Abstract
Background: Recent reports describe discontinuation-emergent adverse events upon cessation
of selective serotonin reuptake inhibitors including dizziness, insomnia, nervousness,
nausea, and agitation. We hypothesized that interruption of fluoxetine treatment would
be associated with fewer discontinuation-emergent adverse events than interruption
of sertraline or paroxetine treatment, based on fluoxetine’s longer half-life.
Methods: In this 4-week study, 242 patients with remitted depression receiving maintenance
therapy with open-label fluoxetine, sertraline, or paroxetine for 4–24 months had
their maintenance therapy interrupted with double-blind placebo substitution for 5–8
days. The Symptom Questionnaire (SQ), the Discontinuation-Emergent Signs and Symptoms
checklist, the 28-item Hamilton Depression Rating Scale, and the Montgomery–Asberg
Depression Rating Scale were used to assess somatic distress and stability of antidepressant
response.
Results: Two hundred twenty patients (91%) completed the study. Following interruption
of therapy, fluoxetine-treated patients experienced fewer discontinuation-emergent
events than either sertraline-treated or paroxetine-treated patients (p < .001). The mean SQ somatic symptom scale score in fluoxetine-treated patients was
significantly lower than that in sertraline-treated and paroxetine-treated patients
(p < .001). Fluoxetine-treated patients also experienced less reemergence of depressive
symptoms than sertraline-treated or paroxetine-treated patients (p < .001).
Conclusions: Abrupt interruption of antidepressant therapy for 5–8 days was associated
with the emergence of new somatic and psychological symptoms in patients treated with
paroxetine and to a lesser degree sertraline, with few symptoms seen with fluoxetine.
Keywords
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Article Info
Publication History
Accepted:
March 24,
1998
Received in revised form:
March 18,
1998
Received:
November 18,
1997
Identification
Copyright
© 1998 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
