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Henssler, 2019, Antidepressant Withdrawal and Rebound Phenomena

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Posting this article because it talks about rebound phenomena of higher relapse or severe relapses after discontinuation.


Dtsch Arztebl Int. 2019 May 17;116(20):355-361. doi: 10.3238/arztebl.2019.0355.

Antidepressant Withdrawal and Rebound Phenomena.

Henssler J, Heinz A, Brandt L, Bschor T.




Antidepressants are among the most commonly prescribed drugs worldwide. They are often discontinued, frequently without the knowledge of the prescribing physician. It is, therefore, important for physicians to be aware of the withdrawal and rebound phenomena that may arise, in order to prevent these phenomena, treat them when necessary, and counsel patients appropriately.



This review is based on a comprehensive, structured literature search on antidepressant withdrawal phenomena that we carried out in the CENTRAL, PubMed (Medline), and Embase databases. We classified the relevant publications and reports by their methodological quality.



Out of a total of 2287 hits, there were 40 controlled trials, 38 cohort studies and retrospective analyses, and 271 case reports that met the inclusion criteria. Withdrawal manifestations are usually mild and self-limiting; common ones include dizziness, headache, sleep disturbances, and mood swings. More serious or pro- longed manifestations rarely arise. There is an increased risk with MAO inhibitors, tricyclic antidepressants, venlafaxine, and paroxetine; on the other hand, for agomelatine and fluoxetine, abrupt discontinuation seems to be unproblematic. There is also some evidence of rebound phenomena, i.e., of higher relapse rates or especially severe relapses of depression after the discontinuation of an antidepressant.



A robust evidence base now indicates that there can be acute withdrawal phenomena when antidepressants are discontinued. Putative rebound phenomena have not been adequately studied to date. It is recommended that antidepressants should be tapered off over a period of more than four weeks.


Full text here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6637660/

My thread here at SA: https://www.survivingantidepressants.org/topic/1775-bubbles/page/14/

2005 St John's Wort / 2006-2012 Lexapro 20mg, 2 failed attempts to stop, tapered over 4.5 months in early 2012

January 2013 started Sertraline, over time worked up to 100mg / July 2014 dropped from 100mg to 75mg, held for six months

2015 tapered to 50mg over several months, held for several months, some more drops

2016 Feb 35mg, 6 Mar 33mg, more drops (note big drop (calc error) & up to 25mg), more drops (about 2mg at a time)

2017 - more small drops, more long holds

2018 March at 11mg;  April 20 9mg; June 11 8.1mg; (July 10 7.7mg / July 18 7.3mg); ( Sept 2 7.2mg, Sept 5 7.1mg, Sept 9 7mg); 30 Sept 6.5mg, ? 6mg, 23 Nov 5.5mg) 19 Dec 5mg

2019 (micro drops over two weeks 24 Mar 4.9mg, 28 Mar 4.8mg, 31 Mar 4.7mg, 4 Apr 4.6mg, 7 Apr 4.5mg / 22 April 4.4mg, 26 April 4.3mg, 2 May 4.2mg, 5 May 4.1mg, 9 May 4mg), 3 Oct 3.9mg, (20 Oct 3.8mg, 27 Oct 3.7mg, 3 Nov 3.6mg), 24 Nov 3.5mg, 8 Dec 3.4mg, 15 Dec 3.3mg, 22 Dec 3.2mg

2020 19 Jan 3.1mg, 26 Jan 3.0mg; 1 Mar 2.9, 7 Mar 2.8, May (some drops here) 24 May 2.5, May 29 2.4, June 21 2.3, June 28 2.2mg,  July 4 2.1mg, July 24 (or maybe a bit before) 2mg

Current Sertraline: July 24: 2 mg / Armour Thyroid / endless allergy meds, erg

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Good work, @bubbles

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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