Withdrawal syndrome, discontinuation syndrome and rebound effect in the treatment with selected drug classes

Objectives
Discontinuation of a medication may result not only in symptoms related to disease recurrence, but also in those associated with the drug’s mechanism of action or arising from dependence or addiction to a substance used for therapeutic purposes. In clinical practice, patients often enquire about the expected duration of therapy and the symptoms that may arise following its discontinuation. When treatment is initiated, particularly with drugs acting on the central nervous system, fear of potential dependence or addiction is one of the factors limiting patient acceptance.

Literature review
This paper describes withdrawal and discontinuation syndromes, as well as reactivation and the rebound effect, outlining their pathogenesis and the most important similarities and differences between them.

Conclusions
The key factor differentiating withdrawal syndrome from discontinuation syndrome is the development of addiction. However, it does not play a crucial role in the pathophysiology of the reactivation syndrome or the rebound effect. Knowledge of the pathogenesis and symptoms associated with each of these syndromes is essential not only for a correct understanding of their causes, but also for predicting the risk of their occurrence, and implementing appropriate management strategies.