From the Guidelines
I strongly advise you to schedule an appointment with me as soon as possible to discuss your medication changes and develop a safer treatment plan, as stopping antidepressants suddenly can cause withdrawal symptoms and potentially worsen mental health symptoms, especially given the increased risk of suicidal thoughts and behaviors associated with antidepressant use, as reported in studies such as 1. Please be aware that your safety is my top priority, and I need to assess your current mental health status to determine the best course of action, which may include adjusting your Propranolol prescription and exploring alternative treatment options, including medical cannabis, while closely monitoring you for any potential adverse effects, such as those associated with SSRIs, including suicidal thinking and behavior, behavioral activation/agitation, and serotonin syndrome, as highlighted in studies like 1 and 1.
From the FDA Drug Label
The usual maintenance dosage is 120 to 160 mg once daily. The dosage may be increased gradually to achieve optimal migraine prophylaxis Dear Brinlee, I have received your letter and I understand your concerns about the antidepressants and the potential effects of Bupropion. Regarding your request to lower the quantity of Propranolol to 20-30 tablets, I recommend that you continue with the current dosage and administration schedule as indicated on the label, and we can discuss alternative options for reducing costs, such as exploring patient assistance programs or generic alternatives 2.
From the Research
Response to Patient's Letter
- Dear Brinlee Spurlock,
- I have received your letter informing me that you have stopped taking your antidepressants as of April 14 due to an increase in suicidal thoughts, which you believe may be related to the addition of Bupropion, and I would like to discuss this further with you in light of studies such as 3 and 4 that highlight the importance of gradual tapering and patient education when discontinuing antidepressants.
Considerations for Discontinuing Antidepressants
- Studies such as 3 and 4 suggest that stopping antidepressants can lead to discontinuation symptoms, including insomnia, flu-like symptoms, and mood disturbances, and that a slow taper or cross-taper can help mitigate these risks.
- Additionally, research such as 5 and 6 indicates that suicidal ideation and behavior can be rare adverse reactions to antidepressant medication, particularly in the early stages of treatment or when increasing the dosage.
- It is also important to consider the potential benefits of antidepressant treatment, as noted in studies such as 7, which suggests that antidepressants can have a positive effect on depressive and other symptoms, including suicidality and suicidal behavior.
Next Steps
- I would like to schedule a follow-up appointment to discuss your decision to stop taking your antidepressants and to explore alternative treatment options, including the use of cannabis products, as you mentioned in your letter.
- In the meantime, I am willing to consider reducing the quantity of Propranolol to 20-30 tablets, as you requested, to help manage your supply and copay costs, and I will also take into account the findings of studies such as 3 and 4 when making this decision.