Antidepressant Discontinuation Syndrome: Getting the Verdict

This is part two of a pair of posts. Click here to see the previous post.

Last Monday morning, while I was getting my breakfast to take up to my office, I got a call from the insurance company that manages my medications: My appeal of its decision not to reauthorize my prescription of the antidepressant Pristiq was denied. I managed to keep from spilling my coffee and headed up to my office where I closed the door, and the tears spilled.

The American Academy of Family Physicians states that “Utilization management can complicate physicians’ lives by requiring them to submit precertification paperwork, deal with the fallout of denied services, and participate in time-consuming appeals.”

What was going to happen to me? I called the insurance company immediately and asked why the appeal to the prior authorization had been denied. The representative said it was because I hadn’t had sufficient trials of duloxetine (Cymbalta) and venlafaxine (EffexorXR). I’d been on duloxetine; it was the medication that had stopped working prior to my fourth suicide attempt in 2014. I couldn’t specifically recall being on venlafaxine, but in my three-plus decades of cycling through many medication cocktails, I was almost sure I’d taken it.

Although I knew the representative wasn’t the person who made the decision and had no power in reversing the denial, I couldn’t help spilling my guts. “I’ve been stable…