A comparison of symptoms following treatment interruption: Evidence from a randomized, double-blind trial with fluoxetine, sertraline, and paroxetine

Compliance with antidepressant therapy and antidepressant discontinuation symptoms

OBJECTIVE

Compliance with antidepressant medication is important in order to achieve all the goals of antidepressant therapy. These goals include symptom resolution, restoration of normal functioning and prevention of relapse or recurrent episodes.

METHOD

We discuss compliance and review adverse symptoms that may occur when antidepressant treatment is abruptly discontinued or interrupted.

RESULTS

The physician's role in managing compliance includes preventing or minimizing the risk for discontinuation symptoms, counselling patients regarding the risk for symptoms if doses are missed and choosing pharmacotherapy that is forgiving of non-compliance. Physicians also need to recognize the symptoms of discontinuation syndrome in order to differentiate patients who are non-compliant from patients who require a dosage adjustment or adjunctive therapy. Finally, physicians need to understand how to treat discontinuation symptoms when they do occur.

CONCLUSION

Since published data indicate that between 30% and 60% of patients do not take their medications as prescribed, non-adherence to antidepressant medication is likely to be a significant clinical issue in the management of many patients.

Interruption of selective serotonin reuptake inhibitor treatment. Double-blind, placebo-controlled trial

BACKGROUND

Abrupt interruption of therapy with selective serotonin reuptake inhibitors (SSRIs) has been associated with somatic and psychological symptoms.

AIMS

Systematically to assess symptoms and effects on daily functioning related to interruption of SSRI therapy.

METHOD

Patients treated with fluoxetine, setraline or paroxetine underwent identical five-day periods of treatment interruption and continued active treatment under double-blind, order-randomised conditions, with regular assessment of new symptoms.

RESULTS

Placebo substitution for paroxetine was associated with increases in the number and severity of adverse events following the second missed dose, and increases in functional impairment at five days. Placebo substitution for sertraline resulted in less pronounced changes, while interruption of fluoxetine was not associated with any significant increase in symptomatology.

CONCLUSIONS

Abrupt interruption of SSRI treatment can result in a syndrome characterised by specific physical and psychological symptoms. Incidence, timing and severity of symptoms vary among SSRIs in a fashion that appears to be related to plasma elimination characteristics.