Discontinuing or Switching Selective Serotonin-Reuptake Inhibitors

Bull, Scott; Hunkeler, Enid M.; Lee, Janelle Y; Rowland, Clayton R.; Williamson, Todd; Schwab, Joseph R; Hurt, Stephen W.

doi:10.1345/aph.1a254

Cited by 169 publications

(70 citation statements)

References 14 publications

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“…Patients often do not wish to stay on their medication long enough to give the SSRI an adequate trial, but instead stop the medication due to the side effects and multiple visits required. 53 The intervention took place in individual format chairside, while the patients were being dialyzed. The protocol consisted of ten 60-minute weekly sessions spread over a maximum of 3 months.…”

Section: Interventionmentioning

confidence: 99%

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

Cukor¹,

Halen²,

Asher³

et al. 2014

Journal of the American Society of Nephrology

208

234

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Patients with ESRD have high rates of depression, which is associated with diminished quality of life and survival. We determined whether individual cognitive behavioral therapy (CBT) reduces depression in hemodialysis patients with elevated depressive affect in a randomized crossover trial. Of 65 participants enrolled from two dialysis centers in New York, 59 completed the study and were assigned to the treatment-first group (n=33) or the wait-list control group (n=26). In the intervention phase, CBT was administered chairside during dialysis treatments for 3 months; participants were assessed 3 and 6 months after randomization. Compared with the wait-list group, the treatment-first group achieved significantly larger reductions in Beck Depression Inventory II (self-reported, P=0.03) and Hamilton Depression Rating Scale (clinician-reported, P,0.001) scores after intervention. Mean scores for the treatment-first group did not change significantly at the 3-month follow-up. Among participants with depression diagnosed at baseline, 89% in the treatment-first group were not depressed at the end of treatment compared with 38% in the wait-list group (Fisher's exact test, P=0.01). Furthermore, the treatment-first group experienced greater improvements in quality of life, assessed with the Kidney Disease Quality of Life Short Form (P=0.04), and interdialytic weight gain (P=0.002) than the wait-list group, although no effect on compliance was evident at follow-up. In summary, CBT led to significant improvements in depression, quality of life, and prescription compliance in this trial, and studies should be undertaken to assess the long-term effects of CBT on morbidity and mortality in patients with ESRD.

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Section: Interventionmentioning

confidence: 99%

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

Cukor¹,

Halen²,

Asher³

et al. 2014

Journal of the American Society of Nephrology

208

234

View full text Add to dashboard Cite

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“…For the majority of relevant diagnoses, regular intake is recommended for months or even longer (Gaebel and Falkai, 2001). However, despite the positive profile of SSRIs, premature discontinuation is common and frequently discussed to account for nonresponse and relapse (Bull et al, 2002). Sexual dysfunction is a typical side effect of SSRI treatment (Serretti and Chiesa, 2009) that conditions discontinuation and may represent the most clinically relevant side effect among patients in their twenties or thirties (Bishop et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Neural Correlates of Antidepressant-Related Sexual Dysfunction: A Placebo-Controlled fMRI Study on Healthy Males Under Subchronic Paroxetine and Bupropion

Abler

Seeringer

Hartmann

et al. 2011

Neuropsychopharmacol

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Sexual dysfunction is a common side effect of selective serotonin reuptake inhibitors (SSRIs) like paroxetine in the treatment of depression, imposing a considerable risk on medication adherence and hence therapeutic success. Bupropion, a norepinephrine and dopamine reuptake inhibitor, is recommended as an alternative treatment without adverse effects concerning sexual arousal and libido. We investigated the neural bases of paroxetine-related subjective sexual dysfunction when compared with bupropion and placebo. We scanned 18 healthy, heterosexual males in a randomized, double-blind, within-subject design while watching video clips of erotic and nonerotic content under steady-state conditions after taking 20 mg of paroxetine, 150 mg of bupropion, and placebo for 7 days each. Under paroxetine, ratings of subjective sexual dysfunction increased compared with placebo or bupropion. Activation along the anterior cingulate cortex (ACC), including subgenual, pregenual, and midcingulate cortices, in the ventral striatum and midbrain was decreased when compared with placebo. In contrast, bupropion let subjective ratings and ACC activations unchanged and increased activity of brain regions including posterior midcingulate cortex, mediodorsal thalamus, and extended amygdala relative to placebo and paroxetine. Brain regions that have been related to the processing of motivational (ventral striatum), emotional, and autonomic components of erotic stimulation (anterior cingulate) in previous studies showed reduced responsiveness under paroxetine in our study. Drug effects on these regions may be part of the mechanism underlying SSRI-related sexual dysfunction. Increased activation under bupropion may point to an opposite effect that may relate to the lack of impaired sexual functioning.

