Antidepressant discontinuation syndrome: A state-of-the-art clinical review

Fornaro, Michele; Cattaneo, C; Berardis, Domenico De; Ressico, Francesca; Martinotti, Giovanni; Vieta, Eduard

doi:10.1016/j.euroneuro.2022.10.005

Cited by 12 publications

(4 citation statements)

References 66 publications

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“…As noted above, it was not possible to investigate the reasons for patients to be continued, discontinued or switched nor for the prescribers' choice of antidepressant in the switched group. Stopping antidepressant treatment has been associated with a discontinuation syndrome, 32 and information related to this, and the method of stopping (e.g., gradual tapering of treatment over a given period of time) was not captured in this study. The classification of continuers, discontinuers and switchers was based upon prescriptions issued.…”

Section: Discussionmentioning

confidence: 99%

Antidepressant prescribing patterns and adverse events following introduction of a National Prescribing Indicator to monitor dosulepin usage in Wales

Chaplin

Bracchi

Haines

et al. 2023

Brit J Clinical Pharma

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AimsLimiting use of the antidepressant dosulepin has been encouraged due to associated risks of toxicity. In April 2011, the All Wales Medicines Strategy Group introduced a National Prescribing Indicator (NPI) to monitor dosulepin usage. The aim of this study was to investigate antidepressant prescribing patterns, and selected adverse events in patients prescribed dosulepin following introduction of the NPI.MethodsAn e‐cohort study was conducted. Adult patients receiving regular dosulepin prescriptions between October 2010 and March 2011 were included. Characteristics of patients who were continued on dosulepin, were switched to an alternative antidepressant or whose dosulepin was discontinued following introduction of the NPI were compared.ResultsIn total, 4121 patients were included. Of these, 1947 (47%) continued dosulepin, 1487 (36%) were switched and 692 (17%) discontinued. Of the 692 who discontinued, 92% did not receive a prescription for another antidepressant during the follow‐up period. Patients whose dosulepin was discontinued were older and were less commonly coprescribed benzodiazepines. During follow‐up, recorded incidence of selected adverse events was low across all groups and no significant difference was observed.ConclusionOver half of patients had discontinued dosulepin at the end of the period when the NPI was in place. Further interventions may have been required to have a greater impact on prescribing. This study provides some reassurance that dosulepin discontinuation can be a successful strategy, and that the risk of the adverse events investigated was unlikely to have been greater in those who had dosulepin discontinued than in those in whom dosulepin had been continued.

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Section: Discussionmentioning

confidence: 99%

Antidepressant prescribing patterns and adverse events following introduction of a National Prescribing Indicator to monitor dosulepin usage in Wales

Chaplin

Bracchi

Haines

et al. 2023

Brit J Clinical Pharma

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“…If the decision is to withdraw treatment, abrupt discontinuation of central serotonergic neuromodulators (mainly SSRIs and SNRIs) may be associated with antidepressant discontinuation syndrome (ADS), which consists of various symptoms, including nausea, headache, flulike symptoms, imbalance, insomnia, anxiety, agitation, and sensory disturbance like brain zaps and paresthesia ( 6 , 22 , 75 ).…”

Section: Prescribing and Discontinuing Central Neuromodulatorsmentioning

confidence: 99%

“…By contrast, fluoxetine has a half-life of 3–4 days, and ADS is less common. Citalopram, escitalopram, and sertraline are intermediate and exhibit half-lives of longer than a day but may still require a gradual taper to avoid the uncomfortable symptoms of ADS ( 22 , 75 ).…”

Section: Prescribing and Discontinuing Central Neuromodulatorsmentioning

confidence: 99%

“…In addition, when comorbidities such as major depression or anxiety disorders are present, cognitive behavioral therapy or other brain-gut behavior therapies should be used concurrently to supplement the loss of the use of the medication. In addition, self-care behavior interventions like mindfulness, relaxation, and supportive relationships explain up to 20%-30% of the variance in predicting successful discontinuation of the antidepressants (75). Some strategies may be helpful.…”

Section: Antidepressant Discontinuation Syndromementioning

confidence: 99%

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Central Neuromodulators in Irritable Bowel Syndrome: Why, How, and When

Hanna-Jairala,

Drossman

2024

Am J Gastroenterol

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Irritable bowel syndrome are responsive to treatments using central neuromodulators. Central neuromodulators work by enhancing the synaptic transmission of 5-hydroxytryptamine, noradrenalin and dopamine, achieving a slower regulation or desensitization of their postsynaptic receptors. Central neuromodulators act on receptors along the brain-gut axis, so they are useful in treating psychiatric comorbidities, modifying gut motility, improving central downregulation of visceral signals and enhancing neurogenesis in patients with IBS. Choosing a central neuromodulator for treating IBS should be according to the pharmacological properties and the predominant symptoms. The first-line treatment for pain management in IBS is using tricyclic antidepressants. An alternative for pain management is the serotonin and noradrenaline reuptake inhibitors. Selective serotonin reuptake inhibitors are useful when symptoms of anxiety and hypervigilance are dominant but are not helpful for treating abdominal pain. The predominant bowel habit is helpful when choosing a neuromodulator to treat IBS; SSRIs help constipation, not pain, but may cause diarrhea; TCAs help diarrhea but may cause constipation. A clinical response may occur in 6-8 weeks, but long-term treatment (usually 6-12 months) is required after the initial response to prevent relapse. Augmentation therapy may be beneficial when the therapeutic effect of the first agent is incomplete or associated with side effects. It is recommended to reduce the dose of the first agent and add a second complementary treatment. This may include an atypical antipsychotic or brain-gut behavioral treatment. When tapering central neuromodulators, the dose should be reduced slowly over 4 weeks but may take longer when discontinuation effects occur.

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