Features:
(1) The patient is regularly taking the medication in maintenance doses.
(2) Prior to the next dose the patient experiences symptoms of the underlying condition (anxiety, depression, other).
(3) The symptoms regress following absorption of the next dose.
Possible mechanism:
(1) development of tolerance to the drug dose
(2) drug interaction or comorbid condition resulting in enhanced metabolism or excretion
(3) interval between doses is greater than the duration of clinical action
(4) onset of withdrawal symptoms
(5) worsening of the underlying condition
Possible solutions:
(1) increase the drug dose
(2) increase dosing frequency
(3) identify and modify the interacting condition
(4) switch to an extended release formulation
Differential diagnosis:
(1) drug discontinuation syndrome
(2) noncompliance (missed dose)
