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DSM-5 Diagnosis Code: Antidepressant Discontinuation Syndrome 995.29 (ICD-10 T43.205A)

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293.83 Mood disorder due to [medical condition], for example, "serotonin withdrawal syndrome" can be applied to antidepressant withdrawal syndrome or other iatrogenic damage.

 

According to the FDA and DSM-IV:

 

DSM IV Diagnostic criteria for 293.83 Mood Disorder Due to …[indicate the General Medical Condition]

 

• A. A prominent and persistent disturbance in mood predominates in the clinical picture and is characterized by either (or both) of the following:

  • depressed mood or markedly diminished interest or pleasure in all, or almost all, activities
  • elevated, expansive, or irritable mood
• B. There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct physiological consequence of a general medical condition.

 

• C. The disturbance is not better accounted for by another mental disorder (e.g., Adjustment Disorder with Depressed Mood in response to the stress of having a general medical condition).

 

• D. The disturbance does not occur exclusively during the course of a delirium.

 

• E. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

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Altostrata

I don't know how this slipped by me. I wrote the DSM-5 committee repeatedly begging them to add a diagnosis code, I was told no can do.

 

The DSM-5 contains a new diagnosis code.

 

From the DSM-5 Desk Reference

 

 
Antidepressant Discontinuation Syndrome 995.29 (T43.205A)
Initial encounter 995.29 (T43.205A)
Subsequent encounter 995.29 (T43.205D)
Sequelae 995.29 (T43.205S)
 

Antidepressant discontinuation syndrome is a set of symptoms that can occur after an abrupt cessation (or marked reduction in dose) of an antidepressant medication that was taken continuously for at least 1 month. Symptoms generally begin within 2-4 days and typically include specific sensory, somatic, and cognitive-emotional manifestations. Frequently reported sensory and somatic symptoms include flashes of lights, "electric shock" sensations, nausea, and hyperresponsivity to noises or lights. Nonspecific anxiety and feelings of dread may also be reported. Symptoms are alleviated by restarting the same medication or starting a different medication that has a similar mechanism of action - for example, discontinuation symptoms after withdrawal from a serotonin-norepinephrine reuptake inhibitor may be alleviated by starting a tricyclic antidepressant. To qualify as antidepressant discontinuation syndrome, the symptoms should not have been present before the antidepressant dosage was reduced and are not better explained by another mental disorder (e.g., manic or hypomanic episode, substance intoxication, substance withdrawal, somatic symptom disorder).

 

Diagnostic Features

Discontinuation symptoms may occur following treatment with tricyclic antidepressants (e.g., imipramine, amitriptyline, desipramine), serotonin reuptake inhibitors (e.g., fluoxetine, paroxetine, sertraline), and monoamine oxidase inhibitors (e.g., phenelzine, selegiline, pargyline)(Blier and Tremblay 2006; Delgado 2006; Demyttenaere and Haddad 2000; Fava 2006; Haddad 2001; Haddad and Qureshi 2000; Kaymaz et al. 2008; Mavissakalian and Perel 1999; Schatzberg et al. 2006; Shelton 2006; Warner et al. 2006). The incidence of this syndrome depends on the dosage and half-life of the medication being taken, as well as the rate at which the medication is tapered. Short-acting medications that are stopped abruptly rather than tapered gradually may pose the greatest risk. The short-acting selective serotonin reuptake inhibitor (SSRI) paroxetine is the agent most commonly associated with discontinuation symptoms, but such symptoms occur for all types of antidepressants(Fava 2006; Haddad 2001; Warner et al. 2006).

 

Unlike withdrawal syndromes associated with opioids, alcohol, and other substances of abuse, antidepressant discontinuation syndrome has no pathognomonic symptoms. Instead, the symptoms tend to be vague and variable(Blier and Tremblay 2006; Delgado 2006; Demyttenaere and Haddad 2000; Fava 2006; Haddad 2001; Haddad and Qureshi 2000; Kaymaz et al. 2008; Mavissakalian and Perel 1999; Schatzberg et al. 2006; Shelton 2006; Warner et al. 2006) and typically begin 2–4 days after the last dose of the antidepressant. For SSRIs (e.g., paroxetine), symptoms such as dizziness, ringing in the ears, “electric shocks in the head,” an inability to sleep, and acute anxiety are described. The antidepressant use prior to discontinuation must not have incurred hypomania or euphoria (i.e., there should be confidence that the discontinuation syndrome is not the result of fluctuations in mood stability associated with the previous treatment). The antidepressant discontinuation syndrome is based solely on pharmacological factors and is not related to the reinforcing effects of an antidepressant. Also, in the case of stimulant augmentation of an antidepressant, abrupt cessation may result in stimulant withdrawal symptoms (see “Stimulant Withdrawal” in the chapter “Substance-Related and Addictive Disorders”) rather than the antidepressant discontinuation syndrome described here.


