title: A review of the management of antidepressant discontinuation symptoms.
abstract: Strong evidence supports the existence of a discontinuation syndrome following the withdrawal of antidepressant medication, particularly second-generation antidepressants. The syndrome is a common phenomenon and guidance as to best avoid the symptoms is essential for both practitioners and patients. The current study reviewed the available literature on the best methods of discontinuation for antidepressants in order to avoid or prevent the occurrence of any unpleasant side effects associated with antidepressant withdrawal. Accordingly, an electronic search of the PubMed/MedLine database and Google Scholar was conducted to find relevant literature published within the last 10 years. From this, 18 related articles were identified; five clinical studies, one case series, one consensus panel's recommendations and 11 literature reviews. Of the articles reviewed there is a general consensus as to tapering the drug slowly over a period of weeks or months. Also, in those patients who experience severe symptoms the drug should be reinstated and discontinued more gradually. The discontinuation syndrome does not occur as frequently or severely with longer-acting agents such as fluoxetine and therefore it is recommended that switching to this drug prior to withdrawal may be advisable. The articles reviewed also emphasize the need for patient education and reassurance throughout the discontinuation process. One in particular adds that cognitive behavioural therapy may be a useful tool in easing the patients' distress. However, this review highlights the lack of controlled data to support the available guidelines. Furthermore, the guidance which is available is somewhat conflicting. Research approaches should address this issue as well as develop appropriate methods of withdrawal for specific drugs.
authors.affiliation: King's College London, Institute of Psychiatry, London SE5 8AF, UK.
authors.forename: Emma
authors.initials: E
authors.lastname: Wilson
authors.affiliation: King's College London, London, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Lader
keywords: antidepressant medication; discontinuation syndrome; gradual dose tapering
references.citation: Consult Pharm. 2007 Aug;22(8):628-44
references.pmid: 18198962
references.citation: Behav Cogn Psychother. 2011 Jan;39(1):77-97
references.pmid: 20849682
references.citation: Am Fam Physician. 2006 Aug 1;74(3):449-56
references.pmid: 16913164
references.citation: Aust N Z J Psychiatry. 2009 Sep;43(9):846-54
references.pmid: 19670058
references.citation: J Psychopharmacol. 2008 May;22(3):330-2
references.pmid: 18515448
references.citation: J Psychopharmacol. 2005 Sep;19(5):554-7
references.pmid: 16166193
references.citation: Expert Opin Drug Saf. 2013 Nov;12(6):873-80
references.pmid: 24033095
references.citation: Eur J Clin Pharmacol. 2005 Jun;61(4):303-7
references.pmid: 15906018
references.citation: J Clin Psychiatry. 2006;67 Suppl 4:27-30
references.pmid: 16683860
references.citation: Tijdschr Psychiatr. 2013;55(10):789-94
references.pmid: 24194351
references.citation: J Clin Psychiatry. 1997;58 Suppl 7:23-7
references.pmid: 9219490
references.citation: Hum Psychopharmacol. 2010 Mar;25(2):95-102
references.pmid: 20196187
references.citation: Expert Opin Drug Saf. 2011 Nov;10(6):839-50
references.pmid: 21545241
references.citation: Aust N Z J Psychiatry. 2011 Sep;45(9):712-25
references.pmid: 21888608
references.citation: Biol Psychiatry. 1998 Jul 15;44(2):77-87
references.pmid: 9646889
references.citation: Int Clin Psychopharmacol. 2004 Sep;19(5):271-80
references.pmid: 15289700
references.citation: Psychiatry Clin Neurosci. 2011 Jun;65(4):384-5
references.pmid: 21489048
references.citation: J Psychiatry Neurosci. 2000 May;25(3):255-61
references.pmid: 10863885
references.citation: Int J Neuropsychopharmacol. 2007 Feb;10(1):73-84
references.pmid: 16359583
references.citation: Depress Anxiety. 2009;26(1):E23-5
references.pmid: 19067320
references.citation: N Engl J Med. 1996 Oct 3;335(14):1010-5
references.pmid: 8793924
references.citation: J Psychiatry Neurosci. 2006 Jan;31(1):11-2
references.pmid: 16496030
references.citation: Breastfeed Med. 2010 Dec;5(6):283-8
references.pmid: 20807106
references.citation: Pharmacotherapy. 2003 May;23(5):678-81
references.pmid: 12741444
references.citation: J Clin Psychiatry. 1997 Jul;58(7):291-7
references.pmid: 9269249
references.citation: Geriatr Nurs. 2007 Mar-Apr;28(2):75-9
references.pmid: 17430741
references.citation: J Affect Disord. 2011 Jan;128(1-2):165-70
references.pmid: 20656359
references.citation: JAMA. 2006 Feb 1;295(5):499-507
references.pmid: 16449615
references.citation: BMC Res Notes. 2012 Dec 13;5:684
references.pmid: 23237104
references.citation: Psychother Psychosom. 2013;82(6):355-62
references.pmid: 24061211
references.citation: J Clin Psychiatry. 2006;67 Suppl 4:8-13
references.pmid: 16683857
references.citation: J Pharm Pract. 2013 Aug;26(4):389-96
references.pmid: 23459282
references.citation: Med Hypotheses. 2011 Dec;77(6):1006-8
references.pmid: 21920673
references.citation: J Psychopharmacol. 2015 May;29(5):459-525
references.pmid: 25969470
references.citation: Am J Psychiatry. 2010 Aug;167(8):934-41
references.pmid: 20478876
references.citation: J Clin Psychiatry. 2006;67 Suppl 4:3-7
references.pmid: 16683856
references.citation: Drugs. 2007;67(12):1657-63
references.pmid: 17683167
references.citation: J Psychosoc Nurs Ment Health Serv. 2010 Jul;48(7):9-12
references.pmid: 20608581
references.citation: Front Pharmacol. 2013 Apr 16;4:45
references.pmid: 23596418
references.citation: Curr Med Res Opin. 2011 Apr;27(4):745-9
references.pmid: 21271795
references.citation: CNS Drugs. 2006;20(8):665-72
references.pmid: 16863271