Paroxetine induced withdrawal effects

Koopowitz, Leslie; Berk, Michael

doi:10.1002/hup.470100210

Cited by 16 publications

(7 citation statements)

References 12 publications

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“…Withdrawal occur on withdrawal of other centrally-acting drugs, including tricyclic antidepressants [ 14]. Withdrawal reactions have been reported with all four SSRIs, most frequently with paroxetine, though this study suggests reactions with fluvoxamine, fluoxetine, paroxetine and sertraline have been described in the literature [15][16][17][18] that they are relatively mild and do not have features of a physical drug dependency syndrome. and have been reported spontaneously to us for all four SSRIs.…”

Section: W Ithdrawal Reactions Methodsmentioning

confidence: 91%

A comparison of the post‐marketing safety of four selective serotonin re‐uptake inhibitors including the investigation of symptoms occurring on withdrawal

Price

Waller

Wood

et al. 1996

Brit J Clinical Pharma

149

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1We have addressed the question of whether there is a ‘serotonin withdrawal syndrome’ by analysis of spontaneous reports of suspected adverse drug reactions (ADRs) associated with four SSRIs. A comparison of the post‐marketing safety profiles of the four SSRIs has also been made. 2The UK database of ADRs was examined for reactions associated with fluoxetine, fluvoxamine, paroxetine and sertraline. The safety profiles of the four SSRIs were similar. However, withdrawal reactions with paroxetine constitute a greater proportion of reports (5.1%) than with the other SSRIs (0.06–0.9%). They have been reported more often with paroxetine (0.3 reports per thousand prescriptions) than with sertraline and fluvoxamine (0.03), and least often with fluoxetine (0.002). 3Descriptions of withdrawal reactions received and further details of 217 reports of withdrawal reaction with paroxetine obtained by mailing a questionnaire to the reporting doctor were examined. Withdrawal symptoms were diverse but most commonly comprised dizziness, paraesthesia, tremor, anxiety, nausea and palpitation. They usually occurred after 2 days and lasted for an average of 10 days. There was no evidence of a physical drug dependency syndrome. 4Symptoms different from the previous depressive illness occur after discontinuing an SSRI, and are reported most often with paroxetine. Paroxetine is the most pharmacologically specific of the SSRIs, but it is not clear whether the reactions constitute a ‘serotonin withdrawal syndrome’.

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Section: W Ithdrawal Reactions Methodsmentioning

confidence: 91%

A comparison of the post‐marketing safety of four selective serotonin re‐uptake inhibitors including the investigation of symptoms occurring on withdrawal

Price

Waller

Wood

et al. 1996

Brit J Clinical Pharma

149

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“…Some individuals require very gradual tapers to prevent discontinuation symptoms reappearing (Koopowitz & Berk, 1995;Amsden & Georgian 1996;Louie et al, 1996). Some antidepressants, including paroxetine, are available in liquid formulations that allow very gradual tapers.…”

Section: Managementmentioning

confidence: 99%

Recognising and managing antidepressant discontinuation symptoms

Haddad¹,

Anderson²

2007

Adv. psychiatr. treat

130

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and an honorary senior lecturer at the University of Manchester. His clinical and research interests include the pharmacological treatment of affective disorders and schizophrenia and the safety and adverse effects of psychotropic medication. He was a member of the Guideline Development Group for the National Institute for Health and Clinical Excellence's guidelines on bipolar disorder (2006 Abstract Antidepressant discontinuation symptoms occur with all classes of antidepressant. A welldescribed discontinuation syndrome occurs with the selective serotonin reuptake inhibitors, common symptoms including dizziness, headache, nausea and lethargy. Rare antidepressant discontinuation syndromes include extrapyramidal syndromes and mania/hypomania. All these syndromes, even isolated discontinuation symptoms, share three common features that facilitate diagnosis; abrupt onset within days of stopping the antidepressant, a short duration when untreated and rapid resolution when the antidepressant is reinstated. Clinicians need to be familiar with strategies for the prevention and management of such symptoms. Preventive strategies include warning patients about the possibility of discontinuation symptoms, encouraging good antidepressant adherence and tapering antidepressants at the end of treatment. Most symptoms are mild and shortlived. Consequently symptoms that follow planned termination of an antidepressant can often be managed by providing an explanation and reassurance. More severe symptoms should be treated symptomatically or the antidepressant restarted, in which case symptoms usually resolve within 24 h. More cautious tapering can then follow.

