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antidepressant deprescribing
Etiology:
- discontinuation symptoms more common & more intense with antidepressants with shorter half-lives
- venlafaxine, desvenlafaxine, imipramine, escitalopram, fluvoxamine, paroxetine, & duloxetine with greatest risk of discontinuation symptoms
Clinical manifestations:
- at least one discontinuation symptom in 31% vs 17% for placebo
- severe discontinuation symptoms in 3% vs < 1% for placebo
- nonspecific physical withdrawal symptoms (dizziness, headache, nausea, fatigue, vivid dreams) vs relapse of anxiety or depression*
* distinguishing may be difficult, more intense symptoms suggest relapse
Management:
- tapering antidepressant or switching to antidepressant with a long half-life (fluoxetine) generally sufficient mitigate discontinuation symptoms
General
medication deprescribing
References
- Henssler J et al.
Incidence of antidepressant discontinuation symptoms: A systematic review and
meta-analysis.
Lancet Psychiatry 2024 Jul; 11:526.
PMID: 38851198
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00133-0/fulltext