management of discontinuation syndrome

Last edited 05/2018

  • management
      • treatment of discontinuation symptoms depends on
        • (i) whether or not further antidepressant medication is warranted and
        • (ii) the severity of the discontinuation symptoms
    • if further antidepressant treatment is warranted
      • then restarting the antidepressant will cause rapid resolution of the symptoms
    • if further antidepressant treatment is not clinically indicated then management depends on the severity of the discontinuation symptoms
      • majority of symptoms are mild and in these cases treatment usually requires only that the patient be reassured about their self-limiting nature
      • if symptoms are of moderate severity then can be treated symptomatically
        • e.g. insomnia may be treated with a short course of a benzodiazepine
      • if severe discontinuation symptoms then the antidepressant can be reinstated, symptoms will usually resolve within 24 h and then the antidepressant can be withdrawn more cautiously
        • always include an appropriate explanation of the symptoms to the patient and follow-up to ensure that the symptoms have resolved
      • if, when attempting to withdraw and stop an antidepressant, severe discontinuation symptoms appear either during or at the end of a taper
        • consider increasing the antidepressant dose back to the lowest dose that prevented their appearance, and then commencing a slower taper
          • some patients may require a very gradual tapers to prevent discontinuation symptoms reappearing

    • specialist advice may suggest a from current SSRI to fluoxetine, the SSRI with the longest half-life in the management of discontinuation symptoms related to an SSRI/venlafaxine
      • some case reports suggest that fluoxetine can suppress discontinuation symptoms associated with other SSRIs
        • if the switch is successful, fluoxetine can usually be stopped after several weeks of treatment without discontinuation symptoms reappearing
        • effectiveness of this strategy appears to reflect the long half-life of fluoxetine (1.9 days) and its active metabolite norfluoxetine, which has a half-life of 7-15 days

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