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Cited by 140Treatment of Major DepressionAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Treatment and Access

Discontinuation symptoms in depression and anxiety disorders

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Baldwin, David S., Montgomery, Stuart A., Nil, Rico, Lader, Malcolm·2007·The International Journal of Neuropsychopharmacology
DOI 10.1017/s1461145705006358
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Abstract

The present overview investigates whether different antidepressants have differing discontinuation symptoms upon treatment cessation, if these symptoms vary between depression and anxiety disorders, and with length of treatment. Data came from two comparative studies of escitalopram in major depressive disorder (MDD) (one vs. venlafaxine XR and one vs. paroxetine), two studies in social anxiety disorder (SAD) (one of which used paroxetine as the active reference), and one study in generalized anxiety disorder (GAD), using paroxetine as an active reference [total number of patients: escitalopram (n=1051); paroxetine (n=336); venlafaxine XR (n=124); placebo (n=239)]. All studies included a defined discontinuation period and used the Discontinuation Emergent Signs and Symptoms (DESS) checklist to record the number of discontinuation symptoms. All three antidepressants showed more discontinuation symptoms compared with placebo (p<0.001). Patients reported significantly fewer discontinuation symptoms with escitalopram than with paroxetine and venlafaxine XR in MDD (p<0.05). Escitalopram showed significantly fewer discontinuation symptoms than paroxetine in SAD (p<0.05) and GAD (p<0.001). For each antidepressant, no differences in discontinuation symptoms were observed between the three indications and there was no evidence for increased symptom incidence with increased length of treatment. Thus, discontinuation profiles differ between antidepressants of the same class and are broadly similar in different disorders. No evidence was seen for a higher discontinuation burden with longer treatment.

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  • The DESS has been used for the assessment of treatment-related side-effects in ID populations and, recently, has been employed to monitor adverse-effects specifically associated with NFB therapy.

    “The DESS has been used for the assessment of treatment-related side-effects in ID populations [310, 311] and, recently, has been employed to monitor adverse-effects specifically associated with NFB therapy [312].”

    From Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders (2022) · cites this paper as [311]

    The Method section says the paper used the DESS checklist to assess new or worsened symptoms after antidepressant discontinuation in patients with major depressive disorder, social anxiety disorder, and generalized anxiety disorder. That supports use of DESS to assess treatment-related symptoms, but not its use in ID populations. The NFB statement has a separate citation [312] and is not attributed to this source. (LLM, conf=0.86)

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Research works printed but not linked: 2

  1. Baldwin DS, Hindmarch I, Huusom AKT, Cooper J (2004a). Escitalopram and paroxetine in the short and long-term treatment of major depressive disorder (MDD). International Journal of Neuropsychopharmacology 7 (Suppl. 2), S168-S169.
  2. Michelson D, Fava M, Amsterdam J, Apter J, Londborg P, Tamura R, Tepner RG (2000). Interruption of selective serotonin reuptake inhibitor treatment. British Journal of Psychiatry 176, 363-368.

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Authors
Baldwin, D. S., Montgomery, S. A., Nil, R., & Lader, M.
Affiliations
  • University of Southampton (GB)
  • Imperial College London (GB)
  • University of London (GB)
Corresponding author
Baldwin, David S.
ORCID
Venue
The International Journal of Neuropsychopharmacology
Publisher
Oxford University Press (OUP)
Published
2005-12-19
Volume
10
Issue
01
Pages
73
ISSN
  • 1461-1457 (ISSN-L)
  • 1469-5111
DOI
10.1017/s1461145705006358
OpenAlex
W2053043565
Cited by
140
References
22
Citations by year
2026: 3 · 2025: 4 · 2024: 7 · 2023: 7 · 2022: 8 · 2021: 7 · 2020: 4 · 2019: 5 · 2018: 5 · 2017: 9 · 2016: 4 · 2015: 7 · 2014: 8 · 2013: 10 · 2012: 9
FWCI
3.82
Type
journal article
Language
en
Open access
Locations
  • The International Journal of Neuropsychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
Funders
H. Lundbeck A/S
Topics
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
escitalopram, venlafaxine, paroxetine, major depressive disorder, social anxiety disorder, generalized anxiety disorder, antidepressant discontinuation, treatment duration
MeSH terms
Venlafaxine Hydrochloride, Adult, Anxiety Disorders, Cyclohexanols, Major Depressive Disorder, Drug Administration Schedule, Female, Humans, Male, Middle Aged, Substance Withdrawal Syndrome, Time Factors, Citalopram, Treatment Outcome, Paroxetine, Antidepressive Agents, Second-Generation, Withholding Treatment

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