Sedative–hypnotics 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 their effects in order to fall asleep. Therefore, when a person has stopped taking the medication and is 'rebounding' from its effects, they may experience insomnia as a symptom of
withdrawal. Occasionally, this insomnia may be worse than the insomnia the drug was intended to treat. Common medications known to cause this problem are
eszopiclone,
zolpidem, and
anxiolytics such as
benzodiazepines which are prescribed to people having difficulties falling or staying asleep. Rebound depression may appear to arise in patients previously free of such an illness. Daytime 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. Rebound phenomena do not necessarily only occur on discontinuation of a prescribed dosage. 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 daytime anxiety rebound effects during treatment, showing that half-life is very important for determining whether a nighttime
hypnotic will cause next-day rebound withdrawal effects or not. Daytime rebound effects are not necessarily mild but can sometimes produce quite marked psychiatric and psychological disturbances.
Stimulants Rebound effects from
stimulants such as
methylphenidate or
dextroamphetamine include
stimulant 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 Up to a third of ADHD children experience a rebound effect when methylphenidate is withdrawn.
Antidepressants Many
antidepressants, including
SSRIs, can cause rebound
depression,
panic attacks,
anxiety, and
insomnia when discontinued.
Antipsychotics Sudden and severe emergence or re-emergence of
psychosis may appear when
antipsychotics are
switched or
discontinued too rapidly.
Alpha-2 adrenergic agents Rebound hypertension, above pre-treatment level, was observed after
clonidine and
guanfacine discontinuation. Continuous usage of
topical decongestants (
nasal sprays) can lead to constant
nasal congestion, known as
rhinitis medicamentosa.
Humanized antibodies Denosumab inhibits osteoclast recycling, which results in the accumulation of pre-osteoclasts and osteomorphs. When denosumab therapy is discontinued, the induced cells quite quickly and abundantly differentiate into osteoclasts causing
bone resorption (rebound effect) and increasing the risk of fractures. For improving mineral bone density and preventing fractures after denosumab discontinuation,
bisphosphonate administration is recommended.
Other medications Another example of
pharmaceutical rebound is a
rebound headache from painkillers when the dose is lowered, the medication wears off, or the drug is abruptly discontinued. In 2022, reports of viral RNA and symptom rebound in people with
COVID-19 treated with
Paxlovid were published. In May, CDC even issued a health alert informing physicians about "Paxlovid rebounds", which received attention when US president
Joe Biden experienced a rebound. The cause of the rebound is unclear however, since around a third of people with COVID-19 experience a symptom rebound regardless of treatment. Abrupt withdrawal of highly potent
corticosteroids, such as
clobetasol for
psoriasis, can cause a much more severe case of the psoriasis to develop. Therefore, withdrawal should be gradual, until very little actual medication is being applied. ==See also==