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Katz, 2011 Tachyphylaxis/tolerance to antidepressants in treatment of dysthymia: results of a retrospective naturalistic chart review study.

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Tachyphylaxis is "poop-out." Thank you, bubbles, for the pointer to this paper.


Psychiatry Clin Neurosci. 2011 Aug;65(5):499-504. doi: 10.1111/j.1440-1819.2011.02231.x.

Tachyphylaxis/tolerance to antidepressants in treatment of dysthymia: results of a retrospective naturalistic chart review study.

Katz G.


Abstract at http://www.ncbi.nlm.nih.gov/pubmed/21851459 Full text https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1819.2011.02231.x



The main goals of this chart-review study were to examine the rate of tachyphylaxis during treatment of dysthymia with antidepressants, to compare the incidence of tolerance during trials of selective serotonin reuptake inhibitors (SSRI) and non-SSRI and to give descriptive analysis of the cases of tachyphylaxis.



The retrospective naturalistic chart review study included 52 cases of successfully treated (with different antidepressants) patients suffering from dysthymia. The overall number of the cases of tolerance to antidepressants were registered as well as the rate of these phenomena in the groups treated with SSRI and non-SSRI.



The cases of tolerance/tachyphylaxis were observed in 12 patients (23% of patients) and in 13 trials (22.4% of trials). All cases of tolerance occurred during monotherapy. No cases of tachyphylaxis were observed in the non-SSRI group while in the SSRI group, tolerance at some stage of the treatment was detected in 41.9% of the successful cases (P < 0.001).



During the treatment of dysthymia with antidepressants in the SSRI group, tachyphylaxis/tolerance might be observed in a relatively in high proportion of cases.


From the paper:



THE PHARMACOLOGIC TERM ‘tachyphylaxis’ is defined as an appearance of progressive decrease in response to a given dose after repetitive administration of a pharmacologically or physiologically active substance.1 In some studies, tachyphylaxis (or ‘poop‐out’) is defined as a relapse or recurrence of an episode of major depression after full recovery from a major depressive episode despite continued treatment with a previously effective antidepressant;2 other studies characterize the phenomenon as a return of depressed mood, apathy or decreased motivation (described by patients as ‘the blahs’), fatigue, dullness in cognitive function, sleep disturbance, weight gain, and sexual dysfunction.3 Patients frequently report the some deterioration they felt after initially achieving remission on the antidepressant, but not as bad as they felt before treatment when they were in an episode of major depression.4 Although in most clinical studies the term tachyphylaxis is used, the term ‘tolerance’ could be more correct from a pharmacologic point of view.5 While the term ‘antidepressant tachyphylaxis’ stresses mostly the possibility of habituation/sensitization mechanisms, the term tolerance is much more comprehensive and includes the mechanisms of pharmacodynamic tolerance, pharmacokinetic tolerance, increase in disease severity, change in disease pathogenesis, depleted effector substance, prominent increase of drug serum level and existence of detrimental metabolite.6 In the current report the terms tachyphylaxis and tolerance have been used interchangeably.



Edited by Altostrata

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