A new study conducted by the University of Florence and Maastricht University, in collaboration with McLean Hospital, the University of Montreal, and McGill University, found that patients withdrawing from antidepressants are often misdiagnosed with mental illnesses, specifically DSM-5 psychiatric disorders like panic disorder and major depressive disorder. This study, led by Fiammetta Coscia, Virginie-Anne Chouinard, and Guy Chouinard, was published in Psychotherapy and Psychosomatics.

Many patients prescribed Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) experience severe withdrawal symptoms when the dosage is reduced or the medication is stopped. However, current diagnostic tools such as the DSM-5 fail to account for these withdrawal symptoms during diagnosis. This study employed a new nosographic classification of withdrawal syndromes caused by SSRI/SNRI reduction or discontinuation to assess whether the DSM is adequate for identifying psychiatric disorders in the context of withdrawal.

The study included 75% self-referred patients who were diagnosed with withdrawal syndrome due to discontinuation of SSRIs or SNRIs. These patients were evaluated using the Diagnostic Clinical Interview for Drug Withdrawal 1 (DID-W1), which identifies new symptoms associated with SSRIs and SNRIs. The data from these interviews were analyzed alongside DSM-5 diagnoses.

The study results showed that in 77.3% of cases (58 patients), a DSM-5 diagnosis of a current mental disorder was not confirmed once the DID-W1 identified a current withdrawal syndrome. Similarly, in 17.3% of cases (13 patients), a past mental disorder diagnosis was ruled out after the criteria for lifetime withdrawal syndrome were met. In 4% of cases (3 patients), both current and past DSM-5 diagnoses were unconfirmed when considering the DID-W1 diagnoses of current and lifetime withdrawal syndromes. The most frequently misdiagnosed disorders were current panic disorder (50.7%) and past major depressive episodes (18.7%).

In 58 (78.4%) of the 74 cases, the DSM-5 diagnosis of current mental disorder was not confirmed when the DID-W1 was completed since patients’ symptoms corresponded to a diagnosis of current withdrawal syndrome.

The study highlights that the DSM-5 does not consider withdrawal symptoms as diagnostic criteria, posing a significant barrier to accurate diagnosis and treatment. While the DSM-5 distinguishes mental disorders caused by drug use, it does not explicitly account for withdrawal effects during diagnosis, leading to potential misdiagnoses.

In conclusion, this study emphasizes the need to revise diagnostic approaches like the DSM-5 to consider withdrawal syndromes associated with SSRIs and SNRIs. By doing so, clinicians may avoid misdiagnosing patients experiencing withdrawal as having mental disorders, ultimately leading to more accurate and effective treatment strategies.

Reference :

1. Fiammetta Cosci, Virginie-Anne Chouinard, and Guy Chouinard, “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,” Psychotherapy and Psychosomatics, July 23, 2024, 1–6, https://doi.org/10.1159/000540031.

(Input from various sources)

(Rehash/Yash Kamble/MSM)