Rebound effect
Encyclopedia
The rebound effect, or rebound phenomenon, is the tendency of some medication
s, when discontinued suddenly, to cause a return of the symptom
s it relieved, and that, to a degree stronger than they were before treatment first began. Medications with a known rebound effect can be withdrawn gradually, or, in conjunction with another medication that does not exhibit a rebound effect.
Several anxiolytic
s and hypnotics have a rebound effect: For example, benzodiazepine withdrawal can cause severe anxiety
and insomnia
worse than the original insomnia or anxiety disorder. Approximately 70% of patients who discontinue a benzodiazepine experience a rebound effect. Rebound withdrawal can be a factor in chronic use of medications and drug dependence with patients taking the medications only to ward off withdrawal or rebound withdrawal effects.
Rebound insomnia
Rebound insomnia is insomnia
that occurs following discontinuation of sedative
substances taken to relieve primary insomnia. Regular use of these substances can cause a person to become dependent
on its effects in order to fall asleep through the process of classical conditioning
. Therefore, when a person has stopped taking the medication and is 'rebounding' from its effects, he or she may experience insomnia as a symptom of withdrawal
. Occasionally, this insomnia may actually be worse than the insomnia the drug was intended to treat.
Common medicines known to cause this problem are Eszopiclone
and Zolpidem
, which are prescribed to people having difficulties falling or staying asleep. This phenomenon can also occur with regular use of anxiolytic
drugs, such as benzodiazepines.
Daytime rebound
Rebound phenomena does not necessarily only occur on discontinuation of a prescribed dosage. For example day time rebound effects of anxiety, metallic taste, perceptual disturbances which are typical benzodiazepine withdrawal symptoms can occur the next day after a short acting benzodiazepine
hypnotic wears off. Another example is early morning rebound insomnia which may occur when a rapidly eliminated hypnotic wears off which leads to rebounding awakeness forcing the person to become wide awake before he or she has had a full night's sleep. One drug which seems to be commonly associated with these problems is triazolam
due to its high potency and ultra short half life but these effects can occur with other short acting hypnotic drugs. Quazepam
due to its selectivity for type1 benzodiazepine receptors and long half life does not cause day time anxiety rebound effects during treatment, showing that half life is very important for determining whether a night time hypnotic
will cause next day rebound withdrawal effects or not. Day time rebound effects are not necessarily mild but can sometimes produce quite marked psychiatric and psychological disturbances.
or dextroamphetamine
. Rebound effects from these medications can include psychosis
, depression
and a return of ADHD symptoms but in a temporarily exaggerated form. Up to a third of ADHD children experience a rebound effect when methylphenidate is withdrawn.
s, such as SSRI
s, can cause rebound depression
or panic attacks and anxiety
when discontinued.
and guanfacine
. The most notable rebound effect of alpha-2 adrenergic agents is rebound hypertension
.
An example is the use of highly potent corticosteroid
s, such as Clobetasol
for psoriasis
. Abrupt withdrawal can cause a much more severe case of the psoriasis to develop. Therefore, withdrawal should be gradual, diluting the medication with lotion perhaps, until very little actual medication is being applied.
Another example of pharmaceutical rebound is a rebound headache
from painkillers when dose is lowered, medication wears off or the drug is abruptly discontinued.
Continuous usage of topical decongestant
s (nasal spray
s) can lead to constant nasal congestion
, known as Rhinitis medicamentosa
.
Medication
A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease.- Classification :...
s, when discontinued suddenly, to cause a return of the symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...
s it relieved, and that, to a degree stronger than they were before treatment first began. Medications with a known rebound effect can be withdrawn gradually, or, in conjunction with another medication that does not exhibit a rebound effect.
Sedative hypnotics
Rebound anxietySeveral anxiolytic
Anxiolytic
An anxiolytic is a drug used for the treatment of anxiety, and its related psychological and physical symptoms...
s and hypnotics have a rebound effect: For example, benzodiazepine withdrawal can cause severe anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
and insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
worse than the original insomnia or anxiety disorder. Approximately 70% of patients who discontinue a benzodiazepine experience a rebound effect. Rebound withdrawal can be a factor in chronic use of medications and drug dependence with patients taking the medications only to ward off withdrawal or rebound withdrawal effects.
Rebound insomnia
Rebound insomnia is insomnia
Insomnia
Insomnia is most often defined by an individual's report of sleeping difficulties. While the term is sometimes used in sleep literature to describe a disorder demonstrated by polysomnographic evidence of disturbed sleep, insomnia is often defined as a positive response to either of two questions:...
that occurs following discontinuation of sedative
Sedative
A sedative or tranquilizer is a substance that induces sedation by reducing irritability or excitement....
substances taken to relieve primary insomnia. Regular use of these substances can cause a person to become dependent
Physical dependence
Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...
on its effects in order to fall asleep through the process of classical conditioning
Classical conditioning
Classical conditioning is a form of conditioning that was first demonstrated by Ivan Pavlov...
