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Title: Gradual, 10% Dose Reductions Dramatically Reduce Antidepressant Discontinuation Symptoms: Presented at CPA

"Gradual, 10% Dose Reductions Dramatically Reduce Antidepressant Discontinuation Symptoms: Presented at CPA"

By Alison Palkhivala MONTREAL, CANADA -- November 20, 2007 -- Ten percent weekly reductions in dose over 10 weeks can diminish discontinuation effects associated with many antidepressants of the selective serotonin reuptake inhibitor (SSRI) class. In fact, using this protocol can allow patients to discontinue SSRI therapy even if they were unable to using standard dose reduction techniques. Data on the effectiveness of this protocol presented here in a poster here on November 16 at the 57th Annual Conference of the Canadian Psychiatric Association (CPA). "All SSRIs product monographs as well as the literature request that doctors reduce dosage very carefully at the end of treatment," lead author Dipen Kalaria, BSc.Phm, Director of Specialty Services, Pharmacy.ca, Toronto, Ontario, Canada in an interview. "But all the monographs are silent on how this is to be done. And we know that there is a proportion of patients... who have severe discontinuation symptoms." Pharmacy.ca is a specialty compounding pharmacy that offers its services throughout Canada. They have developed a device using a patented technique that allows them to reformulate the strength of any drug." Any pharmacy can technically do this, but the labour involved can make it quite expensive. With our patented technology, we're able to do it quite cost effectively," said Mr. Kalaria. Using their technology, Pharmacy.ca provides patients wishing to discontinue SSRI therapy with 10% decreases in doses of the drug. Patients reduce their dose by 10% a week for 10 weeks. To determine whether this novel titration procedure impacts on adverse effects associated with discontinuation, Mr. Kalaria and colleagues contacted 20 patients who had used this service and asked for their feedback. A total of 19 patients agreed to participate in the study, 13 of whom had tried and failed to discontinue SSRI therapy in the past using standard dose reduction techniques, consisting of dropping down to the lowest available dose of the drug and possibly breaking the tablet. The 13 participants rated, on a scale of 0 to 3, the degree to which they suffered from any of nine side effects during their initial, failed attempt to discontinue their SSRI and their attempt using the 10-step dose reduction technique. These side effects were: irritability, dizziness, confusion, headache, nervousness, trouble sleeping, nausea, moodiness, and crying. All 13 of the patients were able to discontinue therapy using the ten-step approach. Also, the mean scores for all nine symptoms were reduced using this approach, compared with standard tapering techniques. While all of the patients experienced symptoms using standard tapering techniques, 53% had no symptoms at all when using the ten-step approach. "It was quite dramatic in terms of the reduction [in discontinuation symptoms] and also the ability of patients to discontinue treatment," said Mr. Kalaria. " [[Presentation title: A Novel Ten-Step Titration of Patients Discontinuing SSRIs Shows a Reduction in Severity and Frequency of Withdrawal Side Effects". Poster P20]

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