antidepressant deprescribing

Etiology

• discontinuation symptoms more common & more intense with antidepressants with shorter half-lives
• venlafaxine, desvenlafaxine, imipramine, escitalopram, fluvoxamine, paroxetine, & duloxetine with greatest risk of discontinuation symptoms

Clinical manifestations

• at least one discontinuation symptom in 31% vs 17% for placebo
• severe discontinuation symptoms in 3% vs < 1% for placebo
• nonspecific physical withdrawal symptoms (dizziness, headache, nausea, fatigue, vivid dreams) vs relapse of anxiety or depression*

* distinguishing may be difficult, more intense symptoms suggest relapse

Management

• tapering antidepressant or switching to antidepressant with a long half-life (fluoxetine) generally sufficient mitigate discontinuation symptoms

More general terms

• medication deprescribing