecitation

    Persistent postwithdrawal disorders have been described with different classes of CNS drugs (e.g. protracted insomnia for alcohol and benzodiazepine withdrawal and major depression/dysphoria for cocaine and amphetamine withdrawal), and even more so with specific drugs (e.g. quetiapine and paroxetine) within a drug class.

    “Persistent postwithdrawal disorders have been described with different classes of CNS drugs (e.g.protracted insomnia for alcohol and benzodiazepine withdrawal [10,36] and major depression/dysphoria for cocaine and amphetamine withdrawal [10,23] ), and even more so with specific drugs (e.g.quetiapine and paroxetine) within a drug class [6,15,16,33] .”
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  • Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.

    Interpretationreasoning

    Differentiating withdrawal from relapse and recurrence of the original illness will allow clinicians to more effectively reduce and withdraw SSRIs, and find a minimal therapeutic dose.

    “Differentiating withdrawal from relapse and recurrence of the original illness will allow clinicians to more effectively reduce and withdraw SSRIs, and find a minimal therapeutic dose.”
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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    Reducing the dose gradually develops a plateau period that can help distinguish the development of new withdrawal symptoms, rebound, or recurrent symptoms.

    “Furthermore, by reducing the dose gradually, a plateau period develops that can help to distinguish the development of new withdrawal symptoms, rebound, or recurrent symptoms.”
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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Checklists such as the DESS are helpful to ensure that all new withdrawal symptoms are inquired about, particularly if the medication is withdrawn before 6 months of continuous intake.

    “Checklists, such as the DESS [20] , are also helpful to ensure that all new withdrawal symptoms are inquired about, particularly if the medication is withdrawn before 6 months of continuous intake.”
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    Premisecitation

    Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness.

    “Significant postwithdrawal illnesses found with SSRI use include anxiety disorders, tardive insomnia, major depression, and bipolar illness.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Withdrawal symptoms may occur with SSRIs, similarly to other CNS drugs, and they must be identified and differentiated from relapse and recurrence of the original illness.

    “Withdrawal symptoms may occur with SSRIs, similarly to other CNS drugs, and they must be identified and differentiated from relapse and recurrence of the original illness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Postwithdrawal disorders may resemble rebound symptoms being more severe than the original symptoms, but these disorders persist at least 6 weeks in contrast to rebound symptoms.

    “They may resemble rebound symptoms being more severe than the original symptoms, but these disorders persist at least 6 weeks in contrast to rebound symptoms and [6,15,16,26,37] .”
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  • May combine two claims.

    Premisecitation

    Fava et al. conducted a study of gradual SSRI discontinuation in panic disorder and found that 9 of 20 patients (45%) experienced new withdrawal symptoms, and that 3 of the 9 (33%) patients treated with paroxetine had postwithdrawal disorders at 1 year of follow-up, including bipolar spectrum disorder (n=2) and major depressive disorder (n=1).

    “Fava et al. [16] conducted a study of gradual SSRI discontinuation in panic disorder and found that 9 of 20 patients (45%) experienced new withdrawal symptoms, and that 3 of the 9 (33%) patients treated with paroxetine had postwithdrawal disorders at 1 year of follow-up, including bipolar spectrum disorder (n = 2) and major depressive disorder (n = 1).”
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    Premisecitation

    There were online cases of persistent postwithdrawal disorders found after the discontinuation of paroxetine, citalopram, escitalopram, and fluvoxamine, but not sertraline or fluoxetine.

    “There were online cases of persistent postwithdrawal disorders found after the discontinuation of paroxetine, citalopram, escitalopram, and fluvoxamine, but not sertraline or fluoxetine [26] .”
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    Premisecitation

    One proposed mechanism for the beneficial effects of using an anticonvulsant as an adjunct to an antipsychotic in schizophrenia is its antikindling effect.

    “One proposed mechanism explaining the beneficial effects of using an anticonvulsant as an adjunct to an antipsychotic in schizophrenia is its antikindling effect [39,40] .”
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    Interpretationnone given

    The proposed diagnostic criteria will assist in distinguishing between new withdrawal symptoms, rebound, and persistent postwithdrawal disorders, and relapse or recurrence of the illness.

