Abstract
Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), like the tricyclic antidepressants and monoamine oxidase inhibitors, are associated with a well recognised syndrome following discontinuation or dose reduction. There appear to be differences in the incidence of discontinuation syndromes within the class of SSRIs. Published case reports and adverse drug reaction reports both suggest the highest incidence of the syndrome with paroxetine and the lowest incidence with fluoxetine, while other SSRIs are associated with an intermediate incidence. Open label comparison and placebo-controlled double-blind studies support this contention.
There is little evidence to separate discontinuation syndromes with different SSRIs on the basis of clinical presentation. Although the pathogenesis of SSRI discontinuation syndromes is unknown, both pharmacodynamic and pharmacokinetic factors may explain differences in incidence with individual SSRIs.
SSRI discontinuation syndromes are usually mild and transient, and prevention is the most effective management strategy.
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References
Kuhn R. On the treatment of depressive states with an iminodibenzyl derivative (G 22355). Nederlansch Tijdschrift Voor Geneeskunde 1957; 87: 1135
Lader M. Benzodiazepine withdrawal states. In: Trimble MR, editor. Benzodiazepines divided. New York (NY): John Wiley &Sons, 1983: 17–31
Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol 1998; 12(3); 305–13
Gillespie C, Wildgust HJ, Haddad P, et al. SSRIs and withdrawal syndrome. Presented at the X World Congress of Psychiatry, 1996 Aug; Madrid, 23–28
Haddad P. Newer antidepressants and the discontinuation syndrome. J Clin Psychol 1997; 58 Suppl. 7: 17–22
Adverse Drug Reactions Advisory Committee. Aust Adv Drug React Bull 1996; 15: 3
Price JS, Waller PC, Wood SM, et al. A comparison of the post-marketing safety of four selective serotonin re-uptake inhibitors including the investigation of symptoms occurring on withdrawal. Br J Clin Pharmacol 1996; 42: 757–63
Stahl MMS, Lindquist M, Pettersson M, et al. Withdrawal reactions with selective serotonin re-uptake inhibitors as reported to the WHO system. Eur J Clin Pharmacol 1997; 53: 163–9
Coupland NJ, Bell CJ, Potokar JP. Serotonin reuptake inhibitor withdrawal. J Clin Psychopharmacol 1996; 16: 356–62
Rosenbaum JF, Fava M, Hoog SL, et al. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomised clinical trial. Biol Psychol 1998; 44: 77–87
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psych 1960; 23: 56–62
Zajecka J, Fawcett J, Amsterdam J, et al. Safety of abrupt discontinuation of fluoxetine: a randomised, placebo controlled study. J Clin Psychopharmacol 1998; 18: 193–7
Oehrberg S, Christiansen PE, Behnke K, et al. Paroxetine in the treatment of panic disorder: a randomised, double-blind, placebo-controlled study. Br J Psychol 1995; 167: 374–9
Dilsaver SC. Withdrawal phenomena associated with antidepressant and anti psychotic agents. Drug Saf 1994; 10(2): 103–14
Lucot JB, Crampton GH. 8-OH-DPAT suppreses vomiting in the cat elicited by motion, cisplatin or xylazine. Pharmacol Biochem Behav 1989; 33(3): 627–31
Richelson E. The pharmacology of antidepressants at the synapse: focus on the newer compounds. J Clin Psych 1994; 55 Suppl. A: 34–9
Preskorn SH. Clinical pharmacology of selective serotonin reuptake inhibitors. 1st ed. Caddo (OK): Professional Communications Inc., 1996
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Olver, J.S., Burrows, G.D. & Norman, T.R. Discontinuation Syndromes with Selective Serotonin Reuptake Inhibitors. Mol Diag Ther 12, 171–177 (1999). https://doi.org/10.2165/00023210-199912030-00001
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DOI: https://doi.org/10.2165/00023210-199912030-00001