. Therefore, when a person has stopped taking the medication and is 'rebounding' from its effects, he or she may experience insomnia as a symptom of withdrawal
Withdrawal
Withdrawal can refer to any sort of separation, but is most commonly used to describe the group of symptoms that occurs upon the abrupt discontinuation/separation or a decrease in dosage of the intake of medications, recreational drugs, and alcohol...
. Occasionally, this insomnia may actually be worse than the insomnia the drug was intended to treat.
Common medicines known to cause this problem are Eszopiclone
Eszopiclone
Eszopiclone, marketed by Sepracor under the brand-name Lunesta, is a nonbenzodiazepine hypnotic used as a treatment for insomnia. Eszopiclone is the active dextrorotatory stereoisomer of zopiclone, and belongs to the class of drugs known as cyclopyrrolones.Eszopiclone is a short acting...
and Zolpidem
Zolpidem
Zolpidem is a prescription medication used for the short-term treatment of insomnia, as well as some brain disorders. It is a short-acting nonbenzodiazepine hypnotic of the imidazopyridine class that potentiates gamma-aminobutyric acid , an inhibitory neurotransmitter, by binding to GABAA...
, which are prescribed to people having difficulties falling or staying asleep. This phenomenon can also occur with regular use of anxiolytic
Anxiolytic
An anxiolytic is a drug used for the treatment of anxiety, and its related psychological and physical symptoms...
drugs, such as benzodiazepines.
Daytime rebound
Rebound phenomena does not necessarily only occur on discontinuation of a prescribed dosage. For example day time rebound effects of anxiety, metallic taste, perceptual disturbances which are typical benzodiazepine withdrawal symptoms can occur the next day after a short acting benzodiazepine
Benzodiazepine
A benzodiazepine is a psychoactive drug whose core chemical structure is the fusion of a benzene ring and a diazepine ring...
hypnotic wears off. Another example is early morning rebound insomnia which may occur when a rapidly eliminated hypnotic wears off which leads to rebounding awakeness forcing the person to become wide awake before he or she has had a full night's sleep. One drug which seems to be commonly associated with these problems is triazolam
Triazolam
Triazolam is a benzodiazepine drug. It possesses pharmacological properties similar to that of other benzodiazepines, but it is generally only used as a sedative to treat severe insomnia...
due to its high potency and ultra short half life but these effects can occur with other short acting hypnotic drugs. Quazepam
Quazepam
Quazepam is a benzodiazepine derivative drug developed by the Schering Corporation in the 1970s. Quazepam is indicated for the treatment of insomnia including sleep induction and sleep maintenance...
due to its selectivity for type1 benzodiazepine receptors and long half life does not cause day time anxiety rebound effects during treatment, showing that half life is very important for determining whether a night time hypnotic
Hypnotic
Hypnotic drugs are a class of psychoactives whose primary function is to induce sleep and to be used in the treatment of insomnia and in surgical anesthesia...
will cause next day rebound withdrawal effects or not. Day time rebound effects are not necessarily mild but can sometimes produce quite marked psychiatric and psychological disturbances.
Stimulants
Rebound effects can also occur from stimulants such as methylphenidateMethylphenidate
Methylphenidate is a psychostimulant drug approved for treatment of attention-deficit hyperactivity disorder, postural orthostatic tachycardia syndrome and narcolepsy. It may also be prescribed for off-label use in treatment-resistant cases of lethargy, depression, neural insult and obesity...
or dextroamphetamine
Dextroamphetamine
Dextroamphetamine is a psychostimulant drug which is known to produce increased wakefulness and focus as well as decreased fatigue and decreased appetite....
. Rebound effects from these medications can include psychosis
Psychosis
Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...
, depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
and a return of ADHD symptoms but in a temporarily exaggerated form. Up to a third of ADHD children experience a rebound effect when methylphenidate is withdrawn.
