Discontinuation Of Antidepressant Medication Research Articles

Emotion-induced frontal α asymmetry as a candidate predictor of relapse after discontinuation of antidepressant medication

One in three patients relapse after antidepressant discontinuation. Thus, the prevention of relapse after achieving remission is an important component in the long-term management of Major Depressive Disorder (MDD). However, no clinical or other predictors are established. Frontal reactivity to sad mood as measured by fMRI has been reported to relate to relapse independently of antidepressant discontinuation and is an interesting candidate predictor. Patients (n=56) who had remitted from a depressive episode while taking antidepressants underwent EEG recording during a sad mood induction procedure prior to gradually discontinuing their medication. Relapse was assessed over a six-months follow-up period. 35 healthy controls were also tested. Current source density of the EEG power in the α band (8-13Hz) was extracted and alpha-asymmetry was computed by comparing the power across two hemispheres at frontal electrodes (F5 and F6). Sad mood induction was robust across all groups. Reactivity of α-asymmetry to sad mood did not distinguish healthy controls from patients with remitted MDD on medication. However, the 14 (25%) patients who relapsed during the follow-up period after discontinuing medication showed significantly reduced reactivity in α- asymmetry compared to patients who remained well. This EEG signal provided predictive power (69% out-of-sample balanced accuracy and a positive predictive value of 0.75). A simple EEG-based measure of emotional reactivity may have potential to contribute to clinical prediction models of antidepressant discontinuation. Given the very small sample size, this finding must be interpreted with caution and requires replication in a larger study.

Abstract- Poster

Background: Antidepressant-induced excessive sweating (ADIES) is a common antidepressant-related side effect, and its prevalence is estimated to range from 4 - 22%. Adverse effects are a common reason for nonadherence and discontinuation of antidepressant medication, and alleviating these side effects may improve adherence and promote positive outcomesCase description: We report 2 cases who were on antidepressants (SSRI) for anxiety disorder and major depressive disorder. After using the drug both patients developed excessive sweating over a period of time, which was found to be independent of their pre-existing condition. Stopping the drug helped in relieving sweating but when the drug was given again sweating recurred. Later on they were given with benztropine and glycopyrrolate which helped their symptoms successfully.Discussion: Adrenergic actions of antidepressants are implicated in causing ADIES. Agents that have been reported successful in controlling the sweating include benztropine and glycopyrrolate.Conclusion: We recommend a patient-specific approach for the management of ADIES. First, consider dose reduction or a trial off antidepressant medication. If patients in whom this is inappropriate or ineffective, substitution of other antidepressant may be considered. If episodes of excessive sweating persist, consider treatment with benztropine or glycopyrrolate or terazosin in the absence of contraindications.

Enhancing shared decision making about discontinuation of antidepressant medication: a concept-mapping study in primary and secondary mental health care

The apparent rise of antidepressant use seems to be explained to a large extent by an increase in long-term use. Both professionals and patients appear reluctant to discontinue antidepressant medication (ADM). It is not known what factors determine this reluctance. This study aimed to identify factors that enable the shared decision-making process about discontinuation of ADM between long-term users and their GPs. Concept-mapping study of a purposive sample of both patients and professionals from primary and secondary mental health care in the Netherlands. Concept mapping was used to conceptualise and structure the topics relevant to the discontinuation process from the perspective of both patients and professionals. Participants generated topics in brainstorming sessions and subsequently prioritised and sorted them. Multidimensional scaling and hierarchical cluster analyses were used for the cluster topics. Thirty-seven patients and 27 professionals generated 50 separate topics. Hierarchical cluster analysis revealed six clusters of topics: 'Process of discontinuation', 'Expectations', 'Professional guidance', 'Current use', 'Environment', and 'Side effects'. Patients and professionals came up with largely similar topics. Nevertheless, a difference was found between these groups regarding the perceived importance of professional guidance. This study yielded an informed selection of the topics that seem most important to discuss when considering whether to discontinue ADM. As perspectives of both patients and professionals were combined, the topics may provide patients and GPs with a broader and more balanced scope of factors to consider, and thus facilitate a better shared decision-making process.

