4.4.4 Dependency and withdrawal

4.4.4 Dependency and withdrawal

Dependency and Withdrawal – including Management

Dependency and withdrawal in psychiatry refer to the physical and psychological effects that can occur when a person stops taking certain types of psychiatric medications, such as benzodiazepines and opioids.

Dependency and withdrawal can be a significant concern for patients who have been taking psychiatric medications for an extended period of time, particularly when they have become dependent on the medication. To minimize the risk of dependency and withdrawal, it is important for patients to be closely monitored and to gradually taper off the medication under the guidance of a healthcare provider (Galloway, 2002).

In some cases, alternative medications may be prescribed to manage symptoms during withdrawal, and psychological support and counselling may be recommended to help patients cope with the physical and emotional effects of withdrawal. Regular drug monitoring is crucial in preventing dependency and managing withdrawal from psychiatric medications.

With substances of abuse:

Dependency and withdrawal in substance misuse can be managed through a variety of strategies, including:

  1. Detoxification: The first step in managing dependency and withdrawal from substance misuse is typically detoxification, which involves stopping the use of the substance and allowing the body to clear it from the system. This can be done under medical supervision in a hospital or detox centre to ensure the safety and comfort of the patient.
  2. Medications: In some cases, medications may be prescribed to manage symptoms of withdrawal and to help reduce the risk of relapse. This may include medications to manage symptoms such as anxiety, insomnia, and agitation, or medications that help alleviate cravings.
  3. Psychological support: Psychological support, such as individual or group therapy, can help patients manage the emotional and psychological effects of withdrawal and reduce the risk of relapse.
  4. Rehabilitation: Rehabilitation programs, such as inpatient or outpatient treatment, can provide structured support and therapeutic activities to help patients manage the physical and psychological effects of withdrawal and work towards long-term recovery.
  5. Ongoing support: Ongoing support, such as support groups or aftercare programs, can help patients maintain their sobriety and manage the challenges of recovery over time.

Here are some examples of medications that are commonly used to aid the management of withdrawal in various substances:

  1. Opioids: Methadone, buprenorphine, and naltrexone are commonly used medications for the management of opioid withdrawal.
    • Methadone: Methadone is a synthetic opioid that is used as a replacement therapy for individuals dependent on opioids, such as heroin or prescription painkillers. Methadone works by binding to the same receptors in the brain as other opioids, but it produces a less intense and longer-lasting effect, which helps to reduce cravings and withdrawal symptoms.
    • Buprenorphine: Buprenorphine is a partial opioid agonist, which means that it produces a milder opioid effect compared to full agonists like methadone. Buprenorphine is used to treat opioid dependence and can help to reduce withdrawal symptoms and cravings.
    • Naltrexone: Naltrexone is an opioid antagonist, which means that it blocks the effects of opioids in the brain. Naltrexone is used to help individuals who are dependent on opioids to stay in recovery and prevent relapse.
  2. Alcohol: Disulfiram, naltrexone, and acamprosate are commonly used medications for the management of alcohol withdrawal
    • Disulfiram: Disulfiram is a type of alcohol deterrent medication, also known as an aldehyde dehydrogenase inhibitor.
    • Naltrexone: Naltrexone is an opioid antagonist and is classified as a medication for the management of alcohol dependence.
    • Acamprosate: Acamprosate is classified as a medication for the management of alcohol dependence and is also known as a glutamate modulator.
  3. Benzodiazepines: Clonazepam and diazepam are commonly used medications for the management of benzodiazepine withdrawal.
  4. Stimulants: Methylphenidate and modafinil are commonly used medications for the management of stimulant withdrawal.
  5. Smoking Cessation: Nicotine replacement therapy, such as nicotine patches, gum, lozenges, or inhalers, and prescription medications, such as bupropion or varenicline, can be used to help manage withdrawal symptoms and cravings during the smoking cessation process.
    • Bupropion is a type of antidepressant and is classified as a norepinephrine-dopamine reuptake inhibitor (NDRI).
    • Varenicline is a nicotine receptor partial agonist and is classified as a smoking cessation medication.

With prescribed psychotropics:

Dependency and withdrawal in psychotropic medications can be managed through a variety of strategies, including:

  1. Tapering off the medication: Gradually reducing the dose of the medication over a period of time, as directed by a healthcare provider, can help minimize the severity of withdrawal symptoms and prevent dependency. This approach is typically recommended for patients who have been taking the medication for an extended period of time.
  2. Alternative medications: In some cases, alternative medications may be prescribed to manage symptoms during withdrawal. This can help mitigate the physical and psychological effects of withdrawal and reduce the risk of relapse.
  3. Psychological support: Counseling and psychological support can help patients manage the emotional and psychological impact of withdrawal. This can include individual therapy, support groups, and other forms of behavioural or cognitive therapy.
  4. Monitoring: Regular drug monitoring is important to ensure that patients are tapering off medications appropriately and to monitor for any adverse effects or withdrawal symptoms.

It is important to note that the management of dependency and withdrawal in psychotropic medications may vary depending on the specific medication and the individual patient.

References:

(1) Galloway GP, Lee J, Galloway MP. Substance dependence and withdrawal. Prim Care. 2002 Dec;29(4):871-86.