Published: February 2010

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Serotonergic agents and discontinuation syndrome - reminder

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Prescriber Update 31(1): 6-7
February 2010

CARM continues to receive reports of “withdrawal symptoms” in patients following discontinuation of serotonergic medicines such as selective serotonin reuptake inhibitors (SSRIs).

While discontinuation syndrome is a recognised reaction that can occur following the abrupt cessation of serotonergic agents, prescribers are reminded that dose tapering may reduce the likelihood of symptoms occurring.^1,2

Paroxetine and venlafaxine have been associated with discontinuation syndrome more often than the other serotonergic antidepressants; in the case of paroxetine this may be due, in part, to its shorter half life.³

Common symptoms associated with discontinuation syndrome include dizziness, paraesthesia, headache, anxiety, agitation, tremor, sweating, confusion and nausea. Symptoms can occur within a few days of discontinuation or may be delayed, particularly in the case of fluoxetine, due to its longer half-life. The majority of symptoms experienced on discontinuation are self-limiting, but can be distressing for patients.

To reduce the likelihood of discontinuation syndrome the dose of serotonergic agents should be reduced gradually over a period of several weeks or months. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered. Subsequently, the dose may continue to be decreased, but at a more gradual rate.

Further information is provided in the relevant product data sheets, available on the Medsafe website.

References

1. Mylan New Zealand Limited. 2 Feb 09. Loxamine (paroxetine) data sheet
   www.medsafe.govt.nz/profs/Datasheet/l/loxaminetab.pdf
2. Antidepressants. In Sweetman SC (ed) 2009. Martindale (36^th Ed). Great Britain: Pharmaceutical Press. p. 372-430.
3. Weller IVD. Report of the CSM Expert Working Group on the safety of selective serotonin reuptake inhibitor antidepressants. 2005. London: The Stationery Office.