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Fava, 2018 Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review.


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Psychother Psychosom. 2018 Jul 17:1-9. doi: 10.1159/000491524. [Epub ahead of print]

Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review.

Fava GA1,2, Benasi G1, Lucente M1, Offidani E3, Cosci F4, Guidi J1.

 

Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30016772

 

BACKGROUND:

Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation.

 

METHODS:

PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: "duloxetine" OR "venlafaxine" OR "desvenlafaxine" OR "milnacipran" OR "levomilnacipran" OR "SNRI" OR "second generation antidepressant" OR "serotonin norepinephrine reuptake inhibitor" AND "discontinuation" OR "withdrawal" OR "rebound." Only published trials in the English language were included.

 

RESULTS:

Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well.

 

CONCLUSIONS:

Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood 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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  • 2 months later...

Just read this in the latest e-newsletter from Mad in America: https://www.madinamerica.com/2018/10/snris-added-list-drugs-potential-withdrawal-symptoms/

 

"SNRIs Added to the List of Drugs with Potential Withdrawal Symptoms

New research suggests that clinicians should exercise caution prescribing SNRIs as first-line treatment for mood and anxiety disorders. 

 

New research, published in the journal Psychotherapy and Psychosomatics, investigates withdrawal symptoms upon discontinuing a commonly prescribed class of antidepressant drugs called Serotonin-Noradrenaline Reuptake Inhibitors (SNRIs). The results of the systematic review indicate that withdrawal symptoms may ensue after discontinuing varying types of SNRIs."... 

(please move this post if this is the wrong forum)

January 2021: Cut Venlafaxine XR by 9% to 125mg; holding Lorazepam at 1.25 mg.

October 2020: Reduced Venlafaxine XR to 137.5 mg while keeping Lorazepam at 1.25 mg.

August 2020:  Made a 16% reduction in Lorazepam at psychiatrist's recommendation (1.25 mg) while holding Venlafaxine at 150 mg.

March 2019 - March 2020: Venlafaxine  XR tapered from  337.5 mg  to 150 mg (60% reduction), while continuing 1.5 mg Lorazepam.

March 2016 - January 2019: Mirtazapine taptered to 0, while continuing on 1.5 mg Lorazepam and 375 mg Venlafaxine XR.

Feb. 2015: 7.5 mg Mirtazapine + 1.5 mg Lorazepam + 375 mg Venlafaxine.

 

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And also this: 

"Systematic Review Finds Antidepressant Withdrawal Common and Potentially Long-lasting

Prominent researchers conduct a review of antidepressant withdrawal incidence, duration, and severity. Results lead to call for new clinical guidelines."

https://www.madinamerica.com/2018/10/systematic-review-finds-antidepressant-withdrawal-common-potentially-long-lasting/

January 2021: Cut Venlafaxine XR by 9% to 125mg; holding Lorazepam at 1.25 mg.

October 2020: Reduced Venlafaxine XR to 137.5 mg while keeping Lorazepam at 1.25 mg.

August 2020:  Made a 16% reduction in Lorazepam at psychiatrist's recommendation (1.25 mg) while holding Venlafaxine at 150 mg.

March 2019 - March 2020: Venlafaxine  XR tapered from  337.5 mg  to 150 mg (60% reduction), while continuing 1.5 mg Lorazepam.

March 2016 - January 2019: Mirtazapine taptered to 0, while continuing on 1.5 mg Lorazepam and 375 mg Venlafaxine XR.

Feb. 2015: 7.5 mg Mirtazapine + 1.5 mg Lorazepam + 375 mg Venlafaxine.

 

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