Selective Serotonin Reuptake Inhibitors Withdrawal Syndrome
Overview
Symptoms begin 1to 3 days after abrupt cessation of selective serotonin reuptake inhibitors (SSRIs).
It also occurs with discontinuation of the serotonin-norepinephrine reuptake inhibitor (SNRI) venlafaxine, and the serotonergic tricyclic antidepressant (clomipramine).
Cause—when SSRI is discontinued, level of serotonin decreases, and is no longer able to provide a stimulus for receptors formerly downregulated while SSRI was in the system.
Frequency—occurs in 25% to 30% patients who discontinue SSRI.
Risks
Duration of treatment ” class=LK href=”javascript:void(0)” target=right xpath=”/CT{06b9ee1beed59419a81e5e1e1a4f60b0cc8cd1057525de73425b2b43f4df7f1bcff08ad1c570ff92af88dff4d2c90f60}/ID(AB1-M10)”>>4 weeks
Higher doses of medication
SSRIs with short half-life and no active metabolite—paroxetine, fluvoxamine
Clomipramine
Note that symptoms may occur weeks later if patient abruptly discontinues an SSRI with a longer half-life.
Diagnosis
Two or more symptoms
Constitutional—flu-like symptoms, malaise, chills, myalgias
Gastrointestinal—nausea, vomiting, diarrhea
Mental status changes and affecting symptoms—anxiety, irritability, mood lability, insomnia, bizarre dreams, confusion, and lethargy
Neuromuscular—dizziness, lightheadedness, vertigo, headache, tremor, dystonia, electrical shock sensation upon neck flexion (identical to Lhermitte’s sign), and gait instabilityRelated posts:
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