Antidepressant discontinuation reactions

Fava, Giovanni A.; Gatti, Alessia; Belaise, Carlotta; Guidi, Jenny; Offidani, Emanuela

doi:10.1136/bmj.316.7138.1105

Cited by 135 publications

(16 citation statements)

References 8 publications

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“…An editorial published in the late 1990s claimed that AD discontinuation reactions were preventable and simple to treat [47]. The evidence that we have just collected indicates the contrary.…”

Section: Discussionmentioning

confidence: 94%

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

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

341

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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Section: Discussionmentioning

confidence: 94%

“…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%

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

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

341

383

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“…Despite similarities between BZD and AD withdrawal syndromes [35, 36], disagreement has existed about whether “discontinuation” or “withdrawal” should name the syndrome for drugs other than BZDs [37]. We observed that industry participation was paired with “discontinuation” in AD and AP trials, but with “withdrawal” in stimulant trials.…”

Section: Discussionmentioning

confidence: 70%

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

Cohen

Recalt

2019

Psychother Psychosom

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Background and Objective: Methods and justifications for discontinuing psychotropic drugs in randomized controlled trials (RCTs), and RCTs’ acknowledgement of possible withdrawal symptoms following discontinuation, have not been examined systematically, which this review aims to do. Study Eligibility, Data Extraction, and Synthesis: Publications in MEDLINE, EMBASE, and PsycINFO (2000–2017) randomly assigning participants diagnosed with mental disorders to discontinue antipsychotic, antidepressant, anticonvulsant, antimanic, mood-stabilizing, benzodiazepine, or stimulant drugs. Authors independently extracted data, devised a typology of trials, and assessed trials’ recognition of withdrawal symptoms. Results: Eighty RCTs (70% with industry participation) discontinued drugs from 5,757 participants to investigate relapse prevention (44%), successful discontinuation (26%), architecture of withdrawal (14%), and practicality of discontinuation (10%). RCTs of stimulants, antidepressants, and antipsychotics mostly aimed to reach conclusions about relapse prevention by testing abrupt or rapid discontinuations; RCTs of benzodiazepines mostly aimed to reduce drug use by testing longer-lasting, supportive discontinuations. In 67% of RCTs, no justification was given for the specific discontinuation strategy, which lasted under 2 weeks in 60% of RCTs. Possible withdrawal confounding of trial outcomes was addressed in 14% of eligible RCTs. Limitations: Only the published literature was searched. Conclusions and Implications: RCTs use drug discontinuation to study several key issues in psychopharmacology but infrequently justify how they implement it or acknowledge that possible withdrawal symptoms may threaten internal validity. Reappraising the use of drug discontinuation and the recognition of withdrawal symptoms in RCTs is required.

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“…Other potential risks, such as side effects, drug interactions or a withdrawal syndrome, may be significant because a large proportion of patients from the general population are exposed to psychotropic drugs (American Psychiatric Association, 1990;Rickels et al, 1990;Lejoyeux and Ades, 1997;Haddad et al, 1998). These adverse consequences are well documented, especially among elderly people.…”

Section: Introductionmentioning

confidence: 96%

Pharmacoepidemiological characterization of psychotropic drugs consumption using a latent class analysis

Wainstein¹,

Victorri-Vigneau²,

Sébille

et al. 2011

International Clinical Psychopharmacology

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France has one of the highest recorded rates of psychotropic use of drugs compared with other European countries, especially for anxiolytics, hypnotics and antidepressants. The aim of this study was to characterize the use of three psychotropic drugs among the most prescribed in France (bromazepam, paroxetine, zolpidem) using reimbursement databases in real-life conditions. Individuals from a region affiliated to the French General Health Insurance Scheme, who had received at least two dispensings of bromazepam, paroxetine or zolpidem reimbursed between 1 January and 30 June 2008, were included. We used a latent class analysis to identify different subgroups of users for these three psychotropic drugs. A total of 40,644 patients were included for bromazepam, 36,264 for zolpidem and 31,235 for paroxetine. Using latent class analysis, four clinical subtypes of users of bromazepam and zolpidem were identified: nonproblematic users, at-risk users, users with a probable mental disorder and compulsive users. Three subgroups were identified for paroxetine that differed rather by the prescription patterns. Users of anxiolytics and hypnotics with at-risk behaviours represented a significant proportion in the studied population. This original method could be extended to other prescription databases to identify populations at risk of abuse or dependence to psychotropic drugs.

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Antidepressant discontinuation reactions

Cited by 135 publications

References 8 publications

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

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

Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review

Pharmacoepidemiological characterization of psychotropic drugs consumption using a latent class analysis

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