Hormonal markers of stress response following interruption of selective serotonin reuptake inhibitor treatment.
Depressive illness is associated with loss of the usual regulation of stress-responsive hormonal and neurotransmitter systems, and antidepressants have intrinsic effects reducing the activity of these systems. Abrupt interruption of treatment with some antidepressants has been associated with a self-limited syndrome of physical and psychological symptoms distinct from relapse, of which drug half-life appears to be the major determinant. We hypothesized that reactivation of stress-response systems could play a role in this syndrome and studied the effects of treatment interruption in patients successfully treated with the antidepressant fluoxetine, paroxetine or sertraline. During placebo substitution, interruption of paroxetine was associated with statistically significant increases in plasma IGF-1 and heart rate. These data suggest that some activation of physiologic stress-responses may accompany symptom increases during treatment interruption of shorter half-life agents.
Michelson
D
D
Lilly Research Laboratories, Lilly Corporate Center, Indianapolis, IN 46285, USA. dmichelson@lilly.com
Amsterdam
J
J
Apter
J
J
Fava
M
M
Londborg
P
P
Tamura
R
R
Pagh
L
L
D000328:Adult; D015415:Biomarkers; D018592:Cross-Over Studies; D003866:Depressive Disorder / Q000097:blood / Q000188:drug therapy / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D005473:Fluoxetine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D006439:Hemodynamics / Q000187:drug effects; D006728:Hormones / Q000097:blood*; D006801:Humans; D008297:Male; D017374:Paroxetine / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D012107:Research Design; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use; D020280:Sertraline / Q000009:adverse effects / Q000097:blood / Q000627:therapeutic use; D013315:Stress, Psychological / Q000097:blood* / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000097:blood* / Q000523:psychology
D015415:Biomarkers; D005473:Fluoxetine; D006728:Hormones; D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline