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Selective serotonin reuptake inhibitors and withdrawal symptoms: a review of the literature

✍ Scribed by François Therrien; John S. Markowitz

Publisher
John Wiley and Sons
Year
1997
Tongue
English
Weight
175 KB
Volume
12
Category
Article
ISSN
0885-6222

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✦ Synopsis

There are accumulating reports of withdrawal symptoms emerging following the discontinuation of selective serotonin reuptake inhibitor antidepressants. This report summarizes published reports, characterizes the withdrawal syndrome, discusses potential mechanisms of withdrawal, and makes recommendations for prevention and management. A computerized search was conducted using MEDLINE (1985±1996) to retrieve all case reports and pertinent studies of antidepressant withdrawal. A total of 46 case reports and two drug discontinuation studies were retrieved. All of the selective serotonin reuptake inhibitors were implicated in withdrawal reactions with paroxetine most often cited in case reports. Withdrawal reactions were characterized most commonly by dizziness, fatigue/ weakness, nausea, headache, myalgias and paresthesias. The occurrence of withdrawal did not appear to be related to dose or treatment duration. Symptoms generally appeared 1±4 days after drug discontinuation, and persisted for up to 25 days. Time of onset and duration of symptoms diered little among the agents. The pathophysiology/ pharmacology of withdrawal is unclear but may involve multiple neurotransmitter systems. It is concluded that all of the SSRIs can produce withdrawal symptoms and if discontinued, they should be tapered over 1±2 weeks to minimize this possibility. Some patients may require a more extended tapering period. No speci®c treatment for severe withdrawal symptoms is recommended beyond reinstitution of the antidepressant with subsequent gradual tapering as tolerated.

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