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Discontinuation symptoms in depression and anxiety disorders
Open accessAbstract
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 [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]
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Metadata
- 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.
- 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
- 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
- bronze
- doi.org
- 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 (medical) › Treatment of Major Depression
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › 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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