Discontinuing antidepressants: Pearls and pitfalls
Samantha J Zwiebel1, Adele C Viguera2
1Assistant Professor of Clinical Psychiatry, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA zwiebels@pennmedicine.upenn.edu.
Cleveland Clinic Journal of Medicine
|January 5, 2022
Summary
Stopping antidepressants can cause challenging discontinuation symptoms. Careful patient education and slow tapering over weeks to months are key to managing antidepressant discontinuation syndrome (ADS).
Area of Science:
- Pharmacology
- Clinical Psychiatry
- Patient Safety
Background:
- Antidepressant discontinuation syndrome (ADS) presents significant challenges for patients stopping medication.
- Common symptoms include insomnia, flu-like illness, mood changes, dizziness, and paresthesias, with potential for diverse adverse effects.
Purpose of the Study:
- To outline strategies for mitigating the risk and managing the symptoms of antidepressant discontinuation syndrome.
- To emphasize the importance of patient education and risk identification in managing ADS.
Main Methods:
- Review of common and possible adverse effects associated with antidepressant cessation.
- Discussion of management strategies including patient education, risk stratification, and slow tapering protocols.
Main Results:
- Antidepressant discontinuation symptoms can manifest with varied durations, lasting from days to months.
- Effective management involves slow antidepressant tapers (weeks to months) and, if needed, restarting the prior dose before a slower taper.
Conclusions:
- Proactive patient education and identifying at-risk individuals are crucial for preventing severe ADS.
- Gradual dose reduction and symptomatic management are essential for safely discontinuing antidepressant therapy.
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