Lecture – Discontinuation of Psychotropic Drugs – Update on a Prevalent Problem

Presented by Ross J. Baldessarini, MD, McLean Hospital – McLean Forum lecture

Individuals stop psychotropic drug treatments for many reasons. Some stop treatment to avoid adverse, sometimes medically serious, side effects. In some cases, drug treatments are discontinued because the medicine is not helping as much as the patient hoped. Also, many women stop using medications while pregnant, fearing that the drugs may harm their babies or themselves.

In this lecture, Baldessarini asserts that treatment discontinuation has broad implications that are not always appreciated. He reports that physiological withdrawal reactions occur in about one-third of patients trying to stop taking modern antidepressants. Discontinuation is often followed by early—sometimes severe or even fatal—recurrences of bipolar and depressive symptoms. Women who stop taking psychotropic medications while pregnant can see their condition recur or grow more severe.

The negative impact of discontinuation is also seen in individuals who take part in clinical trials. When trial subjects switch from the study drug to a placebo, they can experience worsening clinical effects.

Watch now and learn more about:

• The range of symptoms and risk factors associated with antidepressant withdrawal syndromes
• Carryover and discontinuation effects of previous treatment and their implications for clinical treatment and for the design and interpretation of placebo-controlled therapeutic trials
• The challenges of balancing maternal and fetal risks involved in continuing and in discontinuing psychotropic drug treatments in pregnancy

Baldessarini explores the many issues related to discontinuation of psychotropic drugs. Drawing from research studies and his own experience as a clinician, he discusses how many individuals who stop taking medications get sick again—a situation with dangerous, even fatal, implications. He investigates the question of whether dose amounts and dose rates affect relapses and recurrences after discontinuation.

Also, Baldessarini explains how stopping treatment can produce confusing clinical effects when evaluating a new treatment and in experimental trials. He discusses the withdrawal reactions experienced by those who stop taking medications, including physiological and sensory changes.

While exploring the complicated issues surrounding psychotropic drug discontinuation, Baldessarini asserts that “psychopharmacology is great, but it is limited.” He states that in our “quest for elusive pharmacological solutions to complex human problems, we tend to overvalue what medicines can do.”