Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation: Systematic review

Giovanni A. Fava, Giada Benasi, Marcella Lucente, Emanuela Offidani, Fiammetta Cosci, Jenny Guidi

Research output: Contribution to journalReview article

23 Citations (Scopus)

Abstract

Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation. Methods: PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: "duloxetine" OR "venlafaxine" OR "desvenlafaxine" OR "milnacipran" OR "levomilnacipran" OR "SNRI" OR "second generation antidepressant" OR "serotonin norepinephrine reuptake inhibitor" AND "discontinuation" OR "withdrawal" OR "rebound." Only published trials in the English language were included. Results: Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well. Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.

Original languageEnglish (US)
Pages (from-to)195-203
Number of pages9
JournalPsychotherapy and Psychosomatics
Volume87
Issue number4
DOIs
StatePublished - Aug 1 2018

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Substance Withdrawal Syndrome
Library Science
Databases
Psychotropic Drugs
Serotonin and Noradrenaline Reuptake Inhibitors
Anxiety Disorders
Mood Disorders
PubMed
MEDLINE
Antidepressive Agents
Language
Randomized Controlled Trials
Retrospective Studies
Prospective Studies
Guidelines
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Clinical Psychology
  • Applied Psychology
  • Psychiatry and Mental health

Cite this

Fava, Giovanni A. ; Benasi, Giada ; Lucente, Marcella ; Offidani, Emanuela ; Cosci, Fiammetta ; Guidi, Jenny. / Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation : Systematic review. In: Psychotherapy and Psychosomatics. 2018 ; Vol. 87, No. 4. pp. 195-203.
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abstract = "Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation. Methods: PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: {"}duloxetine{"} OR {"}venlafaxine{"} OR {"}desvenlafaxine{"} OR {"}milnacipran{"} OR {"}levomilnacipran{"} OR {"}SNRI{"} OR {"}second generation antidepressant{"} OR {"}serotonin norepinephrine reuptake inhibitor{"} AND {"}discontinuation{"} OR {"}withdrawal{"} OR {"}rebound.{"} Only published trials in the English language were included. Results: Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well. Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.",
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Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation : Systematic review. / Fava, Giovanni A.; Benasi, Giada; Lucente, Marcella; Offidani, Emanuela; Cosci, Fiammetta; Guidi, Jenny.

In: Psychotherapy and Psychosomatics, Vol. 87, No. 4, 01.08.2018, p. 195-203.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Withdrawal symptoms after serotonin-noradrenaline reuptake inhibitor discontinuation

T2 - Systematic review

AU - Fava, Giovanni A.

AU - Benasi, Giada

AU - Lucente, Marcella

AU - Offidani, Emanuela

AU - Cosci, Fiammetta

AU - Guidi, Jenny

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Background: Serotonin-noradrenaline reuptake inhibitors (SNRI) are widely used in medical practice. Their discontinuation has been associated with a wide range of symptoms. The aim of this paper is to identify the occurrence, frequency, and features of withdrawal symptoms after SNRI discontinuation. Methods: PRISMA guidelines were followed to conduct a systematic review. Electronic databases included PubMed, the Cochrane Library, Web of Science, and MEDLINE from the inception of each database to June 2017. Titles, abstracts, and topics were searched using a combination of the following terms: "duloxetine" OR "venlafaxine" OR "desvenlafaxine" OR "milnacipran" OR "levomilnacipran" OR "SNRI" OR "second generation antidepressant" OR "serotonin norepinephrine reuptake inhibitor" AND "discontinuation" OR "withdrawal" OR "rebound." Only published trials in the English language were included. Results: Sixty-one reports met the criteria for inclusion. There were 22 double-blind randomized controlled trials, 6 studies where patients were treated in an open fashion and then randomized to a double-blind controlled phase, 8 open trials, 1 prospective naturalistic study, 1 retrospective study, and 23 case reports. Withdrawal symptoms occurred after discontinuation of any type of SNRI. The prevalence of withdrawal symptoms varied across reports and appeared to be higher with venlafaxine. Symptoms typically ensued within a few days from discontinuation and lasted a few weeks, also with gradual tapering. Late onset and/or a longer persistence of disturbances occurred as well. Conclusions: Clinicians need to add SNRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with other types of psychotropic drugs. The results of this study challenge the use of SNRI as first-line treatment for mood and anxiety disorders.

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