More cases of paroxetine withdrawal syndrome

Abstract

Sm: We wish to add five more cases of paroxetine withdrawal syndrome to those reported by other authors (Barr et a!, 1994; Pyke, 1995).All of our cases occurred in young women (aged 26-39 years), without concurrent organic illness, diagnosed with major depression. Paroxetine was started at a dose of 10 mg/day in the first week and increased to 20 mg for the rest of the treatment period (12â€"14 months). The drug was well tolerated and laboratory tests were always normal through out the period. A benzodiazepine was used during the first 2â€"3 months as an adjunct to manage anxiety but paroxetine was, thereafter, the only maintenance treatment. In three cases paroxetine was discontinued by alternating 20 mg one day and 10 mg the other day during a week. After that, 10 mg/day was main tained for 15 days, then patients were prescribed 10 mg every other day for one more week, before stopping medication. In two patients the tapering was done directly from 20 to 10 mg and after 2 weeks on this dose they stopped the medication.All patients complained of vertigo, light headedness or gait instability during withdrawal. Three patients referred to the symptoms in their next planned out-patient consultation, but two demanded urgent treatment and were prescribed lorazepam 1 mg/day for one week. In all five cases, the symptoms persisted for approximately 7 days. Very similar withdrawal syndromes have been described with other serotonin selective reuptake inhibitors including fluvoxamine, fluoxetine and sertraline, and muscarinic and serotonergic factors have been implicated in the production of these symptoms but what is striking from a clinical point of view is the fact that a conservative tapering regime was unable to prevent symptoms appearing. As a result of this experience we are now applying a dosage reduction of 5 mg per week in an attempt to avoid this withdrawal syndrome. B@x, L. C., GOODMAN, W. K. & PRICE, L. H. (1994)Physical symptoms associated with paroxetine discontinuation (letter).American Journal of Psychiatry. 151, 289. L. PACHECO P. MALO E. ARAGUES M. ETXEBESTESm: There is clinical evidence that yohimbine has an effect in restoring erectile capacity in men with erectile dysfunction (ED) but may be accompanied by side-effects. Case reportA 59-year-old man described a 3 year history of erectile dysfunction. After discussing treatment options he chose oral medication. A trial of yohimbine 5.4 mg tid. was initiated. Three days after starting medication he developed pain and discomfort above both eyes which he described as like ‘¿ a thick head cold'. The area was tender to touch but there were no other symptoms to suggest sinus problems, influenza or an anxiety state. There was no change in his mental state. He stopped medication and symptoms resolved within 24 hours. A week later he re-exposed himself to the tablets and symptoms returned after three days, and again resolved within 24 hours of stopping. During each treatment period, no success was noted with sexual function. The patient refused a third trial of...

Discontinuation symptoms with nefazodone

“…Our patient developed symptoms even though she was on a low dose of nefazodone and this was tapered over 3 days. Other authors have also reported discontinuation symptoms during slow tapering as well as with low doses tapering [10–13].…”

Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review

“…Less common reactions were ‘electric-shock' sensation [9,59,61,62], visual and auditory hallucination [63], nocturnal enuresis [64], pruritus [65], and emesis [6]. In most reports, symptoms lasted until paroxetine was reintroduced or switched to other medications and/or cognitive behavioral therapy [12,13,15,59,62,66]. Only in a few cases did symptoms spontaneously remit in about 2 weeks [4,8,63,67].…”

“…However, when symptoms persist and are distressing, the reinstitution of the same AD that triggered the problem or its substitution with a long-acting SSRI such as fluoxetine [26] may only postpone and aggravate the issue [86]. There are anecdotal reports on the use of clonazepam and other benzodiazepines or mood stabilizers, which, however, need to be properly tested [15,50,59,62,72]. Another neglected area of research is concerned with the role of withdrawal symptoms in assessing switching strategies that are increasingly utilized in the treatment resistance of mood and anxiety disorders [86,91].…”

“…In the 1990s, case reports [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16] started documenting withdrawal reactions following the discontinuation of selective serotonin reuptake inhibitors (SSRI). As the volume of the literature grew, one of the earliest reviews [17] suggested that a discontinuation syndrome consisting of a cluster of somatic and psychological symptoms could indeed occur.…”

Recognising and managing antidepressant discontinuation symptoms

“…For example, case reports of SSRI discontinuation reactions have described ataxia leading to falls (Einbinder, 1995), fa tigue causing difficulty walking (Haddad et al, 2001) and electricshocklike sensations impairing walking and driving (Frost & Lal, 1995). Occasionally discon tinuation symptoms lead to urgent consultations and attendance at accident and emergency departments (Pacheco et al, 1996;Haddad et al, 2001).…”