//fpnotebook.com/
Antidepressant Withdrawal
Aka: Antidepressant Withdrawal, Antidepressant Discontinuation Syndrome, SSRI Discontinuation Syndrome
- Pathophysiology
- Occurs with sudden Antidepressant Withdrawal
- Selective Serotonin Reuptake Inhibitor (SSRI)
- Tricyclic Antidepressant
- MAO inhibitor
- 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)
- Symptoms
- Cholinergic rebound (See Cholinergic Toxicity)
- Diaphoresis
- Nausea or Vomiting
- Diarrhea
- Non-specific Withdrawal symptoms
- Dizziness
- Anxiety
- Headache
- Malaise
- Myalgias
- Weakness
- Sleep Disturbance
- Extrapyramidal Effects
- Paresthesias
- Restless legs
- Differential Diagnosis
- Bipolar Disorder with Antidepressant-induced mania
- 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
- 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
- Reference
- Wolfe (1997) Am Fam Physician 56(2):455-461 [PubMed]