Efficacy of alprazolam in reducing fluoxetine-induced jitteriness in patients with major depression

Abstract

Background: Serotonin selective reuptake inhibitors (SSRIs) have become the most widely prescribed antidepressants in the United States. The selective influence of SSRIs on serotonin neurotransmission has resulted in a specific constellation of adverse effects termed "jitteriness" syndrome, which occurs in at least 30% of patients taking SSRIs. Because there have been no systematic studies examining treatment of SSRI-induced jitteriness, we conducted a prospective study of the efficacy of adjunctive alprazolam therapy for fluoxetine-induced jitteriness symptoms.

Method: Fifty-four subjects with major depression were treated with fluoxetine 20 mg/day. Subjects experiencing an increase in jitteriness symptoms within 2 weeks of starting fluoxetine were given adjunctive alprazolam 0.5 mg to 4.0 mg daily for 2 weeks followed by a 2-week taper period.

Results: Eighteen (33.3%) of 54 patients experienced jitteriness symptoms during fluoxetine treatment. We observed a statistically significant reduction in the severity and number of jitteriness symptoms with adjunctive alprazolam. Moreover, in most cases jitteriness symptoms did not reappear during the alprazolam taper period or after alprazolam was discontinued.

Conclusion: These observations suggest that a brief course of adjunctive alprazolam treatment may be efficacious in reducing the duration and severity of jitteriness symptoms resulting from antidepressants that are selective for serotonin.