Complications
Abruptly discontinuing or rapidly tapering antidepressants can increase the risk of withdrawal symptoms, such as dizziness, irritability, anxiety, restlessness, sweating, nausea, palpitations, and headaches.[65][75] To minimize these risks, a gradual and proportionate tapering schedule with close monitoring is recommended.[65][75] Drugs with a shorter half-life (e.g., paroxetine) should be tapered more slowly. This process may take several months, progressing at a rate that is comfortable for the patient.[76] Withdrawal symptoms can range from mild and transient to prolonged and severe. Close monitoring is necessary to ensure that any withdrawal symptoms do not in fact represent a return of SAD symptoms.[65][75]
Other anxiety disorders may predate, co-occur with, or postdate the onset of seasonal affective disorder (SAD).
Comorbid anxiety disorders are amenable to selective serotonin-reuptake inhibitor or serotonin-norepinephrine reuptake inhibitor pharmacotherapy used to treat SAD.
Cognitive behavioral therapy may also be considered, as it is an effective treatment for anxiety disorders.
Referral to a psychiatrist or other mental health professional is indicated when there are more severe levels of anxiety that may interfere with treatment compliance.
Substance-use disorders may develop as a means of regulating mood symptoms and could complicate treatment response.[14][36]
Seasonal changes in patterns of substance misuse should be routinely assessed.
Toxicology screening may be performed.
Collateral information from family members may prove useful.
Referral for substance misuse treatment programs may be indicated.
There is an increased risk of suicidality in young adults (as well as children and adolescents, who are beyond the scope of this topic) with major depressive or other psychiatric disorders especially during the first months of treatment with antidepressants versus placebo.[74]
Use of this content is subject to our disclaimer