Discontinuation of antidepressant medication in primary care supported by monitoring plus mindfulness-based cognitive therapy versus monitoring alone: design and protocol of a cluster randomized controlled trial

BackgroundAntidepressant use continues to rise, mainly explained by an increase in the proportion of patients receiving long term treatment. Although treatment guidelines recommend discontinuation after sustained remission, discontinuing antidepressants appears to be challenging for both patients and general practitioners (GPs). Mindfulness-Based Cognitive Therapy (MBCT) is an effective intervention that reduces the risk of relapse in recurrent depression and might facilitate discontinuation by teaching patients to cope with withdrawal symptoms and fear of relapse. The current study aims to investigate the effectiveness of the combination of Supported Protocolized Discontinuation (SPD) and MBCT in comparison with SPD alone in successful discontinuation of long-term use of antidepressants in primary care.MethodsThis study involves a cluster-randomized controlled trial conducted in primary care patients with long-term use antidepressants with baseline and 6, 9 and 12 months follow-up assessments. Patients choosing to discontinue their medication will be offered a combination of SPD and MBCT or SPD alone. Our primary outcome will be full discontinuation of antidepressant medication (= 0 mg) within 6 months after baseline assessment. Secondary outcome measures will be the severity of withdrawal symptoms, symptoms of depression and anxiety, psychological well-being, quality of life and medical and societal costs.DiscussionIn theory, stopping antidepressant medication seems straightforward. In practice however, patients and their GPs appear reluctant to initiate and accomplish this process. Both patients and professionals are in need of appropriate tools and information to better support the process of discontinuing antidepressant medication.Trial registrationClinicalTrials.gov PRS ID: NCT03361514 retrospectively registered October 2017.

Discontinuation of antidepressant medication after mindfulness-based cognitive therapy for recurrent depression: randomised controlled non-inferiority trial.

BackgroundMindfulness-based cognitive therapy (MBCT) and maintenance antidepressant medication (mADM) both reduce the risk of relapse in recurrent depression, but their combination has not been studied.AimsTo investigate whether MBCT with discontinuation of mADM is non-inferior to MBCT+mADM.MethodA multicentre randomised controlled non-inferiority trial (ClinicalTrials.gov: NCT00928980). Adults with recurrent depression in remission, using mADM for 6 months or longer (n = 249), were randomly allocated to either discontinue (n = 128) or continue (n = 121) mADM after MBCT. The primary outcome was depressive relapse/recurrence within 15 months. A confidence interval approach with a margin of 25% was used to test non-inferiority. Key secondary outcomes were time to relapse/recurrence and depression severity.ResultsThe difference in relapse/recurrence rates exceeded the non-inferiority margin and time to relapse/recurrence was significantly shorter after discontinuation of mADM. There were only minor differences in depression severity.ConclusionsOur findings suggest an increased risk of relapse/recurrence in patients withdrawing from mADM after MBCT.

Discontinuation of Antidepressant Medication Among Latinos in the USA

Despite recent growth in the variety of antidepressant medications available, many patients discontinue medication prematurely for reasons such as nonresponse, side effects, stigma, and miscommunication. Some analysts have suggested that Latinos may have higher antidepressant discontinuation rates than other US residents. This paper examines Latino antidepressant discontinuation, using data from a national probability survey of Latinos in the USA. In this sample, 8% of Latinos had taken an antidepressant in the preceding 12 months. Among those users, 33.3% had discontinued taking antidepressants at the time of interview, and 18.9% had done so without prior input from their physician. Even controlling for clinical and other variables, patients who reported good or excellent English proficiency were less likely to stop at all. Patients were also less likely to stop if they were older, married, had public or private insurance, or had made eight or more visits to a nonmedical therapist.

Selective serotonin reuptake inhibitor discontinuation syndrome in children: Six case reports

Background: Antidepressant discontinuation syndrome refers to a cluster of symptoms that occur after abrupt dose reduction or discontinuation of antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are increasingly being used for the treatment of depression and other psychiatric disorders in children and adolescents, but published data on SSRI discontinuation syndrome in children are limited. Objective: This paper presents 6 case reports of SSRI discontinuation syndrome in children. Results: SSRI discontinuation syndrome was diagnosed in 6 patients (4 boys, 2 girls; mean age, 11.33 ± 1.75 years) according to established criteria. Three patients had been taking paroxetine, 2 fluvoxamine, and 1 sertraline for an average of 4.00 ± 1.67 months (range, 3–6 months) before abrupt discontinuation or dose reduction. Dizziness/lightheadedness/drowsiness, poor concentration, nausea, headache, and fatigue were the most frequent symptoms. As in previous studies in adults, the 6 patients experienced SSRI discontinuation symptoms 1 to 5 days (mean 2.92 ± 1.63 days) after SSRI discontinuation or dose reduction. In all patients, symptoms resolved on reinitiation of treatment with the same SSRI or a different one. Conclusions: The case reports presented in this article suggest that SSRI discontinuation syndrome can and does occur in children when treatment is stopped or the SSRI dose is reduced abruptly, and is quite similar to that reported in adults. Placebo-controlled prospective studies are needed in children to further assess the prevalence and clinical presentation of SSRI discontinuation syndrome and to develop management strategies for this condition.

