Antidepressant discontinuation (withdrawal) symptoms were first
reported in association with imipramine (
Mann & MacPherson, 1959;
Andersen & Kristiansen, 1959), the first tricyclic antidepressant
(TCA), shortly after it entered clinical use. These symptoms
occur with all classes of antidepressant, including the TCAs,
monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake
inhibitors (SSRIs), serotonin and noradrenaline reuptake inhibitors
(SNRIs) and miscellaneous others such as mirtazapine, a noradrenergic
and specific serotonergic antidepressant (NaSSA). A PubMed review
conducted when preparing this article identified reports of
discontinuation symptoms with 25 antidepressants (Box 1
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). In
recent years the phenomenon has attracted increasing interest,
in both the scientific literature and in the lay media (BBC
Panorama, 2002,
2003). This article provides an overview of
the clinical features of antidepressant discontinuation symptoms,
with the emphasis on their recognition, prevention and management.
Discontinuation symptoms can occur whenever antidepressants
are used, i.e. they are not dependent on the presence of any
underlying psychiatric disorder. The pharmacokinetics and dynamics
of antidepressants, in particular their half-life, are important
determinants of discontinuation symptoms, as are individual
patient characteristics, but their discussion is beyond the
scope of this article (
Schatzberg et al, 1997;
Haddad, 1998;
Bogetto et al, 2002).
http://apt.rcpsych.org/cgi/content/full/13/6/447
Can Psychiatr Assoc J. 1959 Jan;4(1):38-47.
Clinical experience with imipramine (G22355) in the treatment of depression.
MANN AM, MACPHERSON AS.
PMID: 13629473 [PubMed - indexed for MEDLINE]
MeSH Terms, SubstancesMeSH Terms:Depression/therapy*Tranquilizing Agents/therapeutic use*Substances:Tranquilizing Agents
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