Fava, 2015 Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

[Altostrata]

Psychother Psychosom 2015;84:72-81

(DOI:10.1159/000370338)

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

Fava G.A.^{a, b} · Gatti A.^a · Belaise C.^a · Guidi J.^a · Offidani E.^c

 

Abstract at http://www.karger.com/Article/FullText/370338 Fulltext PDF (116 Kb)

 

Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'.

[GiaK]

http://www.thementalelf.net/mental-health-conditions/depression/antidepressant-withdrawal-syndromes-time-to-grasp-the-nettle/

 

commentary on the above article here

[Barbarannamated]

Follow

[Altostrata]

My comment on http://www.thementalelf.net/mental-health-conditions/depression/antidepressant-withdrawal-syndromes-time-to-grasp-the-nettle/#comment-630830

 

Andrew, thank you for taking this issue seriously.

Tapering is the only way we know to lessen the risk of severe withdrawal syndrome lasting weeks, months, or years.

If you look closely at the studies showing little advantage to tapering, you will see they tapered over very short intervals: for example, comparing abrupt discontinuation to a week’s taper.

Dr. Fava’s own study on this used a “most gradual possible” taper based on available drug dosages. However, the dosages available from the drug companies are not of sufficient range for a properly gradual taper.

On my peer support Web site, SurvivingAntidepressants.org, we suggest tapering much more gradually, at a rate of 10% per decrement based on the last dosage — the absolute amount of decrease gets continually smaller. (People use pill cutters, liquids, powders, and digital scales to create interim dosages.)

Most people start out at making decreases every month to test their tolerance for dosage reductions — withdrawal symptom should be none to minimal and lasting only a few days.

If all goes well, they might speed up the taper to decrements every 2 weeks. With 10% reductions, the fastest taper would be about 6 months.

The reason we suggest such long intervals between dosage reductions is because, contrary to popular assumptions, it can take withdrawal symptoms some time to manifest. If one is tapering too fast, the additional dosage reductions compound the severity of the withdrawal symptoms.

We advise people that the emergence of withdrawal symptoms means they have been reducing too fast, and to a) stop any dosage changes, OR updose slightly and stabilize for as long as it takes. Subsequently, they taper more conservatively — sometimes 5% or less per month.

Unfortunately, once severe withdrawal symptoms set in, it can be very difficult for the nervous system to regain equilibrium again. That is why we advise the very conservative starting point of 10% reductions monthly.

Many people come to my site after one or more failed tapers. Having experienced the torment of withdrawal, they are conscientious about taking a slower route off — sometimes tapering for years, one drug at a time.

We do have people who have successfully come off massive drug cocktails in this fashion and are doing much better.

Unfortunately, it seems there are a small number of people at the extreme end of the normal curve for withdrawal, who find they cannot completely go off an antidepressant or other psychiatric drug at all because of withdrawal syndrome — NOT relapse.

This only indicates how very powerful these drugs are. They are overprescribed and overdosed without regard to the resulting adverse effects. This truly is a failure of medicine.

 

[Rhiannon]

Nice, Alto! Thanks for your unflagging dedication and commitment on behalf of victims of psych med drugging everywhere.

[GiaK]

I left this comment which is currently in moderation:

 

Glad to see your comment Alto Strata. I thought I might add a link to some comments about another study also done by those affiliated with Fava and others. I am including this because it seems that people might come away from the above article not understanding that long-term disabling syndromes occur from withdrawal much more frequently than is commonly understood...and not  just from SSRIs but really all the psychotropics that impact the nervous system can be part of what amounts to broad dysregulation in the autonomic nervous system.

 

"Alarming report on persistent side effects of antidepressant drugs published online"   http://beyondmeds.com/2013/03/22/alarming-report/

 

and, yes, thank you Andrew for highlighting this issue. 

 

 

[compsports]

Nice, Alto! Thanks for your unflagging dedication and commitment on behalf of victims of psych med drugging everywhere.

Totally agree with this.

 

CS

[compsports]

 

I left this comment which is currently in moderation:

 

Glad to see your comment Alto Strata. I thought I might add a link to some comments about another study also done by those affiliated with Fava and others. I am including this because it seems that people might come away from the above article not understanding that long-term disabling syndromes occur from withdrawal much more frequently than is commonly understood...and not  just from SSRIs but really all the psychotropics that impact the nervous system can be part of what amounts to broad dysregulation in the autonomic nervous system.

 

"Alarming report on persistent side effects of antidepressant drugs published online"   http://beyondmeds.com/2013/03/22/alarming-report/

 

and, yes, thank you Andrew for highlighting this issue. 

 

 

Great comment GIa K.

[oskcajga]

Thought that this conversation on reddit associated with this very article was relevant to this discussion:

 

https://www.reddit.com/r/worldnews/comments/2y2ef8/new_study_says_ssri_antidepressants_need_to_be/

[Altostrata]

I wish I knew who that Harvard-educated expert on withdrawal is.

[oskcajga]

I think it's Peter Breggin who that poster is referring to - based on reading some of that posters other reddit messages - all public information via reddit.