Thioridazine withdrawal-induced behavioral deterioration treated with clonidine: two case reports

Abstract

Neuroleptic withdrawal reactions have significant clinical and medicolegal implications for individuals with developmental disabilities. Behavioral deterioration following neuroleptic taper can represent (a) relapse of a mental illness, (b) and anticholinergic rebound reaction, (c) tardive akathisia, and (d) possibly a supersensitivity psychosis. Such reactions may preclude the discontinuation of neuroleptic drug therapy, even in the absence of a drug-responsive psychiatric illness. In this report, the case histories of two individuals who experienced a thioridazine (Mellaril) withdrawal-induced behavioral deterioration were presented. Both reactions were characterized by anxiety and insomnia, and the patients' symptoms were relieved by uncontrolled treatment with clonidine (Catapres) therapy. Evidence for adrenergic hyperactivity as a mediating event was presented.