Interruption of selective serotonin reuptake inhibitor treatment

Michelson, David; Fava, Maurizio; Amsterdam, Jay D.; Apter, Jeffrey T.; Londborg, Peter D.; Tamura, Roy; Tepner, R.

doi:10.1192/bjp.176.4.363

Cited by 150 publications

(115 citation statements)

References 19 publications

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“…In a subsequent RCT, 284 patients had placebo substitution after 22 weeks of treatment. Similar results were obtained, with the incidence of discontinuation symptoms in the sertraline group being intermediate between that of paroxetine and fluoxetine, although not significantly greater than the latter (Michelson et al, 2000).…”

Section: Randomised Controlled Trialssupporting

confidence: 76%

Guidelines for choice of selective serotonin reuptake inhibitor in depressive illness

Anderson¹,

Edwards²

2001

Adv. psychiatr. treat

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The selective serotonin reuptake inhibitors (SSRIs) are the most extensively studied of the newer antidepressants and are increasingly being used as first-line treatment for depression (Anderson et al, 2000). In this article we concentrate on issues that need to be taken into account when selecting one of the five SSRIs marketed in the UK (citalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) for individual patients. We have concentrated on treatment of depression and have not reviewed their use in anxiety disorders because comparative data are lacking.

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Section: Randomised Controlled Trialssupporting

confidence: 76%

Guidelines for choice of selective serotonin reuptake inhibitor in depressive illness

Anderson¹,

Edwards²

2001

Adv. psychiatr. treat

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“…Such symptoms are highly character istic of primary discontinuation syndrome. The syndrome was initially reported in case reports and adverse drug reaction reports (Haddad, 1998) but its features have been confirmed in several doubleblind studies in which SSRI treatment is briefly interrupted with placebo (Rosenbaum et al, 1998;Michelson et al, 2000;Judge et al, 2002). A similar discontinuation syndrome occurs with venlafaxine (Fava et al, 1997) and duloxetine (Perahia et al, 2005).…”

Section: Primary Ssri Discontinuation Syndromementioning

confidence: 96%

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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“…Discontinuation symptoms occur with all the major antidepressant classes including TCAs, monamine oxidase inhibitors (MAOIs), SSRIs, serotonin and noradrenaline reuptake inhibitors (SNRIs) and miscellaneous antidepressants including mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA) (Haddad, 2001). The risk of discontinuation symptoms among the SSRIs is highest with paroxetine, lowest with fluoxetine and intermediate with the other SSRIs (Michelson et al, 2000;Rosenbaum et al, 1998). Differences in half-life appear to contribute to this differential risk.…”

Section: Antidepressant Discontinuation Symptomsmentioning

confidence: 99%

Neurological complications of psychiatric drugs: clinical features and management

Haddad

Dursun

2007

Hum. Psychopharmacol. Clin. Exp.

190

109

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This paper reviews the main neurological complications of psychiatric drugs, in particular antipsychotics and antidepressants. Extrapyramidal syndromes include acute dystonia, parkinsonism, akathisia, tardive dyskinesia and tardive dystonia. Extrapyramidal symptoms (EPS) are less frequent with atypical than with conventional antipsychotics but remain common in clinical practice partly due to lack of screening by health professionals. Neuroleptic malignant syndrome (NMS) consists of severe muscle rigidity, pyrexia, change in conscious level and autonomic disturbance but partial forms also occur. NMS is particularly associated with the initiation and rapid increase in dose of high-potency antipsychotics but it has been reported with all the atypical antipsychotics and rarely with other drugs including antidepressants. Serotonin toxicity comprises altered mental state (agitation, excitement, confusion), neuromuscular hyperactivity (tremor, clonus, myoclonus, hyperreflexia) and autonomic hyperactivity and occurs on a spectrum. Severe cases, termed serotonin syndrome, usually follow the co-prescription of drugs that increase serotonergic transmission by different pathways, for example a monoamine oxidase inhibitor (MAOI) and a selective serotonin reuptake inhibitor (SSRI). Most antipsychotics and antidepressants lower the seizure threshold and can cause seizures; the risk is greater with clozapine than with other atypical antipsychotics and greater with tricyclic antidepressants (TCAs) than with SSRIs. In randomised controlled trials in elderly patients with dementia atypical antipsychotics are associated with a higher risk of stroke and death than placebo. Cohort studies suggest that conventional drugs carry at least the same risk. Cessation of treatment with antipsychotics and antidepressants can lead to a wide range of discontinuation symptoms which include movement disorders and other neurological symptoms. Clinicians need to be familiar with strategies to reduce the risk of these adverse events and to manage them when they arise. Their occurrence needs to be balanced against the benefits of psychiatric drugs in terms of efficacy and improved quality of life in a range of disorders.

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Interruption of selective serotonin reuptake inhibitor treatment

Abstract: Abrupt interruption of SSRI treatment can result in a syndrome characterised by specific physical and psychological symptoms. Incidence, timing and severity of symptoms vary among SSRIs in a fashion that appears to be related to plasma elimination characteristics.

Cited by 150 publications

References 19 publications

Guidelines for choice of selective serotonin reuptake inhibitor in depressive illness

Guidelines for choice of selective serotonin reuptake inhibitor in depressive illness

Recognising and managing antidepressant discontinuation symptoms

Neurological complications of psychiatric drugs: clinical features and management

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