Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review
Open accessAbstract
Background: Selective serotonin reuptake inhibitors (SSRI) are widely used in medical practice. They have been associated with a broad range of symptoms, whose clinical meaning has not been fully appreciated. Methods: The PRISMA guidelines were followed to conduct a systematic review of the literature. Titles, abstracts, and topics were searched using the following terms: ‘withdrawal symptoms' OR ‘withdrawal syndrome' OR ‘discontinuation syndrome' OR ‘discontinuation symptoms', AND ‘SSRI' OR ‘serotonin' OR ‘antidepressant' OR ‘paroxetine' OR ‘fluoxetine' OR ‘sertraline' OR ‘fluvoxamine' OR ‘citalopram' OR ‘escitalopram'. The electronic research literature databases included CINAHL, the Cochrane Library, PubMed and Web-of-Science from inception of each database to July 2014. Results: There were 15 randomized controlled studies, 4 open trials, 4 retrospective investigations, and 38 case reports. The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies. Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering. However, many variations are possible, including late onset and/or longer persistence of disturbances. Symptoms may be easily misidentified as signs of impending relapse. Conclusions: Clinicians need to add SSRI to the list of drugs potentially inducing withdrawal symptoms upon discontinuation, together with benzodiazepines, barbiturates, and other psychotropic drugs. The term ‘discontinuation syndrome' that is currently used minimizes the potential vulnerabilities induced by SSRI and should be replaced by ‘withdrawal syndrome'.
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Cites
Statistics
Claims the paper makes
20 of 144 cited sources checked · 2 supported · 1 flagged · accuracy not yet measured
- Findingcitation
In social anxiety disorder patients, 1 and 2 weeks after randomization, the total DESS score was significantly higher in those who discontinued escitalopram than in the continuation group (p < 0.01).
“Results showed that, 1 and 2 weeks after randomization, the total DESS score was significantly higher in those who discontinued escitalopram than in the continuation group (p < 0.01).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [36] source
The Withdrawal reactions section reports spontaneous adverse-reaction reports for paroxetine, sertraline, fluoxetine and fluvoxamine. Our copy does not address escitalopram, social anxiety disorder, DESS scores or a randomized discontinuation-versus-continuation comparison; searches for those terms and the stated time points found no supporting passage. Page numbers were unavailable for the indexed passages. (LLM, conf=0.78)
Experimental — accuracy not yet measured
- Findingcitation
Only a few studies used either a definition of withdrawal reaction based on specific criteria or a cutoff score of the DESS to determine the occurrence of withdrawal symptoms.
“However, only a few studies used either a definition of withdrawal reaction based on specific criteria [23,47] or a cutoff score of the DESS [36,40,43,46] to determine the occurrence of withdrawal symptoms.”
Quote in the paperNot a substantial claim1 of 6 sources checked- cites [23] source
- cites [47] source
- cites [36] source
The Methods describe scrutinising spontaneous reports of withdrawal reactions and following up paroxetine reports with a standardised questionnaire, but the passages found do not state specific criteria for defining a withdrawal reaction. I searched the Methods for a definition and inclusion criteria; the paper also does not assess how many studies used such criteria. (LLM, conf=0.70)
Experimental — accuracy not yet measured - cites [40] source
- cites [43] source
- cites [46] source
- Findingcitation
Discontinuation syndromes subsided within a month in all but 3 patients (27%) in the Fava et al. study.
“Discontinuation syndromes subsided within a month in all but 3 patients (27%).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [50] source
In the letter “Citalopram withdrawal symptoms” (page not provided), Benazzi reports that one patient’s symptoms disappeared after a week, supporting only the general point that symptoms can subside within a month. The letter does not report a Fava et al. study or the claim that three patients (27%) still had symptoms after a month. (LLM, conf=0.85)
Experimental — accuracy not yet measured
- Findingcitation
Nine of 20 patients (45%) with panic disorder and agoraphobia who had remitted upon behavioral treatment experienced a discontinuation syndrome according to specific criteria based on the DESS after gradual tapering of SSRI.
“Nine of 20 patients (45%) experienced a discontinuation syndrome according to specific criteria based on the DESS.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [50] source
The letter “Citalopram withdrawal symptoms” (page not provided) describes one patient who developed symptoms suggestive of a discontinuation syndrome despite slow tapering. It does not report a group of 20 patients, nine cases (45%), behavioral treatment, or DESS-based criteria. (LLM, conf=0.88)
Experimental — accuracy not yet measured
- Premisecitation
Animal studies concerned with the long-term use of antidepressants have limited implications for understanding SSRI discontinuation because clear discontinuation-like behaviors in animal models are not available.
“Animal studies concerned with the longterm use of AD have limited implications, since clear discontinuation-like behaviors in animal models are not available [28] .”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [28] source
The Tolerability assessments and Discussion passages describe discontinuation symptoms in human patients after stopping SSRIs. Searches for animal studies and discontinuation-like behaviors in animal models found no passage addressing whether such behaviors are available or what that means for interpreting long-term antidepressant studies. Page numbers were not provided in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Premisecitation
Bhanji et al. and Fava et al. documented the persistence of symptoms up to 1 year following paroxetine discontinuation.
“Bhanji et al. [59] and Fava et al. [50] documented the persistence of symptoms up to 1 year following paroxetine discontinuation.”
