Discontinuation symptoms are least likely to occur with which of the following?
Antidepressants (discontinuation symptoms)
Discontinuation symptoms are common in patients stopping antidepressants of all types.
The onset is usually within 5 days of stopping but varies depending on half life. Most antidepressant discontinuation reactions are of short duration, resolving spontaneously between 1 day and 3 weeks after onset. The mean duration of SSRI discontinuation symptoms is 5 days. Clinical experience is that discontinuation symptoms usually resolve fully within 24 h if the original antidepressant is recommenced. Tapering antidepressants at the end of treatment, rather than abrupt stoppage, is recommended as standard practice by several authorities and treatment guidelines.
SSRI and related discontinuation
Common symptoms include:-
- Flu-like symptoms
- Dizziness
- Insomnia
- Vivid dreams
- Irritability
- Crying spells
- Sensory symptoms (e.g. sensations resembling electric shocks)
SSRIs and related drugs particularly associated with discontinuation symptoms include:-
- Paroxetine
- Venlafaxine
Discontinuation symptoms seem least likely with fluoxetine (Tint, 2008).
TCA discontinuation
Common symptoms include:-
- Flu-like symptoms
- Insomnia
- Excessive dreaming
TCAs particularly associated with discontinuation symptoms include:-
- Amitriptyline
- Imipramine
MAOI discontinuation
Common symptoms include:-
- Agitation/ irritability
- Ataxia
- Movement disorders
- Insomnia
- Vivid dreams
All MAOIs are associated with prominent discontinuation symptoms.
Risk factors for discontinuation symptoms include:-
- Using drugs with a short half-life (e.g. paroxetine, venlafaxine)
- Using antidepressants for 8 weeks or longer
- Those that developed anxiety symptoms early in treatment
- Those taking other centrally acting drugs (e.g. antihypertensives, antihistamines, antipsychotics)
- Younger people
- Those that have experienced discontinuation symptoms before
Maudsley Guidelines 12th Edition.
Tint (2008) The effect of rate of antidepressant tapering on the incidence of discontinuation symptoms: A randomised study. J Psychopharmacol 22: 330332.
