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In contrast to what the readers’ letter suggests (“The authors also mention “relapses,” although...”), in our review article we explain rebound phenomena in great detail, as the title itself suggests (1). These are overshooting counter-regulations in the context of the development of drug tolerance, which make the course of the illness worse after stopping the medication than it would have been without any medication at all. This has been shown for acetylsalicylic acid and antihypertensive drugs, for example (2).

In contrast to what our correspondents say, rebound phenomena are not among the dependence/addiction criteria in the ICD-10. The authors incorrectly interpret the dependence criterion “sustained substance use in spite of confirmed adverse effects.” This is not met simply if substance use is continued to avoid withdrawal symptoms, because that would mean that this criterion is tautological with “withdrawal symptoms”. Rather, what is meant is that because of the urge to use the substance, affected persons continue using it although they are aware of harmful consequences. Continued alcohol consumption in spite of cirrhosis of the liver might be one such example. Like other medications, antidepressants cause the development of tolerance and withdrawal symptoms as a result of neuroadaptive counter-regulation, as well as possible rebound phenomena when drug intake is stopped abruptly. They are therefore not drugs with the potential for dependence, but the described adverse effects have to be taken very seriously, especially as the effectiveness of antidepressants is confirmed only for severe depression (3). Accordingly, the indication should be defined cautiously, and the drugs should be prescribed for a time limited period. Tapering off should be undertaken at a very slow pace.

DOI: 10.3238/arztebl.2019.0677b

Dr. med. Jonathan Henssler

Lasse Brandt

Psychiatrische Universitätsklinik
der Charité im St. Hedwig-Krankenhaus,

Campus Charité Mitte,
Charité Universitätsmedizin Berlin

jonathan.henssler@charite.de

Prof. Dr. med. Dr. phil. Andreas Heinz

Klinik für Psychiatrie

und Psychotherapie, Campus Charité Mitte,

Charité Universitätsmedizin Berlin

Prof. Dr. med. Tom Bschor

Abteilung für Psychiatrie, Schlosspark-Klinik, Berlin

Klinik für Psychiatrie und Psychotherapie
Universitätsklinikum Carl Gustav Carus,
Technische Universität Dresden

Conflict of interest statement

The authors of both contributions declare that no conflict of interest exists.

1.
Henssler J, Heinz A, Brandt L, Bschor T: Antidepressant withdrawal and rebound phenomena—a systematic review. Dtsch Arztebl Int 2019; 116: 355–61. VOLLTEXT
2.
Reidenberg MM: Drug discontinuation effects are part of the pharmacology of a drug. J Pharmacol Exp Ther 2011; 339: 324–8 CrossRef MEDLINE PubMed Central
3.
Fournier JC, DeRubeis RJ, Hollon SD, et al.: Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303: 47–53 CrossRef MEDLINE PubMed Central
1.Henssler J, Heinz A, Brandt L, Bschor T: Antidepressant withdrawal and rebound phenomena—a systematic review. Dtsch Arztebl Int 2019; 116: 355–61. VOLLTEXT
2.Reidenberg MM: Drug discontinuation effects are part of the pharmacology of a drug. J Pharmacol Exp Ther 2011; 339: 324–8 CrossRef MEDLINE PubMed Central
3.Fournier JC, DeRubeis RJ, Hollon SD, et al.: Antidepressant drug effects and depression severity: a patient-level meta-analysis. JAMA 2010; 303: 47–53 CrossRef MEDLINE PubMed Central

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