{"id":1160,"date":"2012-11-01T00:00:39","date_gmt":"2012-11-01T07:00:39","guid":{"rendered":"http:\/\/rhochistj.org\/RhoChiPost\/?p=1160"},"modified":"2014-02-19T12:15:00","modified_gmt":"2014-02-19T19:15:00","slug":"ssri-discontinuation-syndrome","status":"publish","type":"post","link":"https:\/\/rhochistj.org\/RhoChiPost\/ssri-discontinuation-syndrome\/","title":{"rendered":"SSRI Discontinuation Syndrome"},"content":{"rendered":"

By: Shannon Tellier, PharmD Candidate c\/o 2013<\/span><\/p>\n

–<\/p>\n

Antidepressant discontinuation syndrome has been reported in all categories of antidepressants after an abrupt interruption of therapy.1<\/sup>\u00a0 Symptoms usually occur within a few days of stopping or reducing the dosage of the antidepressant, and rarely occur with therapy of less than five weeks.1<\/sup> \u00a0If left untreated, most symptoms self-resolve within one day and three weeks.1<\/sup> \u00a0It is difficult to determine the incidence of discontinuation symptoms due to underreporting, but selective serotonin reuptake inhibitor (SSRI) discontinuation syndrome may be as high as 40%.2<\/sup><\/p>\n

Many pathological hypotheses exist for this discontinuation syndrome, but a definite explanation remains unknown.\u00a0 Since long-term use of SSRIs results in a down regulation of postsynaptic serotonin receptors, these receptors may remain in their hypoactive state for days to weeks.3<\/sup> \u00a0There is also a concern of a temporary absence of serotonin in the synapse after a sudden withdrawal of an SSRI.3<\/sup>\u00a0 A combination of down-regulated receptors and absence of serotonin may be responsible for SSRI discontinuation syndrome.3<\/sup>\u00a0 All SSRIs may cause a discontinuation syndrome, but it is more prevalent with paroxetine due to its short half-life (and less likely, if ever, with fluoxetine due to its long half-life).3<\/sup><\/p>\n

Recognition of symptoms of antidepressant discontinuation syndrome is important for both the patient and health care provider.1,3<\/sup>\u00a0 The FINISH mnemonic (Flu-like symptoms, Insomnia, Nausea, Imbalance, Sensory Disturbances, Hyperarousal) is used to remember these symptoms.3<\/sup>\u00a0 The most common symptoms for SSRI discontinuation include dizziness, nausea, lethargy and headache.1<\/sup><\/p>\n

To prevent the symptoms of discontinuation syndrome, a healthcare provider-supervised tapering over six to eight weeks is recommended.3<\/sup>\u00a0 There are no validated recommendations, but SSRIs should be tapered slowly (agent-specifically) due to their varying half-lives and active metabolites.3<\/sup>\u00a0 If the patient starts experiencing discontinuation syndrome, the full dose of antidepressant can be restarted and very slowly tapered again.3<\/sup>\u00a0 Another option is to provide fluoxetine, which is \u201cself-tapering\u201d due to its long half-life and active metabolite.2<\/sup>\u00a0 In mild to moderate cases of discontinuation syndrome, the patient can be treated symptomatically.1<\/sup>\u00a0 For example, a patient can be prescribed a short course of benzodiazepines for insomnia.1<\/sup>\u00a0 In general, the patient should be reassured that these symptoms are benign and will subside within one day to three weeks.1<\/sup><\/p>\n

Education about antidepressant discontinuation syndrome for patients and healthcare providers is essential to prevent misdiagnosis (particularly when an antidepressant is discontinued or switched to another agent).\u00a0 Often, discontinuation symptoms, such as fatigue, appetite changes, insomnia, and cognitive problems may be mistaken as a depressive relapse.3<\/sup>\u00a0 It should be explained to the patient that relapses occur two to three weeks after stopping an antidepressant, and discontinuation syndrome can occur in little as a few hours after missing a dose.3<\/sup>\u00a0 In addition, patients who are nonadherent to their antidepressants may experience discontinuation syndrome, and believe that their treatment regimen is ineffective.3<\/sup>\u00a0 Switching antidepressants may also result in discontinuation syndrome from stopping the first agent.3<\/sup>\u00a0 Patients may associate these symptoms as adverse effects from the new antidepressant, leading to more therapy changes.3<\/sup> \u00a0Therefore, it is important for the health care provider to be aware of antidepressant discontinuation syndrome to prevent misdiagnosis and unnecessary therapy changes.<\/p>\n

As mentioned previously, increased professional awareness allows for the early recognition of antidepressant discontinuation syndrome, and can prevent misdiagnosis or unnecessary therapy changes.\u00a0 Patients should not to abruptly stop an antidepressant, and ought to taper slowly (under supervision of their health care provider).\u00a0 The patient should also be reassured that antidepressants are not addictive, and that these symptoms are not life threatening and will resolve in a couple of weeks.1,3<\/sup><\/p>\n

SOURCES:<\/span><\/b><\/p>\n

    \n
  1. Haddad P.\u00a0 Antidepressant Discontinuation Syndromes: Clinical Relevance, Prevention, and Management.\u00a0 Drug Saf<\/i> 2001;24(3):183-197.<\/li>\n
  2. Cole SA, Christensen JF, Raju Cole M, et al.<\/i>\u00a0 Chapter 22.\u00a0 Depression.\u00a0 In: Feldman MD, Christensen JF, eds.\u00a0 Behavioral Medicine: A Guide for Clinical Practice.\u00a0 Third ed.\u00a0 New York: McGraw-Hill; 2008.\u00a0 http:\/\/www.accessmedicine.com\/content.aspx?aID=6441215.<\/a>\u00a0 Accessed Oct 30, 2012.<\/li>\n
  3. Warner CH, Bobo W, Warner C, et al.<\/i>\u00a0 Antidepressant Discontinuation Syndrome.\u00a0 Am Fam Physician <\/i>2006;74(3):449-56.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    By: Shannon Tellier, PharmD Candidate c\/o 2013 – Antidepressant discontinuation syndrome has been reported in all categories of antidepressants after an abrupt interruption of therapy.1\u00a0 Symptoms usually occur within a few days of stopping or reducing the dosage of the antidepressant, and rarely occur with therapy of less than five weeks.1 \u00a0If left untreated, most…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[343,1623,163,13,2227,132,1655,314,20,601,363,968,1625,636,19,169,1679,2252,149,1161,16,1061],"class_list":["post-1160","post","type-post","status-publish","format-standard","hentry","category-clinical","tag-and","tag-combination","tag-dose","tag-drug","tag-ebola-virus-disease","tag-flu","tag-fluoxetine","tag-for","tag-health","tag-inhibitor","tag-of","tag-one","tag-or","tag-paroxetine","tag-patient","tag-relapse","tag-short","tag-symptoms","tag-syndrome","tag-therapy","tag-treatment","tag-with"],"views":2667,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1160","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=1160"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/1160\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=1160"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=1160"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=1160"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}