[Drug discontinuation in depression].
Before stopping or starting medications in depression, the first step is a through assessment of the patient's mood disorder: past medical general and psychiatric history, psychological profile, past specific treatment history... Today some data are well demonstrated: antidepressant or lithium or carbamazepine discontinuation should be done gradually (over weeks or months) and with an intensive medical follow-up; after the acute treatment of the index depressive episode, a full therapeutic dose of the antidepressant agent should be continued for at least 4 to 6 months; antipsychotic drugs and minor tranquilizers use should be limited: combination of a neuroleptic and an antidepressant in depression with psychotic features, combination of a minor tranquilizer in depression with anxiety during the first three weeks if necessary. A contario the timing and the method of discontinuing maintenance treatment (lithium or antidepressant) have not been well studied. Literature data are discussed: frequency of recurrence during treatment discontinuation, even after long-term euthymia; possible risk for developing rapid-cycles or non response after lithium discontinuation. More precise clinical guidelines are necessary.
Vanelle
J M
JM
Service Hospitalo-Universitaire de Santé Mentale et de Thérapeutique, Centre Hospitalier Sainte-Anne, Paris.
Féline
A
A
D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects*; D014150:Antipsychotic Agents / Q000008:administration & dosage / Q000009:adverse effects; D003866:Depressive Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005500:Follow-Up Studies; D006801:Humans; D008094:Lithium / Q000008:administration & dosage / Q000009:adverse effects; D008134:Long-Term Care; D012008:Recurrence; D013375:Substance Withdrawal Syndrome / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology
D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D008094:Lithium
Arrêt du traitement médicamenteux dans la dépression.