Prospective studies of adverse events related to antidepressant discontinuation.
The value of a prospective assessment of discontinuation-emergent symptoms proximal to the termination of antidepressant treatment cannot be overstated. Though varying in frequency and intensity, nearly all classes of antidepressants have been linked with discontinuation reactions and the associated psychological, physical, and somatic discomfort. Spontaneous reports have been typically used to gauge the risks of discontinuation reactions. Judging from a number of prospective studies, spontaneous reports very likely underestimate the occurrence of discontinuation reactions. This probability suggests that systematic inquiry must urgently become a part of the assessment in antidepressant discontinuation studies. Insight into the number and type of events that may occur following antidepressant discontinuation may be gleaned from instruments such as the Discontinuation-Emergent Signs and Symptoms Scale. This article takes a comprehensive view of a number of studies dealing with discontinuation-related adverse events. It discusses key issues in the analysis of incidence rates of antidepressant discontinuation-emergent adverse events such as the obvious bias of both clinicians' and patients' being aware of the treatment discontinuation. This article also looks at early prospective studies of antidepressant discontinuation reactions based on spontaneous reports and discusses, while making the case for, prospective studies based on systematic inquiry.
Fava
Maurizio
M
Depression Clinical and Research Program, Massachusetts General Hospital, Boston 02144, USA. mfava@partners.org