European archives of psychiatry and clinical neuroscience · 2026
The discontinuation-emergent signs and symptoms (DESS) scale: reliable measurement-but perhaps not of antidepressant withdrawal.
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Maß Reinhard
Аннотация
BACKGROUND: Most patients discontinuing antidepressants (ADs) report withdrawal symptoms. The Discontinuation-Emergent Signs and Symptoms (DESS) checklist is widely used to assess such symptoms, although concerns about its validity remain.
METHODS: This naturalistic study investigated the reliability and construct validity of a self-report version of the DESS in an inpatient sample with major depressive disorder (N = 63). Thirty-three patients discontinued a previously prescribed AD (disAD group), whereas 30 patients received no AD during treatment (noAD group). The DESS and the revised Beck Depression Inventory-II were administered. Three time points were analyzed: baseline (T0), defined as the day before the first dose reduction in the disAD group, and the first two assessments following complete discontinuation (T1, T2). Reference time points in the noAD group were yoked to the assessment schedule of the disAD group.
RESULTS: Internal consistency of the DESS ranged from good to excellent. In the disAD group, correlations between DESS and depression scores were weak and non-significant, whereas strong correlations were observed in the noAD group. ANCOVA indicated that DESS scores did not differ between groups but decreased significantly over time. Notably, the highest DESS scores were observed at T0, prior to AD discontinuation. Item-level analyses provided no evidence that individual items captured withdrawal symptoms.
CONCLUSIONS: Although reliable, the self-report DESS showed limited construct validity as a measure of AD withdrawal symptoms. Instead, the instrument may primarily capture depressive symptoms or AD-related adverse effects.
METHODS: This naturalistic study investigated the reliability and construct validity of a self-report version of the DESS in an inpatient sample with major depressive disorder (N = 63). Thirty-three patients discontinued a previously prescribed AD (disAD group), whereas 30 patients received no AD during treatment (noAD group). The DESS and the revised Beck Depression Inventory-II were administered. Three time points were analyzed: baseline (T0), defined as the day before the first dose reduction in the disAD group, and the first two assessments following complete discontinuation (T1, T2). Reference time points in the noAD group were yoked to the assessment schedule of the disAD group.
RESULTS: Internal consistency of the DESS ranged from good to excellent. In the disAD group, correlations between DESS and depression scores were weak and non-significant, whereas strong correlations were observed in the noAD group. ANCOVA indicated that DESS scores did not differ between groups but decreased significantly over time. Notably, the highest DESS scores were observed at T0, prior to AD discontinuation. Item-level analyses provided no evidence that individual items captured withdrawal symptoms.
CONCLUSIONS: Although reliable, the self-report DESS showed limited construct validity as a measure of AD withdrawal symptoms. Instead, the instrument may primarily capture depressive symptoms or AD-related adverse effects.