Discontinuation Syndrome in Dysthymic Patients Treated with Selective Serotonin Reuptake Inhibitors

Bogetto, Filippo; Bellino, Silvio; Revello, R. Bonatto; Patria, Luca

doi:10.2165/00023210-200216040-00006

Cited by 60 publications

(57 citation statements)

References 35 publications

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“…they are not dependent on the presence of any underlying psychiatric disorder. The pharmacokinetics and dynamics of antidepressants, in particular their half life, are important determinants of discontinuation symptoms, as are individual patient characteristics, but their discussion is beyond the scope of this article (Schatzberg et al, 1997;Haddad, 1998;Bogetto et al, 2002).…”

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confidence: 99%

Recognising and managing antidepressant discontinuation symptoms

Haddad¹,

Anderson²

2007

Adv. psychiatr. treat

130

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and an honorary senior lecturer at the University of Manchester. His clinical and research interests include the pharmacological treatment of affective disorders and schizophrenia and the safety and adverse effects of psychotropic medication. He was a member of the Guideline Development Group for the National Institute for Health and Clinical Excellence's guidelines on bipolar disorder (2006 Abstract Antidepressant discontinuation symptoms occur with all classes of antidepressant. A welldescribed discontinuation syndrome occurs with the selective serotonin reuptake inhibitors, common symptoms including dizziness, headache, nausea and lethargy. Rare antidepressant discontinuation syndromes include extrapyramidal syndromes and mania/hypomania. All these syndromes, even isolated discontinuation symptoms, share three common features that facilitate diagnosis; abrupt onset within days of stopping the antidepressant, a short duration when untreated and rapid resolution when the antidepressant is reinstated. Clinicians need to be familiar with strategies for the prevention and management of such symptoms. Preventive strategies include warning patients about the possibility of discontinuation symptoms, encouraging good antidepressant adherence and tapering antidepressants at the end of treatment. Most symptoms are mild and shortlived. Consequently symptoms that follow planned termination of an antidepressant can often be managed by providing an explanation and reassurance. More severe symptoms should be treated symptomatically or the antidepressant restarted, in which case symptoms usually resolve within 24 h. More cautious tapering can then follow.

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mentioning

confidence: 99%

Recognising and managing antidepressant discontinuation symptoms

Haddad¹,

Anderson²

2007

Adv. psychiatr. treat

130

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“…Thus, increased LC activity may be associated not only with low, but also decreasing blood levels of drug. In terms of falling levels of AD drug being important in the clinical situation, Yerevanian et al (2004) found a five-fold increase in risk for suicidal behavior after AD discontinuation; and Bogetto et al (2002) reported that 42.3% of dysthymic patients showed a discontinuation syndrome appearing 2-5 days after discontinuation of PAR. It has been suggested that lack of adherence to AD drug treatment by adolescents, especially with ADs with a shorter half-life which would result in more rapidly falling blood levels, is an important factor in AD-induced increase in suicidality (Weiss and Gorman, 2005).…”

Section: Discussionmentioning

confidence: 99%

Paroxetine-Induced Increase in Activity of Locus Coeruleus Neurons in Adolescent Rats: Implication of a Countertherapeutic Effect of an Antidepressant

West

Ritchie

Weiss

2010

Neuropsychopharmacol

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Concern that antidepressant (AD) drugs, especially selective serotonin reuptake inhibitors and paroxetine (PAR) in particular, can increase suicidality during the early treatment of juvenile patients (children and adolescents) has created a dilemma for clinicians treating depressives. Though preclinical research cannot resolve controversy in this area, our present findings may provide insight into how AD drugs might, under certain conditions, exacerbate rather than ameliorate the depressive state. Both clinical and preclinical evidence indicates that the principle noradrenergic cell group in the brain, the locus coeruleus (LC), is over-active in depressives and that, conversely, effective AD treatments decrease activity of LC neurons. We report here that short-term (2 and 4 day) administration of PAR produces an increase in the activity of LC neurons (spontaneous firing rate and sensory-evoked responses) in young rats, contrary to the “therapeutic” decrease in activity typically observed in adult rats. Blood levels of PAR were lower in young rats than in adult rats, though similar low blood levels produced by a lower dose of PAR in adult rats failed to produce an increase in LC activity. Additionally, activity of young rats in the swim test was determined to assess depressive-like responses. The same dose/durations of PAR which produced the largest increases in LC activity in young rats produced decreases in swim-test activity, indicating that brief administration of PAR in young rats can promote, rather than reduce, the depressive state. These results offer a model which may help screen potential adjunctive treatments to avoid early adverse effects of ADs.

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“…Onset more than 1 week later is unusual. In a naturalistic study of 97 patients the mean interval between stopping an SSRI and the onset of discontinuation symptoms was 2 days (Bogetto et al, 2002). Discontinuation reactions are more common with higher doses and longer courses of treatment and are rare unless treatment has continued for more than 5 weeks.…”

Section: Clinical Featuresmentioning

confidence: 99%

“…In the prospective study by Bogetto et al (2002) the mean duration of SSRI discontinuation symptoms was 5 days. In a series of 71 untreat-…”

Section: Clinical Featuresmentioning

confidence: 99%

“…Turning to newer antidepressants, Fava et al (1997) reported that during the three days following stoppage of venlafaxine and placebo under double blind conditions, seven (78%) of nine venlafaxine treated subjects and two (22%) of nine placebo-treated patients reported the emergence of adverse events, a statistically significant difference. Among the SSRIs prospective studies indicate that paroxetine is associated with the highest incidence of discontinuation symptoms and fluoxetine the lowest (Rosenbaum et al, 1998;Michelson et al, 2000;Judge et al, 2002;Bogetto et al, 2002;Tint et al, 2002). Several factors may account for this difference but the long half-life of fluoxetine and the existence of an active metabolite, norfluoxetine, with an even longer half-life seem important.…”

Section: Incidencementioning

confidence: 99%

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