Benazzi, 2008 Fluoxetine for the treatment of SSRI discontinuation syndrome.

[Altostrata]

Int J Neuropsychopharmacol. 2008 Aug;11(5):725-6. doi: 10.1017/S1461145708008493. Epub 2008 Feb 1.
Fluoxetine for the treatment of SSRI discontinuation syndrome.
Benazzi F.

 

Abstract at http://www.ncbi.nlm.nih.gov/pubmed/18241360

Comment on

• Effects of gradual discontinuation of selective serotonin reuptake inhibitors in panic disorder with agoraphobia. [int J Neuropsychopharmacol. 2007]

 

Full text http://ijnp.oxfordjournals.org/content/11/5/725.long

 

The paper by Fava et al. (2007) on SSRI (selective serotonin reuptake inhibitors) discontinuation syndrome has shown two important points highly impacting clinical practice: (i) its high frequency, and (ii) its difficulty of treatment. Fava et al. have shown that the usually suggested strategy to prevent this syndrome, i.e. slow tapering of the SSRI, often does not work, and that its symptoms may sometimes be difficult to tolerate until a spontaneous remission (which may take weeks). A less stressed strategy to prevent and treat SSRI discontinuation syndrome is switching one SSRI to fluoxetine (Schatzberg et al., 2006). For this purpose, fluoxetine is used only for a short time (i.e. days), and this is rarely followed by a return of the SSRI discontinuation syndrome. This strategy is based on clinical observations, which are found in only a few case reports (Benazzi, 1998a, b, 1999a, b), and in clinicians' clinical practice. In these case reports, using 20–40 mg/d fluoxetine for 1 wk led to the rapid disappearance (usually in 24 h) of the syndrome, which was rarely followed by a relapse; if the syndrome appeared during the SSRI tapering then the SSRI was switched to fluoxetine; if the syndrome appeared soon after the discontinuation of the SSRI, fluoxetine was started at that time. Guidelines (e.g. Schatzberg et al., 2006) suggest switching to fluoxetine only as an alternative to slow tapering, not as the first strategy. On the basis of the Fava et al. (2007) study which reported a high rate of failure of the slow-tapering method, and on the basis of case reports and clinical practice, it seems instead that fluoxetine should have priority in the treatment (and prevention) of SSRI discontinuation syndrome. No systematic studies have investigated this approach. Controlled studies comparing slow tapering of the SSRI vs. short-term shift to fluoxetine should be carried out, given the extensive use of SSRIs and the high frequency of the discontinuation syndrome. The minimum duration of fluoxetine treatment should also be tested (days or weeks?). In case reports, fluoxetine has been used successfully for 1 wk, but it needs to be shown if a shorter trial may be effective as well. One hypothesis about fluoxetine's usefulness (to be confirmed by controlled studies) is that it may be related to its long duration of action (especially of its metabolite) (Delgado, 2006). Currently, on the basis of clinical observations, clinicians may find that while SSRI slow tapering often fails to prevent SSRI discontinuation syndrome, fluoxetine may treat it quickly and this is not usually followed by a relapse. One final, important point about the SSRI discontinuation syndrome is that it is not uncommon to misdiagnose its symptoms as a relapse of the disorder treated by the SSRI (e.g. depression, panic, obsessive–compulsive disorder) (Benazzi, 1998c; Schatzberg et al., 2006), leading to a restart of the same SSRI treatment for a longer period of time, thus only delaying the reappearance of the same syndrome.

 

[Ali]

Hi Alto

 

I've just come across this post. Do you know many people who have tried switching to fluoxetine after previous unsuccessful attempts to taper ? I've had many unsuccessful attempts, even with tapering, so was planning to microtaper. However, I'm now wondering whether this is another option. Just loathe to switch to another antidepressant and all the disruption that can cause.

[Altostrata]

Many, if not most, psychiatrists have adopted a switch to fluoxetine as standard practice for getting people off antidepressants. See The Prozac switch or "bridging" with Prozac