Posted by SLS on August 22, 2005, at 21:22:35 [reposted on August 22, 2005, at 21:46:35 | original URL]
In reply to Re: Prozac Withdrawal - need advice - going off meds » Velodog2, posted by SLS on August 22, 2005, at 20:30:55
> Hi.
>
> The more gradually you withdraw an antidepressant, the less likely you are to relapse.I found an article on Medline that calls into question this traditional assertion.
I still can't help but to have trepidations regarding the abrupt discontinuation of an antidepressant and a subsequent increased risk of relapse. This study was a retrospective review of previous work rather than a prospective investigation involving the direct control of subjects. I am probably wrong in doubting their results, though. Despite this, I can't see any advantage in stopping Prozac abruptly and experiencing a discontinuation withdrawal syndrome unless it is otherwise necessary.
The article helps lay the groundwork for answering any questions you might have regarding your need to continue with treatment. It would be important to take into account your history of depression as it has unfolded during your lifetime. A high degree of recurrence or chronicity indicates the likelihood that there will be a need for indefinite treatment.
- Scott
------------------------------------------------1: Harv Rev Psychiatry. 1998 Mar-Apr;5(6):293-306. Related Articles, Links
Discontinuing antidepressant treatment in major depression.Viguera AC, Baldessarini RJ, Friedberg J.
Consolidated Department of Psychiatry, Harvard Medical School, Boston, Mass., USA.
Maintenance treatments in bipolar disorders and schizophrenia are securely established, and their discontinuation is associated with high but modifiable risk of early relapse. The benefits of long-term antidepressant treatment in major depression and the risks of discontinuing medication at various times after clinical recovery from acute depression are not as well defined. Computerized searching found 27 studies with data on depression risk over time including a total of 3037 depressive patients treated for 5.78 (0-48) months and then followed for 16.6 (5-66) months with antidepressants continued or discontinued. Compared with patients whose antidepressants were discontinued, those with continued treatment showed much lower relapse rates (1.85 vs. 6.24%/month), longer time to 50% relapse (48.0 vs. 14.2 months), and lower 12-month relapse risk (19.5 vs. 44.8%) (all p < 0.001). However, longer prior treatment did not yield lower postdiscontinuation relapse risk, and differences in relapses off versus on antidepressants fell markedly with longer follow-up. Contrary to prediction, gradual discontinuation (dose-tapering or use of long-acting agents) did not yield lower relapse rates. Relapse risk was not associated with diagnostic criteria. More previous illness (particularly three or more prior episodes or a chronic course) was strongly associated with higher relapse risk after discontinuation of antidepressants but had no effect on response to continued treatment; patients with infrequent prior illness showed only minor relapse differences between drug and placebo treatment.
Publication Types:
Review
Review, TutorialPMID: 9559348 [PubMed - indexed for MEDLINE]
poster:SLS
thread:545377
URL: http://www.dr-bob.org/babble/wdrawl/20050822/msgs/545384.html