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Spontaneous lapses in dosing during chronic treatment with selective serotonin reuptake inhibitors

Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht, and Kendle, Utrecht

MARCEL L. BOUVY, PharmD

Department of Pharmacoepidemiology and Pharmacotherapy, UIPS, Utrecht and SIR, Institute for Pharmacy Practice Research, Leiden

EIBERT R. HEERDINK, PhD

Department of Pharmacoepidemiology and Pharmacotherapy, UIPS, Utrecht

JOHN URQUHART, FRCP(E)

Department of Epidemiology, Maastricht University, Maastricht

HUBERT G. M. LEUFKENS, PhD

Department of Pharmacoepidemiology and Pharmacotherapy, UIPS, Utrecht, The Netherlands

Correspondence: Welmoed E. E. Meijer, Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), PO Box 80082, 3508 TB Utrecht, The Netherlands. Tel: +31 30 2537324; fax: +31 30 2539166; e-mail: W.E.E.Meijer{at}pharm.uu.nl

Declaration of interest This study received unconditional grant support from Eli Lilly and Company.

Background In previous research, lapses in dosing of paroxetine or sertraline were associated with significantly more discontinuation symptoms and deterioration of depressive symptomatology compared with fluoxetine.

Aims To evaluate dosing lapses in patients chronically treated with selective serotonin reuptake inhibitors (SSRIs) in uncontrolled circumstances.

Method In a prospective observational study we evaluated compliance data in chronic users of SSRIs using electronic drug exposure monitors.

Results During a 3-month follow-up we found that 50/69 (72.5%) patients missed at least one dosing day and 20/69 (29.0%) missed two or more consecutive days.

Conclusions About 30% of patients treated with short-acting SSRIs had dosing lapses of 2 or more days, which, as described in prior studies, is long enough to result in clinically relevant deterioration of mental status.

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