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Baldessarini, 2019 Effects of Treatment Discontinuation in Clinical Psychopharmacology.

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Psychother Psychosom. 2019;88(2):65-70. doi: 10.1159/000497334. Epub 2019 Mar 28.

Effects of Treatment Discontinuation in Clinical Psychopharmacology.

Baldessarini RJ1, Tondo L2.


Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30923289


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Reports in this issue of Psychotherapy and Psychosomatics by Drs. Cohen and Recalt document the occurrence of treatment discontinuation in therapeutic trials involving most types of drugs used for psychiatric disorders [1, 2]. They conclude that treatment discontinuation has broad implications rarely acknowledged in published reports. The precise prevalence of treatment discontinu- ation in therapeutic trials is not known, but it is common- place clinically and is often associated with trials aimed at testing for both short-term effects and long-term, preven- tive or prophylactic effects of psychotropic drugs [1, 2]. Effects associated with discontinuing psychotropic drugs include several types that have been described elsewhere [3].


First are early reactions arising within hours or first days following discontinuation of many psychotropic drugs. They include apparently physiological withdraw- al-like syndromes but can also include rapid emergence of other new symptoms [3–7]. A description of such reac- tions (Discontinuation-Emergent Signs and Symptoms [DESS] scale) includes 43 signs and symptoms [8]. In ad- dition to physical and sensory phenomena, reactions sometimes include symptoms also found in the illnesses being treated (especially depression and anxiety), as well as other novel syndromes. Examples of the latter include: withdrawal-emergent dyskinesias [9] or catatonia [10], emergence or worsening of tardive dyskinesia [11, 12], and a proposed tardive psychosis syndrome [13] – all on removal of antipsychotic drugs; new panic symptoms and worsening or new depression or mania after removing an antidepressant [3, 8, 14–16]; and new or increased sui- cidal behavior after discontinuing lithium [17] and pos- sibly antidepressants [15, 16]. Second and usually some- what later, symptoms of illnesses being treated can recur more often, sometimes more severely, and much more rapidly than predicted by the natural history of untreated illness, including by comparison to a patient’s own his- tory. Usually such episodes arise over weeks rather than the hours or days characteristic of initial withdrawal- emergent reactions. Post-discontinuation relapse or re- currence has been documented after discontinuing anti- depressants [18], mood stabilizers [19–21], and antipsy- chotics [22], particularly following abrupt or rapid discontinuation over a few days [18–22]. The average time to a relapse after rapid discontinuation of antide- pressants and lithium is about 3 months, whereas it ex-tends to 6 months after gradual discontinuation [18, 20]. Of note, none of these iatrogenic complications was men- tioned in a new, large national survey of morbid condi- tions associated with major psychiatric disorders, prob- ably owing to lack of categorical designations for such conditions in national health information registries [23]. Overall, there seems to be a lack of consensus about a well-defined distinction between the sometimes overlap- ping characteristics of the effects of medication with- drawal and discontinuation.


Edited by Altostrata
Journals format

2005-2015 sertaline, 2015 to November 2018 escatalopram. Used liquid titration to drop doses. By 0.5mg at first then drops as small as 0.01mg at end of taper. Jumped of at 0.02mg

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Sorry I don’t think I posted this right. You can’t see the entire article. And I don’t know how to.

2005-2015 sertaline, 2015 to November 2018 escatalopram. Used liquid titration to drop doses. By 0.5mg at first then drops as small as 0.01mg at end of taper. Jumped of at 0.02mg

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Post discontinuation relapse or recurrence? I didn’t get internal vibrations, tremors or whatever you want to call it for a couple of months after being brought down too fast! And it wasn’t anxiety related. I still have them, and stressful periods make them worse, so I know the difference. Trying telling that to the psychiatrist, family members or friends! Are they still not understanding withdrawal! After all people who have never suffered from anxiety or depression still get these as withdrawal symptoms.

1987 Anafranil

1987-1989 Prothiaden

1990-Jan 2015 Prozac 40mg Feb-Mar Prozac 30mg Ap-Nov Prozac 20mg (+10mg Zoloft for 1 week in Sept) Dec Prozac 10mg 2016 Jan-2017 Oct Prozac 15mg  Nov Prozac 14mg  Nov Prozac14.5mg

Other drugs Humira and Methotrexate for rheumatoid arthritisSupplements :Magnesium and calcium.Folic acid 5mg.

Inderal 10mg (stopped 2018 Dec).        

2018 Nov Quetiapine fumarate 25mg Dec 150-125mg 2019Jan 125-25mg Feb 25-12.5mg

2018 Dec Sertra 25-150-125mg

2018 Dec Pregabalin 75-150mg                                                                                                  

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  • Altostrata changed the title to Baldessarini, 2019 Effects of Treatment Discontinuation in Clinical Psychopharmacology.

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