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Incidence and severity Depression and anxiety disorders CHAPTER 3 Antidepressant withdrawal symptoms Signs and symptoms Antidepressant withdrawal symptoms may be entirely new or similar to some of the original symptoms of the illness for which the medication w...

Time course 374 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Time course The onset and severity of symptoms are related to the half-­life of the antidepressant. Placebo/nocebo effects and loss of therapeutic efficacy may also be important. Shor...

Clinical relevance14,15

Who is at risk?10,14–16,18

How to avoid14–16,18 Depression and anxiety disorders CHAPTER 3 Clinical relevance14,15 The symptoms of a withdrawal reaction may be mistaken for a relapse of illness or the emergence of a new physical illness,16 leading to unnecessary investigations or reintr...

How to treat14–16,23

References 376 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 difficult to stop.13 At-­risk patients (see above) may need a slower taper. Agomelatine can probably be stopped abruptly without provoking withdrawal symptoms but should be slowly with...

Stopping antidepressants

Rate of tapering 378 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Stopping antidepressants Up to 50% of patients will experience withdrawal symptoms on reducing or stopping an antidepressant,1,2 but symptoms are less common in shorter-­term use...

Pattern of tapering Depression and anxiety disorders CHAPTER 3 Pattern of tapering Although reducing by linear amounts (e.g. 50mg, 37.5mg, 25mg, 12.5mg, 0 for sertraline) seems intuitively reasonable (and practical, through splitting tablets), because of the h...

Practical application of tapering 380 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Practical application of tapering Before tapering All patients should be informed of the risk of withdrawal symptoms on stopping any antidepressant. Some antidep...

Troubleshooting Depression and anxiety disorders CHAPTER 3 A cautious initial rate of reduction is prudent. The rate of withdrawal can be sped up if symptoms are tolerable. If severe withdrawal symptoms are precipitated by the first step down, then the process...

References 382 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Unfortunately, most current tablet formulations of antidepressants do not permit hyperbolic tapering regimens, so patients will require the use of liquid formulations, as recommended b...

Electroconvulsive therapy and psychotropic drugs 384 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Electroconvulsive therapy and psychotropic drugs Psychotropics are often continued during ECT. Some agents, such as antidepressants,1,2 enhance it...

References 386 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 References Pluijms EM, et al. Influence of an adjuvant antidepressant on the efficacy of electroconvulsive therapy: a systematic review and meta-­analysis. Aust N Z J Psychiatry 2021;...

Psychostimulants in depression 388 The Maudsley® Prescribing Guidelines in Psychiatry CHAPTER 3 Psychostimulants in depression Psychostimulants reduce fatigue, promote wakefulness and can be mood elevating. Amfetamines have been used as treatments for depressi...

References Depression and anxiety disorders CHAPTER 3 References Satel SL, et al. Stimulants in the treatment of depression: a critical overview. J Clin Psychiatry 1989; 50:241–249. Warneke L. Psychostimulants in psychiatry. Can J Psychiatry 1990; 35:3–10. Go...

Post-stroke depression