I. Hindmarch, S. Kimber, S.M. Cockle:Abrupt and
brief discontinuation of antidepressant treatment: effects on cognitive function and
psychomotor performance, Int Clin Psychopharmacol 2000 Nov;15(6):305-18
Authors' abstract: "The abrupt discontinuation of antidepressants can result
in a syndrome of adverse events, including somatic, mood and psychomotor reactions. This
study examined the effects of discontinuing and resuming antidepressant treatment with
four selective serotonin reuptake inhibitors (SSRIs) on cognitive and psychomotor
function. Eighty-seven patients receiving maintenance therapy with fluoxetine, sertraline,
paroxetine or citalopram had their treatment interrupted for 4-7 days using double-blind
placebo. Assessments of aspects of cognitive and psychomotor performance, mood and
symptoms were carried out at each visit. Following interruption of treatment, significant
differences between the groups emerged. Paroxetine treated patients experienced
significantly more cognitive failures (P = 0.007), poorer quality of sleep (P = 0.016),
and an increase in depressive symptoms, as rated both subjectively, using the Zung scale
(P = 0.006) and by the clinician, using the Montgomery-Asberg Depression Rating Scale (P =
0.0003) and Clinical Global Impression (P = 0.0003), compared to some or all of the other
drugs. All changes were reversed on reinstatement of treatment. Abrupt discontinuation of
treatment with paroxetine leads to deterioration in various aspects of health and
functioning, which may be related to the antidepressant discontinuation syndrome. These
effects are not evident in patients receiving fluoxetine, sertraline and citalopram,
suggesting they are not an SSRI class phenomenon."
Comment: Full report not seen, but the short duration of withdrawal (4-7
days) inevitably favours fluoxetine over paroxetine. See Rosenbaum, Fava et al., 1998
