I. Hindmarch et al., Abrupt and brief discontinuation of antidepressant treatment: effects on cognitive function and psychomotor performance, INT CLIN PS, 15(6), 2000, pp. 305-318
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.