An assessment of selective serotonin reuptake inhibitor discontinuation symptoms with citalopram

The selective serotonin reuptake inhibitors (SSRIs) have recently been asso ciated with a variety of somatic and psychiatric symptoms upon abrupt drug discontinuation. These symptoms have been variously termed SSRI withdrawal, or SSRI discontinuation syndrome. Although all of the available SSRIs have been reported to cause discontinuation symptoms, some appear to have a gre ater propensity to cause these adverse events than others. Data from a prev iously completed placebo-controlled, double-blind study designed to assess citalopram in depression relapse prevention were analysed to assess patient s for the emergence of discontinuation effects following randomization to p lacebo after 8 weeks of active drug treatment. Side-effects that occurred d uring the first 2 weeks following randomization to active drug (n = 150) or placebo (n = 72) were measured using the UKU unwanted side-effect list. Th e proportion of patients that experienced one or more events over the 2-wee k period following randomization was similar in the two groups, and there w as no association between citalopram dose prior to randomization and the re porting of symptoms. Most of the events that did occur were mild in intensi ty and none resulted in discontinuation from the study. Events occurring at a higher frequency in the placebo group were most associated with the cent ral nervous system (CNS). These events may reflect a re-emergence of depres sive symptoms, since only 14.8% of patients randomized to placebo who did n ot relapse experienced CNS events, a low symptom incidence that was non-sig nificant (P = 0.562) compared to patients continuing treatment (10.9%). The refore, this assessment suggests that any symptoms associated with rapid di scontinuation of citalopram are mild and transient, and emphasizes the sign ificant role re emerging depression and / or anxiety may play in the assess ment and identification of SSRI discontinuation symptoms. (C) 2000 Lippinco tt Williams and Wilkins.