Is It Possible Severe Hypomanic Episodes Will Diminish or Stop if the Antidepressant is Discontinued?
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Q:  If I come off antidepressents, is it possible that my severe Hypomanic episodes will diminish/stop altogether?

Many thanks,


Dear Jonny --
Yes, thatís definitely possible -- as long as we presume a couple of other things.  First, diminishing or stopping your hypomanic episodes by gradually tapering off an antidepressant is more likely if you currently have "rapid cycling", although that simply means more than four mood episodes per year, which is a very common pattern.  So it is fair to assume that such a pattern might be the case for you.

Secondly, this outcome is more likely if you are currently taking a mood stabilizer medication in addition to your antidepressant.  That way, when the antidepressant is gone, you will still be on an agent which will help prevent a cycling.

However, although nearly all mood experts that I know of would agree that "this is definite possible", controversy still exists as to how likely that outcome would be.  Some mood specialists would think such an outcome definitely possible; I am one of them.  Other psychiatrists would admit that such an outcome is possible, but they would be much more skeptical as to how likely that is.  In other words, they might think that such outcomes are uncommon, where I think they are quite common.

Of course you would not taper at your antidepressant on your own.  Nor would any other readers of this letter.  That would be unwise for several reasons.  First, you might simply be plunging yourself into a return of symptoms, later than having to explain to your psychiatrist how this came about.  It really you roads and the treatment relationship to be making such moves on your own.  Secondly, different psychiatrists will have different opinions on how slow the taper should be.  After hearing the opinion of the Director of the Mood Disorders Clinic associated with Harvard University, Dr. Gary Sachs, I have started to do what he recommends and have found it very, very helpful: for months, 25% per month (or smaller decrements more frequently if the total size is allowed at conveniently).  Until recently, I had no reference other than his say-so for this approach, which is not commonly practiced. Then about two months ago I came across an article that presents some suggestive data in support of his approach, although certainly not a direct test thereof.  If you show this essay about antidepressant discontinuation to your psychiatrist, be prepared for surprise and probable disbelief.

Finally, making any medication changes on your own is generally not a good idea.  It is nearly always far preferable to work in close conjunction with your psychiatrist, not on your own.  That may be particularly true for this issue about antidepressant tapering.

Good luck with the process --

Dr. Phelps

Published November, 2008

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