dothiepin-hydrochloride and Substance-Withdrawal-Syndrome

The possibility that treatment with tricyclic antidepressants, in the form of dothiepin, might attenuate benzodiazepine withdrawal symptoms was investigated in a double-blind trial.. Eighty-seven non-depressed psychiatric out-patients with putative normal dose benzodiazepine dependence had their benzodiazepines reduced in stepwise amounts of 20% of the original dose for eight weeks. The patients were randomised to receive dothiepin (with dosage increasing to 150 mg/day) or placebo as an aid to withdrawal before benzodiazepine reduction and these drugs were taken for four further weeks before being stopped.. Fewer patients entered and completed the study than expected and a Type II error was possible in the results. Although there was some evidence of withdrawal symptoms being less marked in those patients allocated to dothiepin this was independent of any antidepressant effect as depression scores were lower in the placebo group in the early phase of withdrawal (P < 0.01). Of those completing the study, greater satisfaction (P = 0.03) was recorded by those who had received dothiepin; no other differences reached statistical significance.. Dothiepin (and by implication other tricyclic antidepressants) might have some value in reducing benzodiazepine withdrawal symptoms but does not aid drug withdrawal.

Topics: Ambulatory Care; Anti-Anxiety Agents; Antidepressive Agents, Tricyclic; Benzodiazepines; Dose-Response Relationship, Drug; Dothiepin; Double-Blind Method; Drug Administration Schedule; Humans; Neurologic Examination; Patient Satisfaction; Substance Withdrawal Syndrome; Treatment Outcome

Topics: Aged, 80 and over; Antidepressive Agents, Tricyclic; Delirium; Depressive Disorder; Dothiepin; Humans; Male; Substance Withdrawal Syndrome

To demonstrate that when antidepressants are switched, discontinuation symptoms from the first antidepressant may be misdiagnosed as adverse effects of the second antidepressant.. Single case report.. A female patient was switched from paroxetine to dothiepin due to lack of efficacy. Over the next week she developed physical symptoms which she and her doctor regarded as side effects of dothiepin. It was decided to change the dothiepin and a second opinion was obtained regarding a suitable alternative. At that point it was realized that her symptoms represented a paroxetine discontinuation syndrome. The patient was reassured and continued dothiepin. The discontinuation symptoms resolved over the next 3 weeks and her depression subsequently remitted.. Increased professional awareness of discontinuation symptoms is necessary to prevent misdiagnosis and inappropriate treatment.

Topics: Antidepressive Agents, Second-Generation; Antidepressive Agents, Tricyclic; Depressive Disorder; Diagnosis, Differential; Dothiepin; Female; Humans; Middle Aged; Paroxetine; Substance Withdrawal Syndrome

Topics: Adolescent; Antidepressive Agents; Clomipramine; Depressive Disorder; Dothiepin; Drug Administration Schedule; Electroconvulsive Therapy; Female; Humans; Lithium; Phenelzine; Receptors, Serotonin; Recurrence; Self-Injurious Behavior; Substance Withdrawal Syndrome; Suicide; Suicide Prevention; Syndrome