Antidepressants discontinuation

Warner, Christopher H., William Bobo, Carolynn Warner, Sara Reid and James Rachal, Antidepressant Discontinuation Syndrome , American Family Physician 74, no. 3 (2006) 449-56... 

Discontinuation of antidepressant medication should be concordant with the guidelines for treatment duration (see Acute Major Depression subsection in the preceding section). It is advisable to taper the dose while monitoring for signs and symptoms of relapse. Abrupt discontinuation is also more likely to lead to antidepressant discontinuation symptoms, often referred to as withdrawal symptoms. The occurrence of these symptoms after medication discontinuation does not imply that antidepressants are addictive. 

Perhaps even more important in children is the issue of bipolar disorder. Mania and mixed mania have not only been greatly underdiagnosed in children in the past but also have been frequently misdiagnosed as attention deficit disorder and hyperactivity. Furthermore, bipolar disorder misdiagnosed as attention deficit disorder and treated with stimulants can produce the same chaos and rapid cycling state as antidepressants can in bipolar disorder. Thus, it is important to consider the diagnosis of bipolar disorder in children, especially those unresponsive or apparently worsened by stimulants and those who have a family member with bipolar disorder. These children may need their stimulants and antidepressants discontinued and treatment with mood stabilizers such as valproic acid or lithium initiated. 

Discontinuing selective serotonin reuptake inhibitors (SSRIs) may induce a syndrome wherein the main neuropsychiatric symptoms are dizziness, shock-like sensations, anxiety, irritability, agitation, and insomnia. These symptoms usually develop 1 to 7 days after abrupt or gradual discontinuation. Antidepressant discontinuation may also induce mania, mainly reported with tricyclics and monoamine oxidase inhibitors but also observed with SSRIs. 

Goldstein, T., Frye, M., Denicoff, K., Smith-Jackson, E., Leverich, G., Bryan, A., et al. (1999). Antidepressant discontinuation-related mania Critical perspective observation and theoretical implications in bipolar disorder. Journal of Clinical Psychiatry, 60, 563-567. 

Lejoyeux M, Ades J. Antidepressant discontinuation a review of the literature. J Clin Psychiatry 1997 58(Suppl. 7) 11-5. 

Some patients may experience apparent lack of consistent efficacy due to activation of latent or underlying bipolar disorder, and require antidepressant discontinuation and a switch to a mood stabilizer... 

Haddad P. Antidepressant discontinuation reactions. In Thompson C, chairperson. Discontinuation of antidepressant therapy Emerging complications and their relevance [Academic Highlights]. J CUn Psychiatry 1998 59 541-548. 

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