Development of untoward withdrawal symptoms due to abrupt discontinuation of antidepressants: A comparative study of duloxetine and desvenlafaxine

 

Abstract               Background: About 20 % of patients develop antidepressant discontinuation syndrome following an abrupt stoppage or marked reduction in the dose of an antidepressant taken continuously for one month. It is important to recognize these symptoms in the initial stage itself in order to avoid the problems in further management. Aims and Objectives: Aim of the study was to compare the development of untoward withdrawal symptoms due to abrupt discontinuation of Desvenlafaxine and Duloxetine by the patients themselves either willfully or accidently Materials and Methods: We had taken patients who were already on duloxetine and desvenlafaxine at prescribed dose for at least 1 month and now discontinued on their own for 1 day or more and reported with some untoward symptoms were included in the study. Sample: Total number of patients were 50. 25 consecutive patients who stopped duloxetine for 1 day or more and fulfilled all the inclusion criteria. 25 consecutive patients who stopped desvenlafaxine for 1 day or more and fulfilled all the inclusion criteria. Results: The results of this systemic review indicate that withdrawal symptoms occur after abrupt discontinuation of Desvenlafaxine and Duloxetine.88% of sample on duloxetine and 80% of sample on desvenlafaxine reported lethargy after discontinuing medicines.92% of the patients on duloxetine and 84% patients on desvenlafaxine reported fatigue on stopping the drugs.80% of sample on duloxetine and 62% of the sample on desvenlafaxine reported headache.80% of sample on duloxetine and 72% on desvenlafaxine reported vertigo on sudden stoppage of the drugs.Lethargy and fatigue were the most common withdrawal symptoms. However, no significant difference was found for the comparison of Lethargy, Fatigue, Headache/ Achiness, Achiness and Sweating between Duloxetine and Desvenlafaxine. Both the SNRIs were seen to be equal in causing withdrawal symptoms insomnia, nausea, vomitting, dizziness and vertigo. No significant difference was found for the comparison of light headedness, burning sensation, tingling, electric like / shock-like sensations and anxiety between Duloxetine and Desvenlafaxine. Conclusions: We concluded that both drugs cause similar withdrawal symptoms. The withdrawal symptoms were independent of the dose prescribed. The clinicians need to be aware of this abrupt withdrawal and should counsel the patient well in advance about the severity of withdrawal symptoms while prescribing either of the drugs.

Key Words: Antidepressant Withdrawal, Duloxetine, Desvenlafaxine.

 

 

INTRODUCTION

About 20% of patients develop antidepressant discontinuation syndrome following an abrupt stoppage or marked reduction in the dose of an antidepressant taken continuously for one month.¹ Cessation of antidepressant therapy may increase the risk of relapse of depression or anxiety. Unlike the symptoms of antidepressant discontinuation syndrome, symptoms of relapse usually take more than few days to appear and to disappear following reintroduction of the antidepressant.² Withdrawal symptoms have been reported after reduction and/or discontinuation of antidepressant drugs including selective serotonin reuptake inhibitors (SSRI) and serotonin – noradrenaline reuptake inhibitors (SNRI). Withdrawal symptoms can have either an early or a late onset, may have a short or long duration, and can be easily misinterpreted as signs of an impending relapse. SNRI have been reported to produce similar types of discontinuation/withdrawal symptomologies.^3-5 Such a review appears to be important in view of the fact that SNRIs are increasingly prescribed6 and usually considered the first choice in the treatment of mood and anxiety disorders, both for their efficacy and for their presumed high levels of safety and tolerability.⁷ They are indicated and administered in clinical conditions such as chronic pain, functional medical disorders, and menopausal symptoms.⁷ The aetiology of antidepressant discontinuation syndrome is not fully understood but it tends to occur after the abrupt discontinuation of an antidepressants, though may also occur even with a tapering dose of these medicines. It is known to occur with MAO (inhibitors), SSRI, SNRI, and atypical antidepressants. The syndrome can occur by missing even a single dose of medications with short half-lives, such as paroxetine and venlafaxine. Symptoms can last for weeks, sometimes longer. It is important to recognize these symptoms in the initial stage itself in order to avoid the problems in further management.⁸

 

AIM

Aim of the study was to compare the untoward withdrawal symptoms due to abrupt discontinuation of Desvenlafaxine and Duloxetine by the patients themselves either wilfully or accidently.

 

OBJECTIVES

• To Study the withdrawal symptoms from the discontinuation of desvenlafaxine.

• To Study the withdrawal symptoms from the discontinuation of Duloxetine.

• To compare the withdrawal symptoms arising from the discontinuation of desvenlafaxine and duloxetine.

 

MATERIALS AND METHODS

We had taken patients who were already on duloxetine and desvenlafaxine at prescribed dose for at least 1 month and now discontinued on their own for 1 day or more and reported with some untoward symptoms were included in the study.

Sample size: Total number of patients was 50. 25 consecutive patients were those who stopped duloxetine for 1 day or more and fulfilled all the inclusion criteria. 25 consecutive patients were those who stopped desvenlafaxine for 1 day or more and fulfilled all the inclusion criteria.

Tools: Patients were interviewed based on a structured proforma with a list of commonly occurring withdrawal symptoms from desvenlafaxine and duloxetine.

Inclusion Criteria:

• Patient taking duloxetine or desvenlafaxine continuously for atleast 1 month.

• Patient discontinued duloxetine or desvenlafaxine for 1 day or more.

• Patient willing to participate in the study.

Exclusion Criteria:

• Patient having any major medical / surgical illness.

• Patient taking any drug/drugs other than duloxetine or desvenlafaxine.

RESULTS

Table 1: Sex Wise Distribution of Sample

 

Table 2: Religion Wise Distribution Of Sample

Table 3: Distribution Of Sample According To Marital Status

 

Table 4: Distribution Of Sample As Per Family Type:

 

Table 5: Distribution Of Sample As Per Socioeconomic Status

 

Table 6: Distribution Of Lethargy, Fatigue, Headcahe, Achiness, Sweating Between Duloxetine And Desvenlafaxine

 

Table 7: Distribution Of Insomnia, Nausea, Vomitting, Dizziness And Vertigo Between Duloxetine And Desvenlafaxine

 

Table 8: Distribution Of Irritability, Aggression, Agitation, Mania And Jerkiness Between Duloxetine And Desvenlafaxine