Which elderly depressed patients remain well on maintenance interpersonal psychotherapy alone?: Report from the Pittsburgh Study Of Maintenance Therapies in Late-Life Depression

The aim of this study was to identify elderly depressed patients who can remain well on maintenance Interpersonal Psychotherapy (IPT) alone, after discontinuation of antidepressant medication. Using Cox proportional hazards models, increased severity of depression at pretreatment was associated with increased recurrence rates, to an extent greater in patients maintained on monthly IPT than in those maintained on nortriptyline. The long-term response to maintenance IPT was correctly identified in 20/25 cases by a pretreatment Hamilton score of > or = 20. Fourteen of sixteen patients with pretreatment scores of > or = 20 experienced recurrence of major depression on maintenance IPT, while 6/9 patients with pretreatment scores of less than 20 did not. (Fisher exact P = .01). The same pattern of recurrence in relation to severity was not evident in maintenance placebo, nortriptyline, or combination treatment. In addition, Hamilton scores during continuation treatment were lower (< or = 7) among those who remained well on maintenance IPT than among those who had recurrences. Elderly patients whose depressions are milder at baseline and who show excellent symptomatic remission during acute and continuation therapy may be good candidates for monthly maintenance IPT after initial successful treatment with antidepressant medication and psychotherapy.

Which elderly depressed patients remain well on maintenance interpersonal psychotherapy alone?: Report from the Pittsburgh Study Of Maintenance Therapies in Late‐Life Depression

The aim of this study was to identify elderly depressed patients who can remain well on maintenance Interpersonal Psychotherapy (IPT) alone, after discontinuation of antidepressant medication. Using Cox proportional hazards models, increased severity of depression at pretreatment was associated with increased recurrence rates, to an extent greater in patients maintained on monthly IPT than in those maintained on nortriptyline. The long-term response to maintenance IPT was correctly identified in 20/25 cases by a pretreatment Hamilton score of≥ 20. Fourteen of sixteen patients with pretreatment scores of≥ 20 experienced recurrence of major depression on maintenance IPT, while 6/9 patients with pretreatment scores of less than 20 did not. (Fisher exact P=.01). The same pattern of recurrence in relation to severity was not evident in maintenance placebo, nortriptyline, or combination treatment. In addition, Hamilton scores during continuation treatment were lower (≤ 7) among those who remained well on maintenance IPT than among those who had recurrences. Elderly patients whose depressions are milder at baseline and who show excellent symptomatic remission during acute and continuation therapy may be good candidates for monthly maintenance IPT after initial successful treatment with antidepressant medication and psychotherapy. Depression and Anxiety 10:55–60, 1999. © 1999 Wiley-Liss, Inc

Long-term management of depressive disorders

Evidence suggests that depression is a chronic and recurrent illness rather than a limited or acute condition. Recommendations issued by the World Health Organization Mental Health Collaborating Centres in 1989 called for the continuation of antidepressant therapy for up to 6 months. Many depressed patients require treatment for as long as 2 years or more. The potential complications of antidepressant therapy are of greater concern during long-term prophylactic treatment than during the acute management of depressive episodes. Patient noncompliance, pharmacologic side effects, drug interactions, and drug overdose are among the factors that can interfere with the course of chronic therapy. Discontinuation of antidepressant medication after long-term treatment should be slow, gradual, and individualized, regardless of the pharmacologic agent administered.

Seasonal risk for early recurrence of unipolar depression after discontinuation of antidepressant medication

AbstractThe results of this retrospective chart review suggest that early depressive recurrence is more likely when antidepressant medications are discontinued during fall‐winter months. Forty‐one patients with non‐seasonal unipolar major depression were studied. All patients were considered markedly improved or fully remitted for at least 3 months and had a total duration of treatment between 6 and 18 months before medication was stopped. Recurrence of depression within 3 months of stopping medication was more likely among patients who discontinued their antidepressant regimen between October and March (76% vs. 29%). Patients with comorbid dysthymia, obsessive compulsive disorder, panic disorder, or alcohol or substance abuse were at high risk for early recurrence, but did not show a pattern of increased risk of recurrence following fall‐winter antidepressant discontinuation. Depression 1:324‐326 (1993). © 1993 Wiley‐Liss, Inc.