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

¹ Bolton, Trafford and Salford Mental Health NHS Trust, Kenyon House, Prestwich Hospital,Bury New Road, Manchester M25 3BL, UK.
² Bolton, Trafford and Salford Mental Health NHS Trust, Cromwell House, Cromwell Road,Eccles, Salford M30 0GT, UK.
³ Neuroscience and Psychiatry Unit, University of Manchester, Room G809, Stopford Building,Oxford Road, Manchester M13 9PT, UK.

^* To whom correspondence should be addressed.

	Abstract

Twenty eight patients treated with selective serotonin reuptakeinhibitors /venlafaxine were randomized to a three-day (short) or 14-day(longer) anti-depressant taper and openly assessed after a five to sevenday drug-free washout, and again after seven days treatment with a newanti-depressant of the treating clinician's choice. A 'discontinuationsyndrome' ( _ 3 new symptoms on the Discontinuation Emergent Signsand Symptoms checklist) occurred in 46% of patients with a similarfrequency in those with short (7/15) versus longer (6/13) taper.Patients initially on short half-life anti-depressants had significantlygreater increases in discontinuation and depressive symptoms thanthose stopping fluoxetine. Four patients, all on paroxetine, developedemergent suicidal ideation after taper. These results support theimportance of half-life in determining discontinuation symptoms andsuggest that there is little advantage to a two-week taper over athree-day taper when switching antidepressants. Anti-depressantdiscontinuation in depressed patients can be associated with worseningdepression and increased suicidality.

Key Words: anti-depressant, SSRI, fluoxetine, paroxetine, venlafaxine, discontinuation symptoms, depression, treatment, suicidality, randomised study

First published on January 21, 2008, doi:10.1177/0269881107081550

Journal of Psychopharmacology 2008;22:330.

A more recent version of this article appeared on May 1, 2008


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