Abrupt and brief discontinuation of antidepressant treatment: effects on cognitive function and psychomotor performance

The abrupt discontinuation of antidepressants can result in a syndrome of a dverse events, including somatic, mood and psychomotor reactions. This stud y examined the effects of discontinuing and resuming antidepressant treatme nt with four selective serotonin reuptake inhibitors (SSRIs) on cognitive a nd psychomotor function. Eighty-seven patients receiving maintenance therap y with fluoxetine, sertraline, paroxetine or citalopram had their treatment interrupted for 4-7 days using double-blind placebo. Assessments of aspect s of cognitive and psychomotor performance, mood and symptoms were carried out at each visit. Following interruption of treatment, significant differe nces between the groups emerged. Paroxetine treated patients experienced si gnificantly more cognitive failures (P = 0.007), poorer quality of sleep (P = 0.016), and an increase in depressive symptoms, as rated both subjective ly, using the Zung scale (P = 0.006) and by the clinician, using the Montgo mery-Asberg Depression Rating Scale (P = 0.0003) and Clinical Global Impres sion (P = 0.0003), compared to some or all of the other drugs. All changes were reversed on reinstatement of treatment. Abrupt discontinuation of trea tment with paroxetine leads to deterioration in various aspects of health a nd functioning, which may be related to the antidepressant discontinuation syndrome. These effects are not evident in patients receiving fluoxetine, s ertraline and citalopram, suggesting they are not an SSRI class phenomenon. (C) 2000 Lippincott Williams & Wilkins.