Mad in America

There is a consistent body of knowledge that indicates that dose reduction or discontinuation of Selective Serotonin Reuptake Inhibitors (SSRI) or Serotonin Norepinephrine Reuptake Inhibitors (SNRI) induces a number of clinical phenomena (i.e., withdrawal or discontinuation syndromes, rebound symptoms, persistent post-withdrawal disorders) both in adults and in children.

There have been various definitions as well as diagnostic criteria of these clinical phenomena.

In 2015, a comprehensive and new classification of SSRIs/SNRIs withdrawal phenomena was outlined by Chouinard & Chouinard and specific diagnostic criteria were proposed on the basis of the literature and clinical observations, they allow to formulate the diagnosis of three different syndromes: (a) new symptoms, (b) rebound, (c) persistent post-withdrawal disorders. The prevalence of these syndromes is still unknown, due to their very recent definition as well as a lack of diagnostic tools for several years.

A semistructured clinical interview, the Diagnostic clinical Interview for Drug Withdrawal 1 – New Symptoms of SSRI and SNRI, also named with the acronym DID-W1, was developed for identifying and differentiating the three withdrawal syndromes mentioned above: (a) new symptoms, (b) rebound, (c) persistent post-withdrawal disorders. The interview has shown excellent inter-rater agreement in a preliminary investigation (Riv Psichiatr in press). The DID-W1 may help diagnosing the clinical phenomena related to SSRI and SNRI discontinuation, their differentiation from relapse, and the potential iatrogenic origin of psychiatric symptoms in clinical practice.