II. Pathophysiology
- Occurs with sudden Antidepressant Withdrawal
- Symptom onset occurs within 24 hours to 2-3 weeks
- Likely results from Cholinergic overdrive
- Symptoms similar to Organophosphate Poisoning
- Most common with Paxil
- Least common with Prozac (naturally tapers)
III. Symptoms
- Cholinergic rebound (See Cholinergic Toxicity)
- Non-specific Withdrawal symptoms
-
Extrapyramidal Effects
- Paresthesias
- Restless legs
IV. Differential Diagnosis
- Bipolar Disorder with Antidepressant-induced mania
V. Management: Approach
- Mild Symptoms: Resolve spontaneously
- Withhold treatment
- Reassurance and observe
- Moderate to severe symptoms
- Restart medication and then slowly taper
- See specific medications for taper schedule
- Symptoms abate soon after restarting medication
- Restart medication and then slowly taper
VI. Management: Specific Withdrawal Symptoms
-
Cholinergic rebound symptoms (See above)
- Atropine 0.8 mg PO tid to qid
- Cogentin 0.5 to 4 mg PO qd
- Artane 1-4 mg PO tid to qid
- Donnatal 2 tablets PO tid-qid
- Anxiety
- Lorazepam 0.5 to 1 mg PO tid prn
-
Dizziness
- Antivert 12.5 to 25 mg PO q6 hours prn
- Dramamine 50 mg PO q6 hours prn