Reasons for quitting serotonin reuptake inhibitor therapy: Paradoxical psychological side effects and patient satisfaction

Background: The goal of this study was to document the existence of psychological side effects associated with serotonin reuptake inhibitors (SSRIs) taken for depression and to determine their relationship to patients' decisions to stop treatment, and attitudes toward taking SSRIs again. Method: We conducted 161 semi-structured telephone interviews of adults who had completed a course of treatment for depression with one of the SSRIs. We identified 29 categories of unwanted psychological effects and analyzed data in terms of responders and non-responders, the former split into those who would, and those who would not take the same drug again if depressed in the future ('take-again responders' and 'not-again responders', respectively). Results: Psychological side effects were cited just as often as physical side effects as the primary reason for quitting SSRI treatment. Non-responders cited psychological side effects rather than non-response as the primary reason for quitting, and not-again responders cited physical more than psychological side effects. Not-again responders and non-responders did not differ in the number of side effects experienced, and non-responders experienced significantly more unwanted psychological effects than either type of responder (chi(2) = 6.767, p = 0.009). Conclusion: Psychological side effects might well be included in measures and discussions of side effects, even though they present no known physical danger to the patient. Copyright (C) 2004 S. Karger AG, Basel.