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Recent literature indicates that discontinuation symptoms occur from almost any antidepresant unless dosage is gradually reduced when stopping the medication.
The October 1998 issue of the Journal of Clinical Psychiatry had a special section on problems that occur when stopping antidepressants. The first discontinuation reaction was reported as far back as 1959 with imipramine, but it is now well established that this phenomenon occurs with most antidepressants. This article cited studies that mentioned that 55% of patients developed symptoms of discontinuation on imipramine, 80% with amitryptaline, 33% for clomipramine 32% for phenelzine, and 35% for paroxetine.
Symptom groups following discontinuation of the tricyclics included a variety of GI symptoms, flu like somatic symptoms, sleep disturbance, anxiety and mood changes, and rarely, cardiac arrhythmias.
The SSRI’s had different discontinuation symptoms. These symptoms included dysequilibrium characterized by vertigo and loss of balance, and sensory abnormalities characterized by tingling of the extremities, numbness, sensation of electric shocks, particularly in the head, neck and upper limbs. All of these symptoms are made worse by movement of the head.
Discontinuation symptoms are not the same as those for which the medication is prescribed. They may occur as soon as missing two doses of the shorter acting antidepressants such as paroxetine. It was recommended that antidepressants be tapered over 1 month. Of the SSRI’s, paroxetine (Paxil) was by far the most likely to cause discontinuation symptoms, with Fluvoxamine (Luvox) second, and sertraline (Zoloft) about 1/10 as likely to cause discontinuation symptoms and fluoxetine (Prozac) least likely to cause any symptoms. Discontinuation symptoms were most likely to occur in patients who had been treated for at least 2 months, but the risk did not increase further after 6 months of treatment. Discontinuation symptoms tended to disappear within 10 to 28 days. Venlafaxine (Effexor) and citalopram (Celexa) also caused similar symptoms if stopped abruptly.
Tremendous individual differences were noted in frequency and quality of discontinuation syndromes. The articles concluded that Paxil was the medication to be most cautious about discontinuation symptoms, and the authors noted that in general a 10 mg/week tapering was sufficient, but that some patients need an even more gradual taper lasting 2 months or more. Switching to Prozac from Paxil was reported to be an effective strategy in avoiding discontinuation symptoms.
