Phelps J et al. – This study is limited by the outcome measure used, which assesses anxiety only indirectly in the context of global improvement. However, in view of the broad implications of the findings, these preliminary observations warrant further consideration. Some patients with anxiety may be treatable not by adding medications, but rather by tapering off existing ones.
The authors present 12 patients whose anxiety diminished substantially when antidepressants were tapered off, as reflected in Clinical Global Improvement Scale scores assigned by their respective clinicians.
Mean duration of antidepressant taper was 17weeks (range 0–48), as suggested by limited prior evidence supporting very slow taper rates for this purpose.
Alternative treatments for depression were often used for these patients as antidepressants were tapered, particularly lithium and lamotrigine, but none of the alternatives used are generally regarded as having anti–anxiety effects.
Patients with bipolar disorder diagnoses, including schizoaffective disorder, were specifically excluded.
In many of these cases, other medications that might have anti–anxiety effects (including buspirone, quetiapine, olanzapine, gabapentin, and diphenhydramine) were also tapered off.
Results suggest that antidepressants may actually cause anxiety in some patients with unipolar depression.
Alternatively, lamotrigine or lithium may have more anti–anxiety effects than generally recognized; or these patients may have had subtle bipolar disorder despite the absence of symptoms meeting formal criteria, supporting the “bipolar spectrum” perspective on mood disorder diagnosis.
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