L. Baer, J. Ricciardi, N. Keuthen, A.R. Pettit, M.L. Buttolph, M. Otto, W. Minichiello, M.A. Jenike, Discontinuing obsessive-compulsive disorder medication with behavior therapy (letter), Am. J. Psychiatry, December 1994, 151 (12), 1842.
In an earlier report, authors had noted that patients treated with SSRIs for OCD "often remain on these medication regimens indefinitely", noting also "the sparsity of evidence and the uncertainty of prognosis for discontinuing SSRIs. In this letter they report on experience with six patients attempting discontinuation after drug exposure of at least six months, when assisted with behavior therapy. Five patients took fluoxetine 80mg/day; one was on clomipramine 200mg/day.
One patient on fluoxetine and one on clomipramine were successfully withdrawn and remained well at the 9-month and 6-month follow-up, respectively
Patient three remained well for 18 months after discontinuing fluoxetine but relapsed and restarted medication after 18 months, with good response.
Patient 4 suffered relapse of depression 3 weeks after and obsessions 4 months after discontinuing fluoxetine; the medication was restarted with eventual control of both.
Patent five suffered a relapse of OCD symptoms two months after stopping then restarted fluoxetine with good response
Patient six was unwilling to complete discontinuation but, at the 8-month follow up, was reportedly doing well on 20mg fluoxetine every other day.
Authors do not consider that anything resembling "dependence" might have accounted for the experience of patients 2, 3 and 4. They conclude that behavior therapy may be helpful on some occasions, but that "some patients successfully treated with serotonin reuptake inhibitors may require long-term medication management to prevent relapse".