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22/3/330    most recent
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This version was published on May 1, 2008
Journal of Psychopharmacology, Vol. 22, No. 3, 330-332 (2008)
DOI: 10.1177/0269881107081550

The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: a randomised study

Aung Tint

Bolton, Trafford & Salford Mental Health NHS Trust, Kenyon House, Prestwich Hospital, Bury New Road, Manchester M25 3BL, UK

Peter M Haddad

Bolton, Trafford & Salford Mental Health NHS Trust, Cromwell House, Cromwell Road, Eccles, Salford M30 0GT, UK

Ian M Anderson

Neuroscience and Psychiatry Unit, University of Manchester, Room G809, Stopford Building, Oxford Road, Manchester M13 9PT, UK, ian.anderson{at}manchester.ac.uk

Twenty eight patients treated with selective serotonin reuptake inhibitors /venlafaxine were randomized to a three-day (short) or 14-day (longer) anti—depressant taper and openly assessed after a five to seven day drug-free washout, and again after seven days treatment with a new anti—depressant of the treating clinician's choice. A 'discontinuation syndrome' ( ≥ 3 new symptoms on the Discontinuation Emergent Signs and Symptoms checklist) occurred in 46% of patients with a similar frequency in those with short (7/15) versus longer (6/13) taper. Patients initially on short half-life anti—depressants had significantly greater increases in discontinuation and depressive symptoms than those stopping fluoxetine. Four patients, all on paroxetine, developed emergent suicidal ideation after taper. These results support the importance of half-life in determining discontinuation symptoms and suggest that there is little advantage to a two-week taper over a three-day taper when switching antidepressants. Antidepressant discontinuation in depressed patients can be associated with worsening depression and increased suicidality.

Key Words: antidepressant • SSRI • fluoxetine • paroxetine • venlafaxine • discontinuation symptoms • depression • treatment • suicidality • randomised study


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