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Selective Serotonin Reuptake Inhibitor and Serotonin-Noradrenaline Reuptake Inhibitor Withdrawal Changes DSM Presentation of Mental Disorders: Results from the Diagnostic Clinical Interview for Drug Withdrawal (2024)

Psychother Psychosom. 2024 Jul 23:1-6. doi: 10.1159/000540031. Online ahead of print.

Selective Serotonin Reuptake Inhibitor and Serotonin-Noradrenaline Reuptake Inhibitor Withdrawal Changes DSM Presentation of Mental Disorders: Results from the Diagnostic Clinical Interview for Drug Withdrawal

Fiammetta Cosci 1 2 3, Virginie-Anne Chouinard 4, Guy Chouinard 5 6

Affiliations

  • 1Department of Health Sciences, University of Florence, Florence, Italy.
  • 2International Lab of Clinical Measurements, University of Florence, Florence, Italy.
  • 3Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands.
  • 4Psychotic Disorders Division, McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA.
  • 5University Mental Health Institute of Montreal, University of Montreal, Montreal, Québec, Canada.
  • 6Clinical Pharmacology and Toxicology Program, Royal College of Physicians and Surgeons, McGill University, Montreal, Québec, Canada.

Abstract

Introduction: Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) may cause withdrawal at dose decrease, discontinuation, or switch. Current diagnostic methods (e.g., DSM) do not take such phenomenon into account. Using a new nosographic classification of withdrawal syndromes due to SSRI/SNRI decrease or discontinuation [by Psychother Psychosom. 2015;84(2):63-71], we explored whether DSM is adequate to identify DSM disorders when withdrawal occurs.

Methods: Seventy-five self-referred patients with a diagnosis of withdrawal syndrome due to discontinuation of SSRI/SNRI, diagnosed via the Diagnostic Clinical Interview for Drug Withdrawal 1 - New Symptoms of Selective Serotonin Reuptake Inhibitors or Serotonin-Norepinephrine Reuptake Inhibitors (DID-W1), and at least one DSM-5 diagnosis were analyzed.

Results: In 58 cases (77.3%), the DSM-5 diagnosis of current mental disorder was not confirmed when the DID-W1 diagnosis of current withdrawal syndrome was established. In 13 cases (17.3%), the DSM-5 diagnosis of past mental disorder was not confirmed when criteria for DID-W1 diagnosis of lifetime withdrawal syndrome were met. In 3 patients (4%), the DSM-5 diagnoses of current and past mental disorders were not confirmed when the DID-W1 diagnoses of current and lifetime withdrawal syndromes were taken into account. The DSM-5 diagnoses most frequently mis-formulated were current panic disorder (50.7%, n = 38) and past major depressive episode (18.7%, n = 14).

Conclusion: DSM needs to be complemented by clinimetric tools, such as the DID-W1, to detect withdrawal syndromes induced by SSRI/SNRI discontinuation, decrease, or switch, following long-term use.

Keywords: DSM; Diagnosis; Selective serotonin reuptake inhibitor; Serotonin-norepinephrine reuptake inhibitor; Withdrawal.