SSRI Withdrawal Syndrome

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SSRI Withdrawal Syndrome

Several case reports and small case studies have documented a withdrawal syndrome after abrupt discontinuation of selective serotonin reuptake inhibitors (SSRIs). This review of 352 patients treated with SSRIs or the serotonergic tricyclic clomipramine in a Canadian psychopharmacology clinic examined the responses of 171 patients who stopped treatment under medical supervision.

Most patients were tapered over days to weeks, although a few were discontinued abruptly. Twenty-one patients (12%) had at least one new symptom during or within five days after discontinuation. The most common symptoms were dizziness, paresthesia, lethargy, vivid dreams, irritability, and lowered mood. The frequency of withdrawal symptoms was similar for clomipramine (30%), paroxetine (20%), and fluvoxamine (14%), but significantly lower for sertraline (2%) and fluoxetine (0%). Pooled comparisons of short versus long half-life SSRIs indicated that withdrawal symptoms were not related to age, diagnostic group, response to treatment, or relapse rates. However, patients who received the shorter half-life SSRIs (fluvoxamine and paroxetine) or clomipramine had significantly more withdrawal symptoms. Men tended to have more symptoms, as did patients treated for more than two months.

Comment: These findings confirm previous reports of withdrawal symptoms from SSRIs, particularly short half-life SSRIs. However, withdrawal symptoms may occur weeks later for the longer half-life drugs. This study may underestimate withdrawal symptoms due to narrow definitions and nonstandardized ascertainment of symptoms, and because the patients who discontinued treatment were treated for shorter periods than those who continued SSRIs. It may also overestimate symptoms due to the selected nature of the clinic and the failure to correct for multiple statistical tests and small sample size. The authors speculate that the syndrome's major elements -- dizziness and paresthesia -- could be linked to the role of serotonin in coordinating sensory and autonomic functions with gross motor activity.

— P Roy-Byrne

Published in Journal Watch Psychiatry December 1, 1996

Citation(s):

Coupland NJ et al. Serotonin reuptake inhibitor withdrawal. J Clin Psychopharmacol 1996 Oct 16 356-362.

Medline abstract (Free)

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