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“…Sexual dysfunction is a common and disconcerting sideeffect of SSRIs that influences a patient's desire to continue long-term antidepressant treatment (Bull et al, 2002;Clayton et al, 2002;Montejo et al, 2001). Despite clinical study reports summarized in prescriber information sheets indicating the emergence of sexual difficulties in o15% of subjects, most investigations of this topic show that the real incidence of sexual side-effects subsequent to SSRI initiation is between 20 and 70% (Clayton et al, 2002;Montejo-Gonzalez et al, 1997;Montejo et al, 1996Montejo et al, , 2001.…”

Section: Introductionmentioning

confidence: 99%

“…Sexual side-effects from these medications are of significant clinical importance, particularly in young, sexually active patients. Previous research has shown that approximately 40% of persons starting an SSRI will either discontinue or switch medications owing to an adverse event (Bull et al, 2002). Of persons discontinuing or switching SSRIs due to adverse events, over one-third listed sexual side-effects as either primary or secondary reasons for treatment cessation (Bull et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…Previous research has shown that approximately 40% of persons starting an SSRI will either discontinue or switch medications owing to an adverse event (Bull et al, 2002). Of persons discontinuing or switching SSRIs due to adverse events, over one-third listed sexual side-effects as either primary or secondary reasons for treatment cessation (Bull et al, 2002). In another study of over 1000 outpatients followed prospectively after antidepressant initiation, nearly 40% of persons experiencing changes in their sexual wellbeing indicated that it was sufficient enough to warrant medication discontinuation (Montejo et al, 2001).…”

Section: Introductionmentioning

confidence: 99%

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Serotonin 2A −1438 G/A and G-Protein Beta3 Subunit C825T Polymorphisms in Patients with Depression and SSRI-Associated Sexual Side-Effects

Bishop

Moline

Ellingrod

et al. 2006

Neuropsychopharmacol

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The occurrence of sexual side-effects from antidepressants is thought to be mediated through serotonin 2A (5HT2A) receptors. It is currently unknown if functional polymorphisms in the 5HT2A receptor or its G-protein second messenger complex are related to sexual dysfunction in patients taking an selective serotonin reuptake inhibitor (SSRI) for depression. The purpose of this study was to determine the relationship of the 5HT2A À1438 G/A and GNB3 C825T single nucleotide polymorphisms with overall sexual well-being and individual components of sexual health as measured by the Changes in Sexual Functioning Questionnaire (CSFQ). We evaluated 89 outpatients (18-40 years of age) at low risk for other causes of sexual dysfunction who were being treated for depression with an SSRI and did not have sexual difficulties before taking the antidepressant. Outcome measures were stratified by 5HT2A and GNB3 genotypes. After controlling for age, gender, anxiety scale scores, and depression scale scores, persons with a GG genotype of the 5HT2A À1438 single nucleotide polymorphisms (SNP) were significantly more likely to be categorized as having sexual dysfunction than persons with a GA or AA genotype (OR ¼ 3.6; 95% CI 1.03, 12.6; p ¼ 0.046). Furthermore, the 5HT2A À1438 GG genotype was a significant predictor of lower arousal scores (p ¼ 0.022) after accounting for other measures. There was no significant relationship between any outcome measure and GNB3 genotype.

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Discontinuing or Switching Selective Serotonin-Reuptake Inhibitors

Cited by 169 publications

References 14 publications

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

Psychosocial Intervention Improves Depression, Quality of Life, and Fluid Adherence in Hemodialysis

Neural Correlates of Antidepressant-Related Sexual Dysfunction: A Placebo-Controlled fMRI Study on Healthy Males Under Subchronic Paroxetine and Bupropion

Serotonin 2A −1438 G/A and G-Protein Beta3 Subunit C825T Polymorphisms in Patients with Depression and SSRI-Associated Sexual Side-Effects

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