Drug groups

Examples: Diazepam, Lorazepam, Temazepam.

A high percentage of people who stop benzodiazepine drugs will experience withdrawal symptoms, which can range from being fairly mild to severe. It is well understood that this type of drug should be tapered very slowly (5 to 10% every 1 to 2 weeks) and it can often take 3 months to a year to come off of it completely. In some cases the tapering may involve switching from a different benzodiazepine to diazepam and then tapering off of that instead because it has a longer half life and it comes in a variety of tablet sizes as well as liquid.

Some people will experience long term symptoms including anxiety, insomnia and depression for months or even years after stopping. Despite this, it wasn’t until the 1980s that there was widespread awareness that these drugs could cause long term issues with addiction and withdrawal.

Example: Pregabalin, Gabapentin.

These medications can cause discontinuation symptoms in some people. If stopped abruptly Pregabalin can cause adverse effects e.g. insomnia, headache, nausea, anxiety, sweating and diarrhea. If stopped abruptly Gabapentin can cause adverse effects e.g. headaches, insomnia, confusion, agitation, disorientation and anxiety. Therefore it is recommended that these medications be stopped with a brief taper to prevent these discontinuation symptoms.

Examples: Fluoxetine, Mirtazapine, Paroxetine, Sertraline.

All antidepressants have been linked with a range of discontinuation symptoms e.g. headaches, dizziness, insomnia, stomach upset, anxiety and movement problems. However certain ones are seen to be more problematic than others. People taking paroxetine and venlafaxine are more at risk of getting adverse effects than people taking fluoxetine, for example, because fluoxetine lasts longer in the body and can be said to be ‘self- tapering’ to an extent if you stop it suddenly. It is therefore recommended that these medications be tapered slowly over weeks or months.

Examples: Olanzapine, Aripiprazole, Risperidone, Haloperidol.

Many atypical (newer) antipsychotics affect a lot of different receptors and so can have discontinuation symptoms similar to antidepressants or sedating antihistamines (anxiety, gastro- intestinal disturbances, insomnia). There is also the risk of ‘rebound psychosis’, which is hypothesised to be linked to a supersensitivity of dopamine, serotonin or acetylcholine receptors (Witharana and Basu, 2011). It is therefore recommended that these medications be tapered slowly over weeks or months.

Examples: Lithium, Valproate, Carbamazepine.

Mood stabiliser discontinuation is mainly linked to an increased risk of relapse. Lithium although not having typical discontinuation symptoms should be tapered slowly to reduce the risk of relapse. Antiepileptic medications used as mood stabilisers (e.g. Valproate) can cause discontinuation symptoms when stopped e.g. mood swings, headache, insomnia, weight changes, stomach upset and dizziness. It is recommended that these are tapered over a few weeks.

On the other hand, for example, Faedda et al (2001) found that people with depression (not bipolar) who were on lithium, were statistically more likely to be diagnosed with mania and thus bipolar disorder when the lithium was stopped, than was expected. This suggests that the manic episodes were more likely to be related to discontinuation rather than relapse.

Examples: prescribed opioids, beta-blockers, Proton Pump Inhibitors.

Prescribed opioids, often used for pain relief, are highly addictive drugs and can cause severe and potentially long lasting withdrawal symptoms such as depression, dysphoria (a state of intense unease), anxiety and insomnia.

Beta blockers can cause discontinuation symptoms such as rapid heart rate (tacycardia) and high blood pressure. However these effects rarely last longer than a week or two.

Stopping PPI (proton-pump inhibitor) drugs, such as omeprazole, which are used to suppress stomach acid can result in rebound acidity. Some people who stopped omeprazole too quickly developed heartburn, even when they had never experienced heartburn to begin with.

Examples: Heroin, Cocaine.

The withdrawal symptoms from street drugs are widely known. Abrupt heroin withdrawal may cause many adverse effects e.g. vomiting, sweating, muscle aches or cramps and insomnia. These are often so bad that it is recommended that withdrawal be supervised and supported by a medical professional – this may include rehab.

Cocaine withdrawal can cause many psychological adverse effects e.g. difficulty concentrating, low mood, anhedonia and intense cravings. Although there isn’t a recommendation to taper off of cocaine it is recommended that this withdrawal be supervised by a medical professional.

Examples: Nicotine, Caffeine.

Nicotine is well known as an addictive substance. Nicotine withdrawal can cause many adverse effects e.g. intense cravings, headaches, irritability, agitation and weight gain. Quitting nicotine is recommended as a gradual tapering in order to minimise these effects.

Caffeine can also induce mild withdrawal effects. If you’re used to having several cups of coffee a day and then stop, chances are you’ll develop a headache and feel irritable and sleepy for a few days afterwards.