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Schatzberg, 2006 Antidepressant discontinuation syndrome: consensus panel recommendations for clinical management and additional...


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This publication was sponsored by Wyeth, manufacturer of Effexor. The consensus panel was originally funded by Eli Lilly in 1996.

 

Also see Shelton 2006 The nature of the discontinuation syndrome associated with antidepressant drugs, the first part of this supplement.

 

And the original product of the esteemed 1997 consensus panel (sponsored by Lilly): Schatzberg 1997 Serotonin reuptake inhibitor discontinuation syndrome: a hypothetical definition. Discontinuation Consensus panel.

 

J Clin Psychiatry. 2006;67 Suppl 4:27-30.

 

Antidepressant discontinuation syndrome: consensus panel recommendations for clinical management and additional research.

 

Schatzberg AF, Blier P, Delgado PL, Fava M, Haddad PM, Shelton RC.

 

Source

 

Stanford University School of Medicine, Stanford, Calif. 94305-5717, USA. afschatz@stanford.edu

 

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/16683860 Download full text

 

OBJECTIVE:

 

Currently, no evidence-based guidelines exist for the management of serotonin reuptake inhibitor (SRI) discontinuation syndrome. This article summarizes recommendations with respect to future research as well as clinical management recommendations for SRI discontinuation syndrome.

 

PARTICIPANTS:

 

In April 2004, a panel of physicians convened in New York City to discuss recommendations for clinical management of and additional research on SRI discontinuation syndrome.

 

EVIDENCE:

 

Previous guidance for management of SRI discontinuation syndrome was proposed in 1997 in a consensus meeting also chaired by Alan F. Schatzberg. A literature search of the PubMed database was conducted to identify articles on SRI discontinuation syndrome that have been published since 1997.

 

CONSENSUS PROCESS:

 

The 2004 panel reviewed important preclinical and clinical studies, discussed prospective investigation of this syndrome in clinical trials, and suggested the establishment of a research network to collect data in naturalistic settings. The panel also reviewed the management recommendations published in 1997 and subsequently updated the recommendations, taking into account the latest clinical data as well as the personal experience of its members with patients.

 

CONCLUSIONS:

 

Additional preclinical and clinical studies are necessary to further elucidate the underlying biological mechanisms of SRI discontinuation syndrome and to identify the patient populations and agents that are most affected by this phenomenon. Management strategies include gradual tapering of doses and should emphasize clinical monitoring and patient education.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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This supplement included:
 
J Clin Psychiatry. 2006;67 Suppl 4:3-7.
The nature of the discontinuation syndrome associated with antidepressant drugs.
Shelton RC.

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/16683856 also see http://survivingantidepressants.org/index.php?/topic/822-shelton-2006-the-nature-of-the-discontinuation-syndrome-associated-with-antidepressant-drugs/

A common phenomenon accompanying treatment with nearly every major class of antidepressant is the emergence of the discontinuation syndrome in some patients. It is seen most frequently after the abrupt cessation of agents with shorter half-lives. The term withdrawal has been used in the past; however, the distinctions between discontinuation symptoms and drug withdrawal are clear. Thus, the use of proper terminology when discussing this phenomenon with patients will help to alleviate concerns and stop the spread of common misperceptions. In addition, awareness of the unique nature of discontinuation effects and a grasp of the typical time frame of their emergence can assist in distinguishing between discontinuation syndrome and relapse. As a result, it is vital that both patients and their relatives, especially caregivers, be provided with adequate education and a realistic and objective appraisal of expected outcomes upon initiation of antidepressant treatment.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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This supplement included:

 

J Clin Psychiatry. 2006;67 Suppl 4:22-6.
Monoamine depletion studies: implications for antidepressant discontinuation syndrome.
Delgado PL.

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/16683859

The likelihood of a connection between serotonin reuptake inhibitor (SRI) discontinuation and an acute reduction in synaptic serotonin (5-HT) has ignited interest in the similarities between SRI discontinuation syndrome and the symptoms observed after acute tryptophan depletion, which reduces synaptic 5-HT levels. An open question is whether these 2 phenomena have shared characteristics because of a similar underlying mechanism. The evidence in support of a similar underlying mechanism includes the observation that comparable proportions of SRI-treated patients experience depressive symptoms following tryptophan depletion and SRI discontinuation. Furthermore, the proportion of people who have emotional changes with rapid antidepressant discontinuation may be parallel to the proportion of people who experience those changes with rapid tryptophan depletion.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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This supplement included:
 
J Clin Psychiatry. 2006;67 Suppl 4:14-21.
Prospective studies of adverse events related to antidepressant discontinuation.
Fava M.

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/16683858

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.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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This supplement included:

 

J Clin Psychiatry. 2006;67 Suppl 4:8-13.
Physiologic mechanisms underlying the antidepressant discontinuation syndrome.
Blier P, Tremblay P.

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/16683857

The rate at which serotonin reuptake inhibitor (SRI) treatment is terminated and the duration of treatment appear to be key factors in predicting discontinuation symptoms. The development of animal models to explain the mechanisms of this clinical problem has proved challenging, because less than half of all patients experience any discontinuation symptoms, many of which are subjective in nature. One explanation is that SRI discontinuation symptoms may arise from the rapid decrease in serotonin (5-HT) availability when treatment ends abruptly. Yet, it would appear that discontinuation discomforts may not be mediated exclusively through 5-HT receptors, given the major regulatory role 5-HT exerts on a number of specific chemical receptor systems in the brain. As a result, attempts to explain the determinants of this phenomenon rely on a certain level of speculation. This article examines the possible physiologic bases for the antidepressant discontinuation syndrome and briefly describes these adaptations. It discusses the 3 systems most likely to account for at least part of the symptomatology--the 5-HT, the norepinephrine, and the cholinergic systems--and the possible interactions among them. It also attempts to explain their implications in the therapeutic actions of antidepressants in patients with affective and anxiety disorders.

This is not medical advice. Discuss any decisions about your medical care with a knowledgeable medical practitioner.

"It has become appallingly obvious that our technology has surpassed our humanity." -- Albert Einstein

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