A Comparison of Two Antidepressant Tapering Regimens
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Major Depressive Disorder
- Sponsor
- Emory University
- Enrollment
- 2
- Locations
- 3
- Primary Endpoint
- Discontinuation Emergent Signs and Symptoms Scale (DESS) Scores
- Status
- Terminated
- Last Updated
- 7 years ago
Overview
Brief Summary
The purpose of this study is to compare two ways to stop taking an antidepressant medication and determine whether a faster or slower taper is better tolerated.
Detailed Description
As abrupt cessation of antidepressant medication can cause distressing symptoms (including and not limited to worsened mood, irritability/agitation, anxiety, dizziness, confusion, and headache), the aim of this study is to compare the tolerance of two tapering regimens with the hypothesis that tapering the antidepressant dose over the course of two weeks will yield less discontinuation symptoms than a one week taper regimen. Additionally, it is suspected that discontinuing medications that inhibit the serotonin transporter , such as selective serotonin reuptake inhibitors (SSRI) and serotonin norepinephrine reuptake inhibitors (SNRI) will have a greater difference in the frequency of discontinuation symptoms between the two and one-week tapering regimens versus antidepressants that don't inhibit serotonin transporter. Demographic and clinical features will also be identified that may predict discontinuation symptoms with the hypothesis that patients on SSRIs and SNRIs may experience more discontinuation symptoms versus patients on non-SSRI/SNRI medications. Whether or not the treatment duration is positively associated with the number of discontinuation symptoms will also be determined.
Investigators
Boadie W. Dunlop
Boadie W. Dunlop, MD
Emory University
Eligibility Criteria
Inclusion Criteria
- •Currently taking an FDA-approved antidepressant for at least four weeks on the list of approved medications: SSRIs (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, sertraline, vilazodone or vortioxetine), SNRIs (desvenlafaxine, duloxetine, levomilnacipran, venlafaxine) and other classes (amitriptyline, bupropion, desipramine, doxepin, mirtazapine, nefazodone, nortriptyline, phenelzine, selegiline, or tranylcypromine). Clomipramine, a tricyclic antidepressant approved for the treatment of OCD, will also be included, but will be classed as an SSRI for this study because inhibition of the serotonin transporter is its primary therapeutic mechanism.
- •No longer wish to take the antidepressant medication they are currently prescribed, due to one of the following reasons: 1) ineffective for symptoms; 2) intolerable side effect; 3) improvement of their illness for sufficient duration that it is clinically appropriate to consider tapering the medication.
- •Primary psychiatric diagnosis of major depressive disorder, an anxiety disorder, OCD, or PTSD.
- •Ability to read and understand English language.
Exclusion Criteria
- •Has met criteria at any time during their life for a primary psychotic disorder (e.g. schizophrenia), or dementia.
- •Meets criteria for DSM-5-defined substance use disorder within three months of the screening visit.
- •Currently taking two or more antidepressants.
- •Presents with a clinically significant suicide risk, as assessed by a study physician.
- •Presence of any unstable or central nervous system-related medical illness that would interfere with cognition or participation.
- •Women who are currently pregnant or lactating, or plan to become pregnant during the study.
Outcomes
Primary Outcomes
Discontinuation Emergent Signs and Symptoms Scale (DESS) Scores
Time Frame: Baseline (Post-Taper), Visit 4 (3 Weeks Post Baseline)
To determine a change in the frequency of Discontinuation symptoms, the Discontinuation Emergent Signs and Symptoms Scale (DESS) will be administered by a trained clinician/rater to assess the frequency of discontinuation symptoms. The assessment has 43 items to evaluate discontinuation-emergent symptoms resulting from withdrawal from their antidepressant medication. Symptoms are rated on a scale of 1-5: 1. New symptom 2. Old symptom but worse 3. Old symptom but improved 4. Old symptom but unchanged 5. Symptom not present Total score = sum of number of new symptoms and old (but worse) symptoms (score = 1) and old and unchanged symptom, absent, or old symptom but improved (score = 0); total possible range 0 to 43. Higher score = more symptoms.
Secondary Outcomes
- Number of Participants Who Meet Criteria for Antidepressant Discontinuation Syndrome(Duration of Study (Up to 14 Months))
- Physician Withdrawal Checklist (PWC-20) Scores(Baseline (Post-Taper), Visit 4 (3 Weeks Post Baseline))