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“…Reports confirm, for example, that the resumption of paroxetine (Koopowitz and Berk, 1995;Debattista and Schatzberg, 1995;Phillips, 1995;Dominguez and Goodnick, 1995) resulted in the prompt resolution of symptoms. Meclizine (25 mg/day) or dimenhydrinate (50 mg/day) (Pyke, 1995) have been prescribed in attempts to control dizziness, and cyclizine (dose unknown) (Koopowitz and Berk, 1995) has been used to alleviate nausea following the discontinuation of paroxetine. Prevention of discontinuation syndromes through gradual taper continues to be the preferred option.…”

Section: Treatment Of Antidepressant Withdrawal Symptomsmentioning

confidence: 98%

Extended antidepressant maintenance and discontinuation syndromes

Maixner¹,

Greden²

1998

Depress. Anxiety

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Unipolar and bipolar depression are episodic, recurrent illnesses for the majority of patients. Because each episode engenders considerable costs for patients, families, and society, prevention of recurrences has high priority. Numerous studies demonstrate that maintenance antidepressants or mood stabilizing medications are efficacious in preventing recurrences. A review of maintenance studies supports the view that all antidepressants perform significantly better than placebo in preventing recurrences of depression—with the stipulation that full antidepressant doses be employed. Earliest studies, conducted two decades ago, evaluated tricyclics (TCAs), heterocyclics, and lithium, while recent studies have focused on selective serotonin reuptake inhibitors (SSRIs). Compliance is essential. Strategies for enhancing compliance include selection of medications with reported safety and few side effects, education of patients and families, referral to patient advocacy groups, and use of new technological compliance aids. Preliminary data suggest that SSRIs are better tolerated than TCAs; fewer patients discontinue these agents due to side effects. Selection criteria for maintenance treatment have not been well determined, but three or more prior episodes is recognized as a relatively strong indicator. Other clinical or genetic criteria have also been suggested. For various reasons, patients may discontinue medications, and when this happens withdrawal phenomena may occur. Withdrawal effects are well documented for all antidepressants and can be profound with TCAs. After stopping some SSRIs, a few withdrawal symptoms may have similarities with those following discontinuation of TCAs, but unique “CNS‐like” effects are frequently described, including brief recurrent episodes of dizziness, lightheadedness, vertigo, electric shock‐like sensations, and gait instability. These appear to be half‐life dependent, with agents with shorter half‐lives having more discontinuation symptoms. If antidepressant medications must be discontinued, a gradual taper is preferable, perhaps extending three to six months or longer to prevent discontinuation effects, enable adaptation at the receptor level and allow earlier recognition and treatment of recurrent depressive symptoms. Depression and Anxiety, Volume 8, Supplement 1:43–53, 1998. © 1998 Wiley‐Liss, Inc.

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Paroxetine induced withdrawal effects

Abstract: Withdrawal reactions following discontinuation of tricyclic antidepressants and short acting selective serotonin reuptake inhibitors (SSRI) have been reported. We describe three cases of paroxetine induced withdrawal effects.

Cited by 16 publications

References 12 publications

A comparison of the post‐marketing safety of four selective serotonin re‐uptake inhibitors including the investigation of symptoms occurring on withdrawal

A comparison of the post‐marketing safety of four selective serotonin re‐uptake inhibitors including the investigation of symptoms occurring on withdrawal

Recognising and managing antidepressant discontinuation symptoms

Extended antidepressant maintenance and discontinuation syndromes

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