Antidepressants (discontinuation symptoms)

Question 1

Discontinuation symptoms are common in patients stopping antidepressants of all types.

The onset is usually within 5 days of stopping but varies depending on half life. Most antidepressant discontinuation reactions are of short duration, resolving spontaneously between 1 day and 3 weeks after onset. The mean duration of SSRI discontinuation symptoms is 5 days. Clinical experience is that discontinuation symptoms usually resolve fully within 24 h if the original antidepressant is recommenced. Tapering antidepressants at the end of treatment, rather than abrupt stoppage, is recommended as standard practice by several authorities and treatment guidelines.

SSRI and related discontinuation

Common symptoms include:-

Answer 1

Flu-like symptoms
Dizziness
Insomnia
Vivid dreams
Irritability
Crying spells
Sensory symptoms (e.g. sensations resembling electric shocks)

Question 2

SSRIs and related drugs particularly associated with discontinuation symptoms include:-

Answer 2

Paroxetine
Venlafaxine

Discontinuation symptoms seem least likely with fluoxetine (Tint, 2008).

Question 3

TCA discontinuation

Answer 3

Common symptoms include:-

Flu-like symptoms
Insomnia
Excessive dreaming

TCAs particularly associated with discontinuation symptoms include:-

Amitriptyline
Imipramine

Question 4

MAOI discontinuation

Answer 4

Common symptoms include:-

Agitation/ irritability
Ataxia
Movement disorders
Insomnia
Vivid dreams

All MAOIs are associated with prominent discontinuation symptoms.

Question 5

Risk factors for discontinuation symptoms include:-

Answer 5

Using drugs with a short half-life (e.g. paroxetine, venlafaxine)
Using antidepressants for 8 weeks or longer
Those that developed anxiety symptoms early in treatment
Those taking other centrally acting drugs (e.g. antihypertensives, antihistamines, antipsychotics)
Younger people
Those that have experienced discontinuation symptoms before

Question 6

Which of the following scales is most helpful for eveluating discontinuation symptoms associated with antidepressants?

Answer 6

DESS