خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده: 3

Approach for discontinuing antidepressants that have been continuously prescribed for at least 4 consecutive weeks

Approach for discontinuing antidepressants that have been continuously prescribed for at least 4 consecutive weeks
Reasonable tapering schedules prior to discontinuation
Antidepressant Taper for at least 2 to 4 weeks Taper for at least 4 weeks Taper over 1 to 2 weeks Abruptly stop
SSRI
Citalopram X      
Escitalopram* X      
Fluoxetine     X X
Fluvoxamine* X      
Paroxetine* X      
Sertraline X      
SNRI
Desvenlafaxine* X      
Duloxetine X   X  
Levomilnacipran X      
Milnacipran X      
Venlafaxine (extended- and immediate-release)*   X    
Atypical antidepressants
Agomelatine (not available in the United States)     X  
Bupropion     X  
Mirtazapine X      
Serotonin modulators
Nefazodone     X X
Trazodone (antidepressant dose) X      
Trazodone (hypnotic dose)Δ     X  
Vilazodone     X  
Vortioxetine     X X
 
Tricyclics (for imipramine, refer to the * footnote definition) X        
 
MAOIs   X    
When discontinuing an antidepressant, we gradually taper the dose to minimize discontinuation symptoms. Reasons for a slower taper (eg, ≥4 weeks) include:
  • Discontinuation symptoms during the current taper.
  • Prior history of antidepressant discontinuation symptoms.
  • Relatively high antidepressant dose.

For tapering schedules and clinical considerations, refer to UpToDate content on antidepressant discontinuation syndrome and discontinuing antidepressants.

MAOI: monoamine oxidase inhibitor; SNRI: serotonin-norepinephrine reuptake inhibitor; SSRI: selective serotonin reuptake inhibitor.

* Antidepressants associated with a higher incidence of discontinuation symptoms (≥30%) may need more gradual tapering. Patients having difficulty tapering off can switch to fluoxetine 10 to 20 mg/day, which can be tapered over 1 to 2 weeks.

¶ As an example, daily dose 200 to 400 mg.

Δ As an example, 50 to 150 mg at bedtime.

References:
  1. Jha MK, Rush AJ, Trivedi MH. When discontinuing SSRI antidepressants is a challenge: Management tips. Am J Psychiatry 2018; 175:1176.
  2. Schatzberg AF, Blier P, Delgado PL, et al. Antidepressant discontinuation syndrome: Consensus panel recommendations for clinical management and additional research. J Clin Psychiatry 2006; 67:27.
  3. Perahia DG, Kajdasz DK, Desaiah D, Haddad PM. Symptoms following abrupt discontinuation of duloxetine treatment in patients with major depressive disorder. J Affect Disord 2005; 89:207.
  4. Bauer M, Pfennig A, Severus E, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of unipolar depressive disorders, part 1: Update 2013 on the acute and continuation treatment of unipolar depressive disorders. World J Biol Psychiatry 2013; 14:334.
  5. Lam RW, Kennedy SH, Adams C, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 update on clinical guidelines for management of major depressive disorder in adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023: Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. Can J Psychiatry 2024; 69:641.
  6. Depression in adults: Treatment and management. NICE guideline, Publication no. NG222, National Institute for Health and Care Excellence 2022. https://www.nice.org.uk/guidance/ng222/evidence (Accessed on July 9, 2024).
Graphic 148184 Version 2.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