Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial

Human Immunodeficiency Virus and Depression in Primary Care

“…The syndrome is characterized by a flu-like picture with symptoms of cholinergic rebound, paresthesias, heightened depressive symptoms, affective lability, deterioration of mood state, dizziness, insomnia, nausea, nervousness, and agitation. 61 Although especially prominent with abrupt paroxetine discontinuation, the potential for a discontinuation syndrome is also a concern for all shorter half-life SSRIs and serotonin and norepinephrine reuptake inhibitors (SNRIs). Among the SSRIs, citalopram 62 and its S-enantiomer, escitalopram, are generally well tolerated; they have intermediate half-lives and favorable pharmacokinetic profiles.…”

Neurological complications of psychiatric drugs: clinical features and management

“…Discontinuation symptoms occur with all the major antidepressant classes including TCAs, monamine oxidase inhibitors (MAOIs), SSRIs, serotonin and noradrenaline reuptake inhibitors (SNRIs) and miscellaneous antidepressants including mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA) (Haddad, 2001). The risk of discontinuation symptoms among the SSRIs is highest with paroxetine, lowest with fluoxetine and intermediate with the other SSRIs (Michelson et al, 2000;Rosenbaum et al, 1998). Differences in half-life appear to contribute to this differential risk.…”

Do antidepressants cause dependence?

“…Turning to newer antidepressants, Fava et al (1997) reported that during the three days following stoppage of venlafaxine and placebo under double blind conditions, seven (78%) of nine venlafaxine treated subjects and two (22%) of nine placebo-treated patients reported the emergence of adverse events, a statistically significant difference. Among the SSRIs prospective studies indicate that paroxetine is associated with the highest incidence of discontinuation symptoms and fluoxetine the lowest (Rosenbaum et al, 1998;Michelson et al, 2000;Judge et al, 2002;Bogetto et al, 2002;Tint et al, 2002). Several factors may account for this difference but the long half-life of fluoxetine and the existence of an active metabolite, norfluoxetine, with an even longer half-life seem important.…”

“…Several factors may account for this difference but the long half-life of fluoxetine and the existence of an active metabolite, norfluoxetine, with an even longer half-life seem important. Abrupt discontinuation of paroxetine leads to approximately 1/3 of patients complaining of one or more discontinuation symptoms on open questioning (Oehrberg et al, 1995) but if symptoms are screened for with a checklist approximately 2/3 of patients experience a 'discontinuation syndrome', defined as 4 or more new or worsened symptoms (Rosenbaum et al, 1998).…”