Persistent Postwithdrawal Disorders Induced by Paroxetine, a Selective Serotonin Reuptake Inhibitor, and Treated with Specific Cognitive Behavioral Therapy

Belaise, Carlotta; Gatti, Alessia; Chouinard, Virginie-Anne; Chouinard, Guy

doi:10.1159/000362317

Cited by 41 publications

(33 citation statements)

References 7 publications

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“…The most commonly reported symptoms were dizziness, light-headedness, fatigue, sleep disturbance, and gastrointestinal disturbance [7,11,60]. Less common reactions were ‘electric-shock' sensation [9,59,61,62], visual and auditory hallucination [63], nocturnal enuresis [64], pruritus [65], and emesis [6]. In most reports, symptoms lasted until paroxetine was reintroduced or switched to other medications and/or cognitive behavioral therapy [12,13,15,59,62,66].…”

Section: Resultsmentioning

confidence: 99%

“…Less common reactions were ‘electric-shock' sensation [9,59,61,62], visual and auditory hallucination [63], nocturnal enuresis [64], pruritus [65], and emesis [6]. In most reports, symptoms lasted until paroxetine was reintroduced or switched to other medications and/or cognitive behavioral therapy [12,13,15,59,62,66]. Only in a few cases did symptoms spontaneously remit in about 2 weeks [4,8,63,67].…”

Section: Resultsmentioning

confidence: 99%

“…Bhanji et al [59] and Fava et al [50] documented the persistence of symptoms up to 1 year following paroxetine discontinuation. Belaise et al [62] described 3 cases of what they defined as ‘persistent post-withdrawal disorders induced by paroxetine'. Such disturbances appear to be quite common on patients' websites [30] but await adequate exploration in clinical studies.…”

Section: Discussionmentioning

confidence: 99%

“…Third, discontinuation of SSRI may trigger complex phenomena, which may or may not be related to the onset of withdrawal symptomatology, such as hypomania or mania [85,88] and persistent postwithdrawal disorders [62]. The term iatrogenic comorbidity refers to the lasting effects that previous treatments may entail (e.g., mood instability and high reactivity to environmental stimuli in persistent postwithdrawal disorders), well beyond their time of administration [89,90].…”

Section: Discussionmentioning

confidence: 99%

“…However, when symptoms persist and are distressing, the reinstitution of the same AD that triggered the problem or its substitution with a long-acting SSRI such as fluoxetine [26] may only postpone and aggravate the issue [86]. There are anecdotal reports on the use of clonazepam and other benzodiazepines or mood stabilizers, which, however, need to be properly tested [15,50,59,62,72]. Another neglected area of research is concerned with the role of withdrawal symptoms in assessing switching strategies that are increasingly utilized in the treatment resistance of mood and anxiety disorders [86,91].…”

Section: Discussionmentioning

confidence: 99%

See 4 more Smart Citations

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

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

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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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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

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

Fava

Gatti

Belaise

et al. 2015

Psychother Psychosom

Self Cite

340

383

View full text Add to dashboard Cite

show abstract

Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process

et al. 2017

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A specific psychotherapeutic strategy for increasing psychological well-being and resilience, well-being therapy (WBT), has been developed and validated in a number of randomized controlled trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continued growth and development, the belief that life is purposeful and meaningful, the possession of quality relations with others, the capacity to manage effectively one's life, and a sense of self-determination. The evidence supporting the use of WBT and its specific contribution when it is combined with other psychotherapeutic techniques is still limited. However, the insights gained by the use of WBT may unravel innovative approaches to assessment and treatment of mood and anxiety disorders, to be confirmed by controlled studies, with particular reference to decreasing vulnerability to relapse and modulating psychological well-being and mood. An important characteristic of WBT is self-observation of psychological well-being associated with specific homework. Such perspective is different from interventions that are labeled as positive but are actually distress oriented. Another important feature of WBT is the assumption that imbalances in well-being and distress may vary from one illness to another and from patient to patient. Customary clinical taxonomy and evaluation do not include psychological well-being, which may demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same diagnosis.

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The pursuit of euthymia

2020

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Psychiatrists often consider the positive characteristics displayed by a patient in their clinical judgment, yet current assessment and treatment strategies are shifted on the side of psychological dysfunction. Euthymia is a transdiagnostic construct referring to the presence of positive affects and psychological well‐being, i.e., balance and integration of psychic forces (flexibility), a unifying outlook on life which guides actions and feelings for shaping future accordingly (consistency), and resistance to stress (resilience and tolerance to anxiety or frustration). There is increasing evidence that the evaluation of euthymia and its components has major clinical implications. Specific instruments (clinical interviews and questionnaires) may be included in a clinimetric assessment strategy encompassing macro‐analysis and staging. The pursuit of euthymia cannot be conceived as a therapeutic intervention for specific mental disorders, but as a transdiagnostic strategy to be incorporated in an individualized therapeutic plan. A number of psychotherapeutic techniques aiming to enhance positive affects and psychological well‐being (such as well‐being therapy, mindfulness‐based cognitive therapy, and acceptance and commitment therapy) have been developed and validated in randomized controlled clinical trials. The findings indicate that flourishing and resilience can be promoted by specific interventions leading to a positive evaluation of one's self, a sense of continuing growth and development, the belief that life is purposeful and meaningful, satisfaction with one's relations with others, the capacity to manage effectively one's life, and a sense of self‐determination.

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Persistent Postwithdrawal Disorders Induced by Paroxetine, a Selective Serotonin Reuptake Inhibitor, and Treated with Specific Cognitive Behavioral Therapy

Cited by 41 publications

References 7 publications

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

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

Well-being therapy in depression: New insights into the role of psychological well-being in the clinical process

The pursuit of euthymia

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