Discontinuing Antidepressant Medications

One in six people in the US are currently taking psychotropic drugs. In 80% of cases, the medication is taken for long-term use and predominantly involves new-generation antidepressants, such as SSRIs (e.g. paroxetine) and SNRIs (e.g. venlafaxine). When patients want to stop taking these drugs and/or their physicians decide it is time for them to stop, substantial problems often can ensue. About 50% of patients experience withdrawal symptoms that do not necessarily subside after a few days or weeks and may be severe and debilitating. Physicians often do not know what to do in these situations. As a result, patients experiencing the anguish and mental pain of withdrawal syndromes are unlikely to receive appropriate medical attention. Discontinuing antidepressants is a highly technical challenge that requires specific strategies. This handbook guides clinicians through each clinical step (assessment; what the counter-indications would be for stopping or continuing; and how discontinuation can best be achieved). It provides a detailed account of the assessment and management strategies, with many case illustrations and clinical examples, drawing from the literature that is available and the extensive personal experience of the author.

1 - Gaining Insight of the Problem
2 - The Clinical Manifestations of Withdrawal Following Antidepressant Drugs Discontinuation
3 - The Associated Clinical Manifestations of Behavioral Toxicity
4 - Understanding the Pathophysiology of Withdrawal Syndromes
5 - The Decision of Discontinuing Antidepressants
6 - The Setting of Guided Antidepressant Discontinuation
7 - The Role of Clinical Assessment
8 - Pharmacological Strategies and Options
9 - First Psychotherapeutic Module: Explanatory Therapy
10 - Second Psychotherapeutic Module: Cognitive-Behavioral Therapy
11 - Third Psychotherapeutic Module: Well-Being Therapy
12 - Prevention of Dependence and Withdrawal with Antidepressant Medications
13 - A Different Psychiatry is Possible

Giovanni Andrea Fava , MD, is currently Clinical Professor of Psychiatry at the University of Buffalo, State University of New York. He has authored more than 500 scientific papers on depression, psychotherapy, psychopharmacology and psychosomatic medicine. He has introduced a novel psychotherapeutic approach (Well-Being Therapy. Basel, Karger, 2016), the sequential model for combining pharmacotherapy and psychotherapy, the concept of staging in psychiatry, the Diagnostic Criteria for Psychosomatic Research, and new methods of psychiatric evaluation. He is also editor-in-chief of the top journal Psychotherapy and Psychosomatics. As an investigator, he has published groundbreaking research on antidepressant drug discontinuation . As an editor, he has published key papers that have suggested a reconsideration of the problem and modification of the guidelines.