How to safely discontinue antidepressants יואל קסלר .com
The development of antidepressant medications, particularly SSRI /SNRI have revolutionized the treatment of depression and anxiety. However, duration of treatment in patients with improvement in symptoms remains an ongoing area of investigation. At Discontinuing Antidepressants @ יואל קסלר .com we explore some of the data about how physicians can best decrease or discontinue medication with the least amount of side effects for patients.
Antidepressant Discontinuation Syndrome
Discontinuation of antidepressants, particularly SSRI / SNRI with shorter half-lives can lead to a constellation of symptoms that are referred to as either withdrawal or Antidepressant Discontinuation Syndrome. The following are some of the more common symptoms:
Symptoms of Antidepressant Discontinuation Syndrome @ יואל קסלר .com
| ystem | SSRIs | SNRIs | TCAs | MAOIs | Atypicals |
|---|---|---|---|---|---|
| General | Flu-like symptoms | Flu-like symptoms | Flu-like symptoms | Flu-like symptoms | Flu-like symptoms |
| Fatigue | Fatigue | Fatigue | Fatigue | ||
| Diaphoresis | Fatigue | ||||
| Cardiovascular | Tachycardia | Tachycardia | Tachycardia | Tachycardia | (Limited data) |
| Flushing | Hypertension, hypotension Syncope | Arrhythmia | Arrhythmia | ||
| Gastrointestinal | Nausea, vomiting | Nausea, vomiting | Nausea, vomiting | Nausea, vomiting | Nausea, vomiting |
| Diarrhea | Diarrhea | Diarrhea | Diarrhea | Diarrhea | |
| Anorexia | Anorexia | Anorexia | Anorexia | Anorexia (mirtazapine) | |
| Neurologic | Headache | Headache | Headache | Headache | Headache |
| Gait instability | Gait instability | Paresthesias | Paresthesias | Dizziness | |
| Dizziness | Dizziness | Tremor, ataxia | Tremor, ataxia | Paresthesias | |
| Paresthesias, brain zaps | Parasthesias, brain zaps | Seizure | Seizure, myoclonus, muscle jerking | Tremor | |
| Tremor, ataxia | Tremor, ataxia | Parkinsonism | Dystonia (bupropion) | ||
| Myclonus, muscle jerking | Stroke-like symptoms | Parkinsonism | |||
| Parkinsonism | Seizure, myoclonus, muscle jerking | Dystonia Catatonia | |||
| Psychiatric | Anxiety, panic | Anxiety, panic | Anxiety, panic | Depression, lability | Anxiety, panic |
| Depression, mania | Depression, mania | Depression, mania | Suicidal ideation | Depression, mania | |
| Suicidal ideation | Suicidal ideation | Suicidal ideation | Anger, irritability | Suicidal ideation | |
| Anger, irritability | Anger, irritability | Anger, irritability | Aggression, agitation | Anger, irritability | |
| Mood swings | Mood swings | Mood swings | Mood swings | ||
| Depersonalization, derealization | Depersonalization, derealization | Derealization | Hallucinations | Depersonalization, derealization | |
| Hallucinations | Delusions | ||||
| Hallucinations | Hallucinations | Delusions | |||
| Cognitive | Confusion, delirium | Confusion, delirium | Confusion, delirium | Confusion, delirium | (Limited data) |
| Inattention | Inattention | Inattention | Inattention | ||
| Sleep | Sleep disturbances | Sleep disturbances | Sleep disturbances | Sleep disturbances | Sleep disturbances |
| Nightmares, vivid dreams | Nightmares, vivid dreams | Nightmares, vivid dreams | Nightmares, vivid dreams | Nightmares, vivid dreams | |
| Visual | Vision changes | Vision changes | Vision changes | Vision changes | (Limited data) |
| Sexual | Dysfunction | Dysfunction | Dysfunction | Dysfunction | Dysfunction |
- MAOIs = monoamine oxidase inhibitors; SNRIs = serotonin-norepinephrine reuptake inhibitors; SSRIs = selective serotonin reuptake inhibitors; TCAs = tricyclic and tetracyclic antidepressants
In the Cleveland Clinic Journal of Medicine this month a great review article describing the symptoms/ syndrome and ways to minimize it was published. The link to the full article is here.
הפיתוח של תרופות נוגדות דיכאון, (במיוחד קבוצות ס.ס.ר.י/ס.נ.ר.י) חוללו מהפכה בטיפול בדיכאון וחרדה. עם זאת, משך הטיפול בחולים עם שיפור בתסמינים נותר תחום חקירה מתמשך. ב- @ יואל קסלר .קום אנו בוחנים חלק מהנתונים לגבי האופן שבו רופאים יכולים להפחית או להפסיק את הטיפול התרופתי עם הכמות הנמוכה ביותר של תופעות לוואי עבור המטופלים.
