Ask the Psychiatric Pharmacist Columns
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Question:
I have heard that there may be negative effects associated with stopping antidepressants. Is this true?
Answer:
Yes, this is true. The effects you may experience if you abruptly stop an antidepressant medication are known as discontinuation or withdrawal symptoms. Up to eighty percent of patients who abruptly stop taking antidepressants develop discontinuation symptoms. These symptoms generally appear within days of stopping an antidepressant and can last up to two weeks. If the antidepressant is restarted, the discontinuation symptoms are quickly eliminated.
Common antidepressant discontinuation symptoms can be divided into four groups.
- Gastrointestinal symptoms: nausea, vomiting, diarrhea and abdominal cramps
- Somatic symptoms: headaches, lethargy and sweating
- Sleep-related symptoms: insomnia, excessive dreaming and nightmares
- Affective symptoms: anxiety, agitation and low mood
In order to avoid withdrawal symptoms associated with stopping these drugs, the dosages are often reduced gradually by your health care provider. Therefore, you should never abruptly stop taking your antidepressant medication. You should always consult your doctor or pharmacist before discontinuing any medication. Finally, be sure to maintain a sufficient amount of antidepressant medications at all times by refilling your prescriptions regularly.
Thompson C. Discontinuation of antidepressant therapy: Emerging complications and their relevance. J Clin Psychiatry 1998 Oct;59:541-548.
Written by:
Meredith Shawn Riser, Pharm.D.
Eugene H. Maklela, Pharm.D., BCPP
Question:
I was recently prescribed an antidepressant. The information sheet from the pharmacy said the medication may increase suicidal thoughts. Is this true?
Answer:
It is true that antidepressants may increase the risk of suicidal thoughts and behavior in children and young adults up to age 24. However, studies did not show an increased risk beyond age 24. Also, studies show that older adults (ages 65 and older) taking antidepressants actually have a decreased risk of suicidal thoughts and behavior. The information sheet that came with the medication may be intimidating but if you know what signs to look for, depression can be safely treated.
Depression is a disease that affects over 14 million Americans a year. In 2006, about 33,000 people in the United States committed suicide. Typically 90% of those people have some type of mood disorder (i.e. - major depression, bipolar disorder). However, long term treatment of depression with antidepressants can decrease suicidal thoughts and behavior.
All patients, but especially children, should be monitored for any signs of worsening depression or suicidal thoughts or actions, especially during the first several weeks of treatment. Things to look for include irritability, sleeplessness or withdrawal from normal social situations or activities. Contact your healthcare provider if you experience any new or unusual changes in behavior, feelings or mood. Also, it is important that you do not stop taking the antidepressant without first consulting a healthcare provider, so make sure you keep any follow-up appointments.
References:
"Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers." National Institute of Mental Health. Web. 11 Nov. 2010. <http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml>.
“Antidepressant Use in Children, Adolescents, and Adults.” US Food and Drug Administration. Web. 11 Nov. 2010. <http://www.fda.gov/Drugs/DrugSafety/>
Kratochvil C, Vitiello B, et al. "Selective Serotonin Reuptake Inhibitors in Pediatric Depression: Is the Balance Between Benefits and Risks Favorable?" Journal of Child and Adolescent Psychopharmacology 16.1/2 (2006): 11-24. Print.
Written by:
Karen Moeller, Pharm.D., BCPP
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