Physical dependence: Wikis

  

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Physical dependence refers to a state resulting from chronic use of a drug that has produced tolerance [1] and where negative physical symptoms[2] of withdrawal result from abrupt discontinuation or dosage reduction.[3] Physical dependence can develop from low-dose therapeutic use of certain medications as well as misuse of recreational drugs such as alcohol. The higher the dose used typically the worse the physical dependence and thus the worse the withdrawal symptoms. Withdrawal symptoms can last days, weeks or months or occasionally longer and will vary according to the dose, the type of drug used and the individual person.[4]

Contents

Symptoms

Physical dependence can manifest itself in the appearance of both physical and psychological symptoms but which are caused by physiological adaptions in the central nervous system and the brain due to chronic exposure to a substance. Symptoms which may be experienced during withdrawal or reduction in dosage include increased heart rate and/or blood pressure, sweating, and tremors. More serious withdrawal symptoms such as confusion, seizures, and visual hallucinations indicate a serious emergency and the need for immediate medical care. Sedative hypnotic drugs such as alcohol, benzodiazepines, and barbiturates are the only commonly available substances that can be fatal in withdrawal due to their propensity to induce withdrawal convulsions. Abrupt withdrawal from other drugs, such as opioids or psychostimulants, can exaggerate mild to moderate neurotoxic side effects due to hyperthermia and generation of free radicals[5], but life-threatening complications are very rare.

Treatment

Treatment for physical dependence depends upon the drug being withdrawn and often includes administration of another drug, especially for substances that can be dangerous when abruptly discontinued. Physical dependence is usually managed by a slow dose reduction over a period of weeks, months or sometimes longer depending on the drug, dose and the individual.[4] A physical dependence on alcohol is often managed with a cross tolerant drug, such as long acting benzodiazepines to manage the alcohol withdrawal symptoms.

Drugs that cause physical dependence

Rebound syndrome

A wide range of drugs whilst not causing a true physical dependence can still cause withdrawal symptoms or rebound effects during dosage reduction or especially abrupt or rapid withdrawal.[17] These can include stimulants,[18][19][20][21], antidepressants,[22][23] anticonvulsants,[24][25][26] steroidal drugs and antiparkinsonian drugs.[27] Antipsychotics are another drug class that do not cause true physical dependency[28] but if discontinued too rapidly can cause an acute withdrawal syndrome.[29] Drugs like cocaine, marijuana, amphetamines, and hallucinogens can be associated with minimal physical dependence[30] but can still cause withdrawal or rebound symptoms. However, with sustained and heavy cocaine abuse signs of physiological dependence may occur.[31] When talking about illicit drugs rebound withdrawal is, especially with stimulants, sometimes referred to as "coming down" or "crashing".

Some drugs, like anticonvulsants and antidepressants, describe the drug category and not the mechanism. The individual agents and drug classes in the anticonvulsant drug category act at many different receptors and it is not possible to generalize their potential for physical dependence or incidence or severity of rebound syndrome as a group so need to be looked at individually. Anticonvulsants as a group however are known to cause tolerance to the anti-seizure effect.[32] SSRI drugs, which have an important use as antidepressants, are not considered to cause physical dependence, but it's generally accepted that they cause a discontinuation syndrome. Due to this, in Europe these drugs cannot be advertised as "non-habit forming".[citation needed] There has however been case reports of dependence with venlafaxine (Effexor).[33]

See also

References

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