Rebound effect: when is it linked to psychotropic drugs? The ‘rebound effect’ is a phenomenon that occurs after an abrupt withdrawal of a psychopharmaceutical drug and leads to significant negative consequences, including the return and exacerbation of the original symptom

What causes the rebound effect of psychotropic drugs and antidepressants

Psychotropic drugs can cause a rebound effect because they can have undesirable consequences on the systems on which they act during the treatment period.

The rebound effect has for some drugs its mirror corresponding to the start of treatment, especially with antidepressants, which should usually be started at low doses and then slowly increased.

For example, for anxiety disorders and panic disorder in particular, starting the full dose immediately runs the risk of worsening rather than improving symptoms.

The importance of gradualness

The initiation and discontinuation of psychotropic therapy must be followed with particular care and be gradual by increasing or decreasing the dosage and speed of the therapy, which in the first and last phases entails more frequent consultations with the medical specialist.

There are detailed and valid recommendations in the field of psychiatry especially for:

• antidepressants;
• benzodiazepines (of which, due to the specific neuropharmacological mechanism, prolonged use is also discouraged in the package leaflets, which in some individuals in particular establishes a dependency mechanism with withdrawal phenomena as well as rebound of any symptoms)
• antipsychotic drugs and mood stabilisers.

How does the rebound effect manifest itself?

Rebound side effects can be of the most diverse nature and are related to the nature of the drugs’ effects on the brain (e.g. the specific neuropharmacological systems that are affected).

To sum up, also looking at the diagnostic criteria available in the literature, side effects

• consist of a rapid return of the symptoms for which the drug was administered with increased intensity;
• are transient with a duration (in the absence of measures such as resumption of treatment and gradual reduction where possible) of up to 6 weeks;
• appear within 36-96 hours of discontinuation or abrupt dose reduction;
• they are reversible.

Of course, it must always be considered that there is no concomitant medical condition that causes those symptoms independently of the drug.

How to avoid the rebound effect

The only way to avoid the rebound effect is not to stop the drug suddenly or too quickly.

The main treatment usually implemented is to resume the interrupted drug.

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