From the Guidelines
I strongly advise that you schedule an appointment with me as soon as possible to discuss your decision to stop taking antidepressants and to evaluate your current mental health status, as discontinuing these medications can lead to a higher risk of suicidal thoughts and behaviors, especially in the first few months after stopping treatment 1. I appreciate your honesty about stopping your antidepressants due to increased suicidal thoughts, which is indeed a concerning side effect that warrants immediate discontinuation, especially with bupropion, as noted in the guidelines for adolescent depression in primary care 1. I would be happy to reduce your propranolol prescription to 30 tablets as requested, as this medication can be helpful for managing physical symptoms of anxiety without the side effects you experienced with antidepressants, and we can discuss alternative treatment options for your depression, including the potential use of medical cannabis, while ensuring that your overall treatment plan addresses your needs safely and effectively 1.
From the Research
Patient Response
The patient has stopped taking their antidepressants as of April 14 due to increased suicidal thoughts, which they believe were caused by the addition of Bupropion.
- The patient would like to remain off antidepressants unless an alternative is found, and they have had better results with cannabis products, which they would like to explore further by obtaining a medical card.
- They would also like to continue taking Propranolol, which has helped them, and request a lower quantity of 20-30 tablets to reduce supply and copay costs, as they have a sufficient supply that will last for a while.
Relevant Studies
Studies have shown that switching or stopping antidepressants can be complex and requires careful consideration, as abrupt discontinuation can lead to withdrawal syndromes and relapse of depression 2.
- Bupropion, the medication the patient believes caused their increased suicidal thoughts, has been shown to be effective as an antidepressant, particularly when used in combination with other medications, and has a unique pharmacology that may provide benefits for certain patients 3, 4.
- Additionally, research has explored the use of cannabis products for treating anxiety and depression, with some studies suggesting that medicinal cannabis use may reduce symptoms of anxiety and depression, although more research is needed to fully understand its effects 5.