When to Discontinue Stiloz (SSRI)
Stiloz (SSRI) should be discontinued if symptoms persist or worsen, and after consulting with a healthcare professional, especially for patients who are pregnant or breastfeeding. 1
General Discontinuation Guidelines for SSRIs
Timing of Discontinuation
- SSRIs should generally be continued for at least 6 months after symptom improvement for optimal treatment outcomes 2
- Patients who understand they need to take their medication for at least 6 months are 61% less likely to discontinue prematurely 2
- For patients with panic disorder, pharmacotherapy should continue for 6-12 months when patients respond favorably 3
Reasons for Discontinuation
Medical Reasons
- Persistent or worsening symptoms despite adequate treatment 1
- Development of significant adverse effects, particularly within the first 3 months of treatment 2
- Pregnancy or breastfeeding (requires consultation with healthcare provider) 1
- Suicidal ideation or behavior (a potential adverse effect that warrants immediate discontinuation) 4
Treatment Response Considerations
- Poor psychiatric response with worsening symptoms is the most common reason for discontinuation (36% of cases) 5
- Patient perception of poor response is a significant factor in early discontinuation (80% vs. 20% physician-directed discontinuation) 5
Discontinuation Process
Tapering Schedule
- Gradual tapering is recommended rather than abrupt discontinuation 4
- Consider tapering the dose gradually when discontinuing or interrupting therapy to minimize withdrawal symptoms 4
- A 14-week tapering schedule (reducing by approximately 12.5% of initial dosage every 2 weeks) has been shown to be effective and not associated with worsening behavioral symptoms 6
Monitoring During Discontinuation
- Monitor for return of symptoms, which may occur over approximately one week following discontinuation 4
- Watch for withdrawal symptoms, which are distinct from relapse of the original condition 2
Special Considerations
High-Risk Patients
- Patients with severe symptoms or history of relapse may require longer treatment duration 4
- For patients with history of severe symptoms, some guidelines recommend indefinite continuation of therapy 4
Medication Interactions
- If the patient is taking beta-blockers, careful consideration is needed before discontinuation of any psychotropic medication due to potential interaction effects 4
Common Pitfalls to Avoid
- Discontinuing too early (before 6 months of treatment) may lead to symptom recurrence 2, 3
- Failing to taper the medication gradually can result in withdrawal symptoms 4
- Not informing patients about the expected duration of treatment increases the risk of premature discontinuation 2
- Overlooking patient-reported concerns about medication effectiveness, which is a major factor in early discontinuation 5