EFFICACY OF ALPRAZOLAM IN REDUCING FLUOXETINE-INDUCED JITTERINESS IN PATIENTS WITH MAJOR DEPRESSION

Background: Serotonin selective reuptake inhibitors (SSRIs) have becom e the most widely prescribed antidepressants in the United States. The selective influence of SSRIs on serotonin neurotransmission has resul ted in a specific constellation of adverse effects termed ''jitterines s'' syndrome, which occurs in at least 30% of patients taking SSRIs. B ecause there have been no systematic studies examining treatment of SS RI-induced jitteriness, we conducted a prospective study of the effica cy of adjunctive alprazolam therapy for fluoxetine-induced jitteriness symptoms. Method: Fifty-four subjects with major depression were trea ted with fluoxetine 20 mg/day. Subjects experiencing an increase in ji tteriness symptoms within 2 weeks of starting fluoxetine were given ad junctive alprazolam 0.5 mg to 4.0 mg daily for 2 weeks followed by a 2 -week taper period. Results: Eighteen (33.3%) of 54 patients experienc ed jitteriness symptoms during fluoxetine treatment. We observed a sta tistically significant reduction in the severity and number of jitteri ness symptoms with adjunctive alprazolam. Moreover, in most cases jitt eriness symptoms did not reappear during the alprazolam taper period o r after alprazolam was discontinued. Conclusion: These observations su ggest that a brief course of adjunctive alprazolam treatment may be ef ficacious in reducing the duration and severity of jitteriness symptom s resulting from antidepressants that are selective for serotonin.