    “The proposed diagnostic criteria will assist in distinguishing between new withdrawal symptoms, rebound, and persistent postwithdrawal disorders, and relapse or recurrence of the illness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    We previously reported two types of persistent postwithdrawal psychiatric disorders (pathological gambling and generalized anxiety) with paroxetine that were treated successfully with specific cognitive behavioral therapy (CBT) and medications.

    “We previously reported two types of persistent postwithdrawal psychiatric disorders (pathological gambling and generalized anxiety) with paroxetine that were treated successfully with specific cognitive behavioral therapy (CBT) and medications [37] .”
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  • Probably not a substantial claim: may not pass S4 (based). May combine two claims.

    Interpretationnone given

    Gradual withdrawal may reduce new withdrawal and rebound symptoms but may have no effect on persistent postwithdrawal disorders.

    “Of note, it may be that gradual withdrawal reduces new withdrawal and rebound symptoms, but has no effect on persistent postwithdrawal disorders.”
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    Premisecitation

    Persistent postwithdrawal panic disorder has been shown to occur following withdrawal of paroxetine, and paroxetine has also been associated with other postwithdrawal disorders.

    “Persistent postwithdrawal panic disorder [15,38] has been shown to occur following withdrawal of paroxetine, and paroxetine has also been associated with other postwithdrawal disorders [6,15,16] .”
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    Premisecitation

    In another study, we analyzed online reports from individuals who described postwithdrawal disorders after SSRI discontinuation.

    “In another study, we analyzed online reports from individuals who described postwithdrawal disorders after SSRI discontinuation [26] .”
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  • Probably not a substantial claim: may not pass S4 (based).

    Interpretationnone given

    The proposed diagnostic criteria will permit the identification of three types of withdrawal associated with SSRIs.

    “The proposed diagnostic criteria will permit the identification of three types of withdrawal associated with SSRIs.”
    Quote in the paperNot a substantial claim
38 of 38

  • The paper relies on this without support.

    The three types of withdrawal (new withdrawal symptoms, rebound, and persistent postwithdrawal disorders) are distinct and can be reliably differentiated from relapse or recurrence of the original illness using the proposed criteria.

    “These types of withdrawal need to be differentiated from relapse and recurrence of the original illness.”
    “Our proposed classification aims to improve the detection and management of SSRI withdrawal, differentiating it from relapse and recurrence of the original illness.”

  • The paper relies on this without support.

    A minimum of 6 months of continuous SSRI use prior to reduction or discontinuation is necessary to establish the drug's pharmacologic effect well enough to differentiate withdrawal phenomena from relapse or recurrence.

    “We deem this treatment duration requirement necessary, so that the pharmacologic effect of the drug is well established, allowing for differentiation between withdrawal phenomena and relapse or recurrence of the original illness.”

  • The paper relies on this without support.

    Symptoms common to CNS drugs and specific symptoms related to serotonergic pharmacology can be used to classify SSRI withdrawal.

    “We will derive a classification for SSRI withdrawal based on withdrawal symptoms common to different CNS drug classes and specific symptoms common to SSRIs and SNRIs.”

  • The paper relies on this without support.

    After 2 years of maintenance treatment, many types of persistent postwithdrawal disorders may be observed.

    “After 2 years of maintenance treatment, many types of persistent postwithdrawal disorders may be observed.”

  • The paper relies on this without support.

    Lamotrigine has a depression-stabilizing effect.

    “Lamotrigine may also be beneficial as an adjunctive therapy with SSRIs to treat depression as it has a depression-stabilizing effect.”

  • The paper relies on this without support.

    Long-term receptor changes occur with SSRI maintenance treatment and can be minimized by low doses and adjunct treatments such as CBT.

    “Giving low doses of SSRIs and decreasing the lengths of SSRI maintenance treatment by using adjunct treatments, such as CBT, should be considered whenever possible to try to minimize long-term receptor changes.”

  • The paper relies on this without support.

    SSRI withdrawal is similar enough to alcohol, opiate, and benzodiazepine withdrawal that the same management principles apply.

    “Third, the same principles recommended for the management of alcohol, opiate and benzodiazepine withdrawal should apply to SSRIs, including the use of long half-life drugs [9,10] , such as fluoxetine.”
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Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The literature distinguishes between acute withdrawal syndromes, including rebound disorders, and persistent post-acute withdrawal syndromes (PAWS), including persistent post-withdrawal disorders.

    “The literature further distinguishes between two broad categories of withdrawal syndromes: acute withdrawal syndromes, including rebound disorders, and persistent post-acute withdrawal syndromes (PAWS), including persistent post-withdrawal disorders (Chouinard and Chouinard, 2015; Cosci and Chouinard, 2020; Lerner and Klein, 2019).”

    From Post-acute withdrawal syndrome (PAWS) after stopping antidepressants: a systematic review with meta-narrative synthesis (2025) · cites this paper as Chouinard and Chouinard, 2015

    The introduction proposes three types of SSRI withdrawal: new withdrawal symptoms, rebound, and persistent postwithdrawal disorders. The Rebound Symptoms and Postwithdrawal Disorders sections distinguish transient rebound symptoms from disorders lasting at least six weeks. The paper does not present these as two broad categories called acute withdrawal and PAWS, so that framing is not supported by this source. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Relapse and recurrence have symptom severity as before drug treatment, while drug withdrawal produces greater severity.

    “(2) symptom severity as before drug treatment, while drug withdrawal produces greater severity [10].”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [10]

    The introductory passage describes relapse and recurrence as a return of the original symptoms at the same intensity as before treatment. The “Rebound Symptoms” section says symptoms return at greater intensity, and “Postwithdrawal Disorders” describes greater intensity as one possible presentation. The claim overgeneralizes this distinction: the paper also identifies new withdrawal symptoms, which are not necessarily more severe versions of the original symptoms. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Relapse and recurrence have gradual onset of the original symptoms and illness, while drug withdrawal produces acute, abrupt return.

    “both relapse and recurrence have 2 clinical features different from withdrawal syndromes: (1) the gradual onset of the original symptoms and illness, while drug withdrawal produces acute, abrupt return”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [10]

    The introductory classification describes relapse and recurrence as a gradual return of the original symptoms, and the Rebound Symptoms section describes rebound as a rapid return. The claim overgeneralizes that rapid return to drug withdrawal as a whole; the paper distinguishes rebound from other withdrawal phenomena, which can have different onset patterns. No page number is available for these passages in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Both FGAs and SGAs have shown to trigger withdrawal at decrease, switch, or discontinuation.

    “Since both FGAs and SGAs have shown to trigger withdrawal at decrease, switch, or discontinuation,”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [10]

    The 'New Withdrawal Symptoms' section says antipsychotics can cause withdrawal when a drug is decreased or discontinued, and the 'Rebound Symptoms' section gives clozapine and quetiapine as examples. The paper does not explicitly establish the claim for both first- and second-generation antipsychotics, or address withdrawal during switching. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Persistent post-withdrawal tardive dyskinesia is characterized by a hyperkinetic, involuntary, purposeless movement disorder occurring after decrease, discontinuation, or switch of antipsychotics.

    “Persistent post-withdrawal tardive diskinesia is characterized by a hyperkinetic, involuntary, and purposeless movement disorder [10] occurring after decrease, discontinuation, or switch of antipsychotics.”

    From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [10]

    The Postwithdrawal Disorders section (page not provided) identifies tardive dyskinesia as a postwithdrawal disorder associated with antipsychotic medication. It does not describe the movements as hyperkinetic, involuntary, or purposeless, or specify that the disorder occurs after switching antipsychotics. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

Cites

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Related

Authors
Chouinard, G., & Chouinard, V.-A.
Affiliations
  • McGill University (CA)
  • Harvard University (US)
ORCID
Chouinard, Virginie-Anne
Venue
Psychotherapy and Psychosomatics
Publisher
S. Karger AG
Published
2015
Volume
84
Issue
2
Pages
63-71
ISSN
  • 0033-3190 (ISSN-L)
  • 1423-0348
DOI
10.1159/000371865
OpenAlex
W2084924129
Cited by
164
References
44
Citations by year
2026: 4 · 2025: 9 · 2024: 16 · 2023: 11 · 2022: 12 · 2021: 20 · 2020: 21 · 2019: 22 · 2018: 18 · 2017: 14 · 2016: 10 · 2015: 6
FWCI
11.53
Type
journal article
Language
en
Open access
Licence
Locations
  • Psychotherapy and Psychosomatics (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
Keywords
selective serotonin reuptake inhibitors, relapse and recurrence, serotonin-norepinephrine reuptake inhibitors, benzodiazepine withdrawal, elimination half-life, antidepressant tapering, antidepressant withdrawal syndrome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Statistics and arithmetic are recomputed, not judged.

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