DEPRESSION-YOU ARE NOT ALONE

 

 

Mental Health Friday 2022-07-29

On Mental Health Friday, we post, in alphabetical order, one per week, information on mental health disorders. Mental Health Friday is for informational purposes only, and is in no way meant to diagnose, treat or cure any disease. Please do not self diagnose and seek professional help for what ails you.

Drug Withdrawal

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Drug withdrawal, drug withdrawal syndrome, or substance withdrawal syndrome,^[1] is the group of symptoms that occur upon the abrupt discontinuation or decrease in the intake of pharmaceutical or recreational drugs.

In order for the symptoms of withdrawal to occur, one must have first developed a form of drug dependence. This may occur as physical dependence, psychological dependence or both. Drug dependence develops from consuming one or more substances over a period of time.

Dependence arises in a dose-dependent manner and produces withdrawal symptoms that vary with the type of drug that is consumed. For example, prolonged use of an antidepressantmedication is likely to cause a rather different reaction when discontinued compared to discontinuation of an opioid, such as heroin. Withdrawal symptoms from opiates include anxiety, sweating, vomiting, and diarrhea. Alcohol withdrawal symptoms include irritability, fatigue, shaking, sweating, and nausea. Withdrawal from nicotine can cause irritability, fatigue, insomnia, headache, and difficulty concentrating. Many prescription and legal nonprescription substances can also cause withdrawal symptoms when individuals stop consuming them, even if they were taken as directed by a physician.

The route of administration, whether intravenous, intramuscular, oral or otherwise, can also play a role in determining the severity of withdrawal symptoms. There are different stages of withdrawal as well; generally, a person will start to feel bad (crash or come down), progress to feeling worse, hit a plateau, and then the symptoms begin to dissipate. However, withdrawal from certain drugs (barbiturates, benzodiazepines, alcohol, glucocorticoids) can be fatal. While it is seldom fatal to the user, withdrawal from opiates (and some other drugs) can cause miscarriage, due to fetal withdrawal. The term “cold turkey” is used to describe the sudden cessation use of a substance and the ensuing physiologic manifestations.

The symptoms from withdrawal may be even more dramatic when the drug has masked prolonged malnutrition, disease, chronic pain, infections (common in intravenous drug use), or sleep deprivation, conditions that drug abusers often develop as a secondary consequence of the drug. When the drug is removed, these conditions may resurface and be confused with withdrawal symptoms. Genes that encode for the Alpha5 Nicotinic Acetylcholine Receptor affect nicotine and alcohol withdrawal symptoms.

Effect on homeostasis

Homeostasis is the body’s ability to maintain a certain chemical equilibrium in the brain and throughout the body. For example, the function of shivering in response to cold is to produce heat maintaining internal temperature at around 37 °C (98.6 °F). Homeostasis is impacted in many ways by drug usage and withdrawal. The internal systems perpetuate homeostasis by using different counter-regulatory methods in order to create a new state of balance based on the presence of the drug in the system.^[2] These methods include adapting the body’s levels of neurotransmitters, hormones, and other substances present to adjust for the addition of the drug to the body.^[3]

Substances

Addiction and dependence glossary[4][5][6][7]
addiction – a biopsychosocial disorder characterized by persistent use of drugs (including alcohol) despite substantial harm and adverse consequences addictive drug – psychoactive substances that with repeated use are associated with significantly higher rates of substance use disorders, due in large part to the drug’s effect on brain reward systems dependence – an adaptive state associated with a withdrawal syndrome upon cessation of repeated exposure to a stimulus (e.g., drug intake) drug sensitization or reverse tolerance – the escalating effect of a drug resulting from repeated administration at a given dose drug withdrawal – symptoms that occur upon cessation of repeated drug use physical dependence – dependence that involves persistent physical–somatic withdrawal symptoms (e.g., fatigue and delirium tremens) psychological dependence – dependence that involves emotional–motivational withdrawal symptoms (e.g., dysphoria and anhedonia) reinforcing stimuli – stimuli that increase the probability of repeating behaviors paired with them rewarding stimuli – stimuli that the brain interprets as intrinsically positive and desirable or as something to approach sensitization – an amplified response to a stimulus resulting from repeated exposure to it substance use disorder – a condition in which the use of substances leads to clinically and functionally significant impairment or distress tolerance – the diminishing effect of a drug resulting from repeated administration at a given dose
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Examples (and ICD-10 code) of withdrawal syndrome include:

• F10.3 alcohol withdrawal syndrome (which can lead to delirium tremens)
• F11.3 opioid withdrawal, including methadone withdrawal^[8]
• F12.3 cannabis withdrawal
• F13.3 benzodiazepine withdrawal
• F14.3 cocaine withdrawal
• F15.3 caffeine withdrawal
• F17.3 nicotine withdrawal

Symptoms

Symptoms of withdrawal vary widely based on what drug a person is withdrawing from.

Cravings

When going through a withdrawal period, craving is a psychological urge for the substance that is being withheld. This substance can be alcohol or a form of drug but is not limited to these.

The duration that cravings last after discontinuation varies substantially between different addictive drugs. For instance, in smoking cessation, a substantial relief is achieved after approximately 6–12 months, but feelings of craving may temporarily appear even after many years following cessation.

Cravings may be triggered by seeing objects or experiencing moments that are associated with the drug or usage of it, and this phenomenon, termed post acute withdrawal syndrome, may linger the rest of the life for some drugs.^[9] For the alcohol withdrawal syndrome, the condition gradually improves over a period of months or in severe cases years.^[10][11]

Prescription medicine

As noted above, many drugs should not be stopped abruptly^[12] 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, likeepilepsy, depression, hypertension, schizophrenia and psychosis. The stopping of antipsychotics in schizophrenia and psychoses needs monitoring.^[13] The stopping of antidepressants for example, can lead to antidepressant discontinuation syndrome. With careful physician attention, however, medication prioritization and discontinuation can decrease costs, simplify prescription regimens, decrease risks of adverse drug events and poly-pharmacy, focus therapies where they are most effective, and prevent cost-related under-use of medications.^[14]

Medication Appropriateness Tool for Comorbid Health Conditions in Dementia^[15] (MATCH-D) warns that people with dementia are more likely to experience adverse effects, and to monitor carefully for withdrawal symptoms when ceasing medications for these people as they are both more likely to experience symptoms and less likely to be able to reliably report symptoms.^[16]

Anti-hypertensive drugs

The latest evidence does not have evidence of an effect due to discontinuing vs continuing medications used for treating elevated blood pressure or prevention of heart disease in older adults on all-case mortality and incidence of heart attack.^[17] The findings are based on low quality evidence suggesting it may be safe to stop anti-hypertensive medications. However, older adults should not stop any of their medications without talking to a healthcare professional.^[17]

 

Source: Wikipedia under Creative Commons License.