Antidepressant discontinuation syndrome occurs in approximately 20 percent of patients after abrupt discontinuation of an antidepressant medication that was taken for at least six weeks. Typical symptoms of antidepressant discontinuation syndrome include flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, and hyperarousal. These symptoms usually are mild, last one to two weeks, and are rapidly extinguished with reinstitution of antidepressant medication. Antidepressant discontinuation syndrome is more likely with a longer duration of treatment and a shorter half-life of the treatment drug. A high index of suspicion should be maintained for the emergence of discontinuation symptoms, which should prompt close questioning regarding accidental or purposeful self-discontinuation of medication. Before antidepressants are prescribed, patient education should include warnings about the potential problems associated with abrupt discontinuation. Education about this common and likely underrecognized clinical phenomenon will help prevent future episodes and minimize the risk of misdiagnosis.

Antidepressant Discontinuation Syndrome

According to the World Health Organization, depression is one of the most debilitating disorders affecting humankind. The social and economic costs of chronic ill health resulting from untreated or inadequately treated depression are considerable and frequently underestimated.

The CINP established the Task Force on Antidepressant Medications in 2004 to examine all aspects of therapy with antidepressant drugs. This was considered necessary as, despite the availability of effective antidepressants for the past 50 years, a substantial minority of depressed patients either remains untreated or under treated. As the only international organization devoted to the promotion of research, education and the applications of neuropsychopharmacology to the clinic, the main task of the CINP is to extend the knowledge of the drugs that are available with the aim of improving the management of mental disorders. The purpose of this Task Force document was not to produce an academic monograph nor a set of guidelines, but to provide mental health and other professionals with comprehensive and objective information about the different aspects of the use of antidepressants important in clinical practice.

The Task Force consisted of 15 experts in psychiatry, psychopharmacology, public health, economics and family care. The majority of its members are senior members of the CINP. The Task Force was also advised to rely in the course of its work on advisors in different countries selected because of their outstanding expertise in the matters covered by the review. The report presented here was approved by the Executive Committee and the Council of the CINP at its meeting in Chicago in July 2006.

As a service to those engaged in mental health care and to ensure maximum impact, the Task Force review is being published as a supplement to the CINP's journal, the International Journal of Neuropsychopharmacology. In addition, the information will later …

Antidepressant medications and other treatments of depressive disorders: a CINP Task Force report based on a review of evidence

Cytokines in Human Health

Flu-Like Syndrome and Cytokines

The aim of the present study was to compare the possible dependence potential of antidepressants (ADs) to benzodiazepines (BZDs). The Schedules for Clinical Assessment in Neuropsychiatry (SCAN), the Benzodiazepine Dependence Self-Report Questionnaire (Bendep-SRQ) and the Symptom Checklist-90 (SCL-90) were administered to 70 psychiatric outpatient BZD users and 54 psychiatric outpatient AD users. Significantly more Diagnostic and Statistical Manual of Mental Disorders, Third Edition Revised (DSM-III-R) as well as International Classification of Diseases, Tenth Edition (ICD-10) past year (PY) and lifetime (LT) dependence diagnoses were made in the BZD group than in the AD group. Bendep-SRQ scale scores for Problematic Use, Preoccupation and Lack of Compliance were significantly higher in the BZD group than in the AD group. The BZD group also had a higher rating on the Withdrawal scale, but this difference was not statistically significant. According to DSM-III-R and ICD-10 criteria ADs do have some dependence liability in psychiatric outpatients, but clearly to a lesser extent than BZDs. Further research is needed to differentiate the dependence potential among the various classes of ADs.

Dependence potential of antidepressants compared to benzodiazepines

Antidepressant withdrawal symptoms, following abrupt or gradual discontinuation of antidepressants, include general somatic distress (flu-like syndromes, gastro-intestinal disturbances, myalgias, headache, chills, weakness and rhinorrhea), anxiety, agitation, sleep disturbances, movement disorders, cardiac arrhythmias, delirium and manic reactions. Two cases of delirium, an hypomanic reaction and two general distress and movement disorders are reported. Cases 1 and 2 required admission to a general hospital. The etiology of the delirium was difficult to assess as long as the clinicians did not know that patients were taking antidepressants. Case 3 corresponds to the paradoxical activation following antidepressant interruption. Cases 4 and 5 constitutes light withdrawal syndromes. Most of cases are probably unrecognized. These cases reflect the importance in daily practice of the phenomena. It can be concluded from our study that: antidepressants must not be abruptly discontinued when a somatic disease appears. When a patient treated with a psychotropic drug develops delirium, the withdrawal of antidepressant must be suspected and the prescribing physician contacted to know what kind of psychoactive medication was prescribed.

C Rodière-Rein

Papers

Withdrawal syndrome from antidepressive drugs. Report of 5 cases