Discontinuing or switching selective serotonin-reuptake inhibitors.
OBJECTIVE
To describe reasons for discontinuing or switching selective serotonin-reuptake inhibitors (SSRIs) at 3 and 6 months after starting treatment, and to identify information provided to patients that may help prevent premature discontinuation of medication.


METHODS
Telephone surveys were conducted at 3 and 6 months after patients (n = 672) were started on an SSRI for a new or recurrent case of depression.


RESULTS
Significantly more patients discontinued or switched their SSRI because of an adverse effect within the first 3 months of starting (43%) compared with the second 3 months (27%; p = 0.023). The adverse effect most frequently reported as the reason for early discontinuation or switching was drowsiness/fatigue (10.2%), followed by anxiety, headache, and nausea - all at just over 5%. The odds ratio for discontinuation was 61% less in patients who recalled being told to take the medication for at least 6 months compared with those who did not (OR 0.39; p < 0.001). Patients who recalled being informed of potential adverse effects increased their reported incidence of mild to moderate adverse effects by 55% (OR 1.55; p < 0.05) without affecting rates of premature discontinuation (OR 1.06; p = 0.77).


CONCLUSIONS
Adverse effects are the most frequent reason for discontinuing or switching SSRIs within the first 3 months of treatment. Patients are more likely to continue taking their antidepressant if they fully understand how long to take the medication. Informing patients of potential adverse effects does not appear to prevent premature discontinuation, but may increase the patient's awareness and reporting of mild to moderate adverse effects.
Bull
Scott A
SA
The Permanente Medical Group Division of Research, Kaiser Permanente, Oakland, CA, USA.
Hunkeler
Enid M
EM
Lee
Janelle Y
JY
Rowland
Clayton R
CR
Williamson
Todd E
TE
Schwab
Joseph R
JR
Hurt
Stephen W
SW
D000328:Adult; D000368:Aged; D001007:Anxiety / Q000139:chemically induced; D003625:Data Collection; D016903:Drug Monitoring / Q000379:methods*; D005221:Fatigue / Q000139:chemically induced; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000139:chemically induced; D018579:Patient Selection; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects*; D016312:Treatment Refusal / Q000706:statistics & numerical data*
D017367:Selective Serotonin Reuptake Inhibitors