Abrupt and brief discontinuation of antidepressant treatment: effects on cognitive function and psychomotor performance

Hindmarch, Ian; Kimber, S.; Cockle, Sarah

doi:10.1097/00004850-200015060-00001

Cited by 68 publications

(33 citation statements)

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“…Judge et al (2002), and Michelson et al (2000) found that patients had more symptoms upon interruption of paroxetine vs. fluoxetine treatment, together with an increase in depressive symptoms and worsened functional measures. Hindmarch et al (2000) found significantly more discontinuation effects (including the total DESS score) with paroxetine than with citalopram.…”

Section: Discussionmentioning

confidence: 87%

Discontinuation symptoms in depression and anxiety disorders

Baldwin

Montgomery

Nil³

et al. 2005

Int. J. Neuropsychopharm.

101

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The present overview investigates whether different antidepressants have differing discontinuation symptoms upon treatment cessation, if these symptoms vary between depression and anxiety disorders, and with length of treatment. Data came from two comparative studies of escitalopram in major depressive disorder (MDD) (one vs. venlafaxine XR and one vs. paroxetine), two studies in social anxiety disorder (SAD) (one of which used paroxetine as the active reference), and one study in generalized anxiety disorder (GAD), using paroxetine as an active reference [total number of patients: escitalopram (n=1051); paroxetine (n=336); venlafaxine XR (n=124); placebo (n=239)]. All studies included a defined discontinuation period and used the Discontinuation Emergent Signs and Symptoms (DESS) checklist to record the number of discontinuation symptoms. All three antidepressants showed more discontinuation symptoms compared with placebo (p<0.001). Patients reported significantly fewer discontinuation symptoms with escitalopram than with paroxetine and venlafaxine XR in MDD (p<0.05). Escitalopram showed significantly fewer discontinuation symptoms than paroxetine in SAD (p<0.05) and GAD (p<0.001). For each antidepressant, no differences in discontinuation symptoms were observed between the three indications and there was no evidence for increased symptom incidence with increased length of treatment. Thus, discontinuation profiles differ between antidepressants of the same class and are broadly similar in different disorders. No evidence was seen for a higher discontinuation burden with longer treatment.

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Section: Discussionmentioning

confidence: 87%

Discontinuation symptoms in depression and anxiety disorders

Baldwin

Montgomery

Nil³

et al. 2005

Int. J. Neuropsychopharm.

101

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“…Specifically, Hindmarch et al [40], in 87 patients suffering from depression who had their maintenance therapy with paroxetine, fluoxetine, sertraline, and citalopram interrupted for 4-7 days, reported that, although DESS scores increased in all treatment groups, paroxetine caused significantly more discontinuation symptoms than other SSRI did (p < 0.05).…”

Section: Resultsmentioning

confidence: 99%

“…In patients with SAD, rates of discontinuation symptoms after treatment with escitalopram (10-20 mg/day) ranged from 17 to 27% [36,43]. However, only a few studies used either a definition of withdrawal reaction based on specific criteria [23,47] or a cutoff score of the DESS [36,40,43,46] to determine the occurrence of withdrawal symptoms.…”

Section: Resultsmentioning

confidence: 99%

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Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

340

383

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Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'.

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“…Several controlled studies have reported significant differences between antidepressants in discontinuation symptoms observed following treatment interruption, with fluoxetine and citalopram associated with the lowest level of discontinuation symptoms compared to paroxetine [21,31,32]. Venlafaxine has been associated with significant discontinuation symptoms and a down-tapering regimen is recommended [33].…”

Section: Discussionmentioning

confidence: 99%

A Randomised Study Comparing Escitalopram with Venlafaxine XR in Primary Care Patients with Major Depressive Disorder

2004

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This 8-week, randomised, double-blind study compared the efficacy and tolerability of escitalopram to that of venlafaxine XR in primary care patients with major depressive disorder. The efficacy of escitalopram (10– 20 mg; n = 148) was similar to venlafaxine XR (75– 150 mg; n = 145), based on mean change from baseline to week 8 in Montgomery and Åsberg Depression Rating Scale total score. In ad hoc analyses, escitalopram-treated patients achieved sustained remission significantly faster than did venlafaxine-treated patients. More venlafaxine-treated patients had nausea, constipation, and increased sweating (p < 0.05). When treatment was completed after 8 weeks, significantly more venlafaxine-treated patients had discontinuation symptoms (p < 0.01). Thus escitalopram treatment was similar to venlafaxine treatment with respect to efficacy and was better tolerated by patients in primary care.

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Abrupt and brief discontinuation of antidepressant treatment: effects on cognitive function and psychomotor performance

Cited by 68 publications

References 0 publications

Discontinuation symptoms in depression and anxiety disorders

Discontinuation symptoms in depression and anxiety disorders

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

A Randomised Study Comparing Escitalopram with Venlafaxine XR in Primary Care Patients with Major Depressive Disorder

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