The Efficacy of a Group CBT Relapse Prevention Program for Remitted Anxiety Disorder Patients Who Discontinue Antidepressant Medication: A Randomized Controlled Trial

Effects of Treatment Discontinuation in Clinical Psychopharmacology

“…However, studies aiming to test the prediction that slow removal of drugs can reduce risk of withdrawal reactions are rare and most have major design limitations. For SRIs, these sometimes include lack of adequate controls, small numbers of subjects, multiple drugs with major pharmacokinetic differences, and short discontinuation times with few downward steps in dose, or lack of matching of the presence and severity of DESS outcome items at baseline [15, 40-42]. Despite such limitations, some findings suggest that gradual reduction of doses of SRIs may not provide important reduction of withdrawal symptoms.…”

“…Another trial evaluated withdrawal symptoms after discontinuing desvenlafaxine in older women treated for menopausal vasomotor instability, with randomization to abrupt discontinuation or to various stepwise reductions of doses over 2 weeks; the findings supported a ­reduction of risk of withdrawal symptoms with more gradual discontinuation [41]. A third study of anxiety disorder patients found that antidepressants could be ­discontinued, even very slowly over 4 months, in only 37%, and that two-thirds became newly anxious [42]. A fourth study found little difference in risks of DESS- defined withdrawal symptoms after discontinuing various SRIs or venlafaxine given for depression over 3 versus 14 days, and that drugs of long half-life (mainly fluoxetine) and those of short half-life had similar risks of DESS-based withdrawal symptoms; however, depressive symptoms were more likely with rapidly eliminated agents, with associated new suicidal preoccupations and behaviors [32].…”

“…However, none of these options has undergone rigorous testing for efficacy and safety. In addition, psychotherapy may or may not be helpful [16, 42]. Finally, the safe management of discontinuation of increasingly prevalent combinations of psychotropic drugs presents a challenge [10].…”

Discontinuing Antidepressant Drugs: Lesson from a Failed Trial and Extensive Clinical Experience

“…

Scholten et al [1] reported on the first randomized controlled trial that attempted to prevent relapse in patients with remitted anxiety disorder who discontinued antidepressant drugs (AD) by use of a cognitive-behavioral therapy (CBT) relapse prevention group compared to treatment as usual. The patients who were assigned to CBT received 8 group sessions of relapse prevention, targeting vulnerability factors and discontinuation symptoms.

…”

“…AD were tapered every 2 weeks within 4 months according to a fixed schedule. In the control group (treatment as usual), tapering and discontinuation of AD were carried out without CBT, in individual sessions, according to the same schedule [1]. Primary outcomes were occurrence/reoccurrence of any anxiety disorder or major depressive disorder.…”