Antidepressants
Many antidepressantAntidepressant
An antidepressant is a psychiatric medication used to alleviate mood disorders, such as major depression and dysthymia and anxiety disorders such as social anxiety disorder. According to Gelder, Mayou &*Geddes people with a depressive illness will experience a therapeutic effect to their mood;...
s, such as SSRI
Selective serotonin reuptake inhibitor
Selective serotonin re-uptake inhibitors or serotonin-specific reuptake inhibitor are a class of compounds typically used as antidepressants in the treatment of depression, anxiety disorders, and some personality disorders. The efficacy of SSRIs is disputed...
s, can cause rebound depression
Clinical depression
Major depressive disorder is a mental disorder characterized by an all-encompassing low mood accompanied by low self-esteem, and by loss of interest or pleasure in normally enjoyable activities...
or panic attacks and anxiety
Anxiety
Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...
when discontinued.
alpha-2 adrenergic agents
Rebound effects can occur after discontinuation of alpha-2 adrenergic agents such as clonidineClonidine
Clonidine is a sympatholytic medication used to treat medical conditions, such as high blood pressure, some pain conditions, ADHD and anxiety/panic disorder...
and guanfacine
Guanfacine
Guanfacine is a sympatholytic. It is an agonist of the α2A subtype of norepinephrine receptors. These receptors are concentrated heavily in the prefrontal cortex and the locus coeruleus, with the potential to improve attention abilities via modulating post-synaptic α2A receptors in the prefrontal...
. The most notable rebound effect of alpha-2 adrenergic agents is rebound hypertension
Hypertension
Hypertension or high blood pressure is a cardiac chronic medical condition in which the systemic arterial blood pressure is elevated. What that means is that the heart is having to work harder than it should to pump the blood around the body. Blood pressure involves two measurements, systolic and...
.
Others
Other rebound effectsAn example is the use of highly potent corticosteroid
Corticosteroid
Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex. Corticosteroids are involved in a wide range of physiologic systems such as stress response, immune response and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte...
s, such as Clobetasol
Clobetasol propionate
Clobetasol propionate is a corticosteroid used to treat various skin disorders including eczema and psoriasis. It is also highly effective for contact dermatitis caused by exposure to poison ivy/oak. Clobetasol belongs to US Class I of the corticosteroids, making it one of the most potent...
for psoriasis
Psoriasis
Psoriasis is an autoimmune disease that appears on the skin. It occurs when the immune system mistakes the skin cells as a pathogen, and sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. However, psoriasis has been linked to an increased risk of...
. Abrupt withdrawal can cause a much more severe case of the psoriasis to develop. Therefore, withdrawal should be gradual, diluting the medication with lotion perhaps, until very little actual medication is being applied.
Another example of pharmaceutical rebound is a rebound headache
Rebound headache
Medication overuse headaches , also known as rebound headaches usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and can be very painful and are a common cause of chronic daily headache...
from painkillers when dose is lowered, medication wears off or the drug is abruptly discontinued.
Continuous usage of topical decongestant
Topical decongestant
Topical decongestants are decongestants applied directly to the nasal cavity. By applying them directly to the site of action, topical decongestants relieve nasal congestion while reducing the side effects associated with systemically-acting decongestants, such as high blood pressure...
s (nasal spray
Nasal spray
Nasal sprays come in a variety of forms. Medicated such as Astelin, Afrin and Nasonex and natural such as Sinusoothe and Sterimar. Although delivery methods vary, most nasal sprays function by instilling a fine mist into the nostril by action of a hand-operated pump mechanism.-Antihistamine nasal...
s) can lead to constant nasal congestion
Nasal congestion
Nasal congestion is the blockage of the nasal passages usually due to membranes lining the nose becoming swollen from inflamed blood vessels. It is also known as nasal blockage, nasal obstruction, blocked nose, stuffy nose, or stuffed up nose.Nasal congestion has many causes and can range from a...
, known as Rhinitis medicamentosa
Rhinitis medicamentosa
Rhinitis medicamentosa is a condition of rebound nasal congestion brought on by extended use of topical decongestants that work by constricting blood vessels in the lining of the nose.-Presentation:This condition typically occurs after 5 to 7 days of use of such medications...
.
See also
- Physical dependencePhysical dependencePhysical dependence refers to a state resulting from chronic use of a drug that has produced tolerance and where negative physical symptoms of withdrawal result from abrupt discontinuation or dosage reduction...
- Rebound headacheRebound headacheMedication overuse headaches , also known as rebound headaches usually occur when analgesics are taken frequently to relieve headaches. Rebound headaches frequently occur daily and can be very painful and are a common cause of chronic daily headache...
- Withdrawal syndromeWithdrawal syndromeA withdrawal syndrome, also called a discontinuation syndrome, occurs when a person suddenly stops taking or reduces the dosage of some types of medications...
- Rhinitis medicamentosaRhinitis medicamentosaRhinitis medicamentosa is a condition of rebound nasal congestion brought on by extended use of topical decongestants that work by constricting blood vessels in the lining of the nose.-Presentation:This condition typically occurs after 5 to 7 days of use of such medications...