Prevalence

The prevalence of antidepressant discontinuation syndrome is unknown but is thought to vary according to the dosage prior to discontinuation, the half-life and receptor-binding affinity of the medication, and possibly the individual’s genetically influenced rate of metabolism for this medication.


Course and Development

Because longitudinal studies are lacking, little is known about the clinical course of antidepressant discontinuation syndrome. Symptoms appear to abate over time with very gradual dosage reductions. After an episode, some individuals may prefer to resume medication indefinitely if tolerated.


Differential Diagnosis

The differential diagnosis of antidepressant discontinuation syndrome includes anxiety and depressive disorders, substance use disorders, and tolerance to medications.

 

Anxiety and depressive disorders Discontinuation symptoms often resemble symptoms of a persistent anxiety disorder or a return of somatic symptoms of depression for which the medication was initially given.

 

Substance use disorders Antidepressant discontinuation syndrome differs from substance withdrawal in that antidepressants themselves have no reinforcing or euphoric effects. The medication dosage has usually not been increased without the clinician’s permission, and the individual generally does not engage in drug-seeking behavior to obtain additional medication. Criteria for a substance use disorder are not met.


Tolerance to medications Tolerance and discontinuation symptoms can occur as a normal physiological response to stopping medication after a substantial duration of exposure. Most cases of medication tolerance can be managed through carefully controlled tapering.

 

Comorbidity Typically, the individual was initially started on the medication for a major depressive disorder; the original symptoms may return during the discontinuation syndrome.


References: Antidepressant Discontinuation Syndrome

    Blier , Tremblay : Physiologic mechanisms underlying the antidepressant discontinuation syndrome. J Clin Psychiatry (suppl 4):–,
    Delgado : Monoamine depletion studies: implications for antidepressant discontinuation syndrome. J Clin Psychiatry (suppl 4):–,
    Demyttenaere , Haddad : Compliance with antidepressant therapy and antidepressant discontinuation symptoms. Acta Psychiatr Scand Suppl :–,
    : Prospective studies of adverse events related to antidepressant discontinuation. J Clin Psychiatry (suppl 4):–,
    Haddad : Antidepressant discontinuation syndromes. Drug Saf ():–,
    Haddad , Qureshi : Misdiagnosis of antidepressant discontinuation symptoms. Acta Psychiatr Scand ():–,
    Kaymaz , van Os , Loonen , Nolen : Evidence that patients with single versus recurrent depressive episodes are differentially sensitive to treatment discontinuation: a meta-analysis of placebo-controlled randomized trials. J Clin Psychiatry ():–,
    Mavissakalian , Perel : Long-term maintenance and discontinuation of imipramine therapy in panic disorder with agoraphobia. Arch Gen Psychiatry ():–,
    Schatzberg , Blier , Delgado , et al: Antidepressant discontinuation syndrome: consensus panel recommendations for clinical management and additional research. J Clin Psychiatry (suppl 4):–,
    Shelton : The nature of the discontinuation syndrome associated with antidepressant drugs. J Clin Psychiatry (suppl 4):–,
    Warner , , Warner , et al: Antidepressant discontinuation syndrome. Am Fam Physician ():–,

 

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Altostrata

Effective October 1, 2018, here is the US ICD-10 diagnosis code tree for psychiatric drug discontinuation syndrome, starting with

 

ICD-10-CM Diagnosis Code T43 Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere classified

https://www.icd10data.com/ICD10CM/Codes/S00-T88/T36-T50/T43-/T43

 

The code that applies to antidepressant withdrawal syndrome:

 

ICD-10-CM Diagnosis Code T43.205 Adverse effect of unspecified antidepressants

https://www.icd10data.com/ICD10CM/Codes/S00-T88/T36-T50/T43-/T43.205

 

The doctor chooses variations from the tree -- click on the links.

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Rabe

Thank you for this!!!!  

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