Quote in the paperNot a substantial claim2 of 2 sources checked- cites [59] source
The Withdrawal Reactions section (page not specified in our copy) reports that discontinuation symptoms can persist for months or even years. The References section (p. 204) cites a report of persistent post-withdrawal disorders induced by paroxetine. The paper does not give a specific duration of up to one year for paroxetine symptoms, so that detail is not established by this source. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [50] source
The letter ‘Citalopram withdrawal symptoms’ (page unavailable) mentions that paroxetine can cause discontinuation symptoms, but does not discuss symptoms persisting for a year or findings by Bhanji et al. or Fava et al. Its reported case concerns citalopram, with symptoms disappearing after one week. Searches for paroxetine, the named authors, and year-long persistence found no passage addressing the attributed finding. (LLM, conf=0.76)
Experimental — accuracy not yet measured
- Interpretationcitation
When withdrawal symptoms persist and are distressing, reinstitution of the same antidepressant that triggered the problem or its substitution with a long-acting SSRI such as fluoxetine may only postpone and aggravate the issue.
“However, when symptoms persist and are distressing, the reinstitution of the same AD that triggered the problem or its substitution with a long-acting SSRI such as fluoxetine [26] may only postpone and aggravate the issue [86] .”
Quote in the paperNot a substantial claim1 of 2 sources checked- cites [26] source
The Interventions section describes tapering sertraline and venlafaxine XR, and Signs and Symptoms of Discontinuation reports symptoms during that taper. The copy does not address substituting fluoxetine for a withdrawn antidepressant or reinstituting the same drug to manage persistent symptoms (searched: fluoxetine substitution, reinstitution, and postponing taper). The sentence attaches a separate citation, [86], to the claim that these approaches may postpone and aggravate the issue. (LLM, conf=0.75)
Experimental — accuracy not yet measured - cites [86]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Placebo substitution, but not continued active medication, was associated with statistically significant increases in total numbers of solicited adverse events for patients treated with paroxetine by the end of the fourth day (p < 0.001).
“The study showed that placebo substitution, but not continued active medication, was associated with statistically significant increases in total numbers of solicited adverse events for patients treated with paroxetine by the end of the fourth day (p < 0.001).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [37] source
- Findingcitation
In a citalopram trial, there were no differences in neurological and psychiatric symptoms between individuals switched to placebo and those who continued active treatment.
“Results, obtained according to the patients' relapse status, showed no differences in neurological and psychiatric symptoms between individuals switched to placebo and those who continued with the active treatment.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [33] source
- Findingcitation
After 2 weeks of fluoxetine discontinuation, somnolence was significantly more frequent in patients who abruptly discontinued fluoxetine (4%) than in those who continued fluoxetine (0%, p < 0.01).
“After 2 weeks, somnolence was found to be significantly more frequently present in patients who abruptly discontinued the medication (4%) than in those who continued to receive fluoxetine (0%, p < 0.01).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] source
- Findingnone given
The estimation of the SSRI discontinuation syndrome was hindered by a lack of case identification in many studies.
“syndrome was variable, and its estimation was hindered by a lack of case identification in many studies.”
Quote in the paperNot a substantial claim - Findingnone given
Many variations in SSRI withdrawal symptoms are possible, including late onset and/or longer persistence of disturbances.
“However, many variations are possible, including late onset and/or longer persistence of disturbances.”
Quote in the paperNot a substantial claim - Findingown data
There were 15 RCT comparing fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and placebo or other AD.
“There were 15 RCT comparing fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and placebo or other AD (online suppl.table 1).”
Quote in the paperNot a substantial claim - Findingcitation
During discontinuation, anxiety, depression, somatic symptoms, and hostility were significantly greater in the paroxetine and sertraline groups (p < 0.001 in all conditions) than in the fluoxetine arm.
“Further, during discontinuation, anxiety, depression, somatic symptoms, and hostility were significantly greater in the paroxetine and sertraline groups (p < 0.001 in all conditions) than in the fluoxetine arm.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
- Findingcitation
About 16% of patients taking paroxetine versus 6% of those receiving fluoxetine reported discontinuation symptoms (p < 0.05).
“About 16% of patients taking paroxetine versus 6% of those receiving fluoxetine reported discontinuation symptoms (p < 0.05).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [38] source
- Findingcitation
Two open trials of fluvoxamine involving 17 obsessive-compulsive disorder and 14 panic disorder patients systematically reported the emergence of withdrawal syndromes.
“Two open trials of fluvoxamine involving respectively 17 obsessive-compulsive disorder [48] and 14 panic disorder [3] patients systematically reported the emergence of withdrawal syndromes.”
Quote in the paperNot a substantial claim0 of 2 sources checked - Findingcitation
About 27% of a sample of 97 patients with dysthymic disorder reported withdrawal symptoms after discontinuing paroxetine or fluoxetine according to their psychiatrist's instructions.
“About 27% of the total sample reported withdrawal symptoms after discontinuing their medication according to their psychiatrist's instructions.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] source
- Findingcitation
Six case reports of fluoxetine withdrawal reactions were retrieved.
“Six case reports of fluoxetine withdrawal reactions were retrieved [1,5,10,[56][57][58] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1,5,10,[56][57][58]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
Patients who suspended their SSRI abruptly reported a significantly greater number of adverse events than those who tapered the drug (p < 0.01).
“Specifically, patients who suspended their medication abruptly reported a significantly greater number of adverse events than those who tapered the drug (p < 0.01).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [55] source
- Findingcitation
In 385 outpatients with a single episode of MDD who had undergone monotherapy with paroxetine, 10% experienced discontinuation symptoms.
“Findings showed that 10% of patients experienced discontinuation symptoms.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54] source
- Findingcitation
There were no differences between sertraline and venlafaxine XR in ADDS symptoms that occurred in more than 10% of patients.
“The authors reported only ADDS symptoms that occurred in more than 10% of patients, showing no differences between those who received sertraline compared to venlafaxine XR.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] source
- Findingcitation
In a short placebo substitution condition, there were no significant differences in discontinuation-emergent effects.
“During the short placebo substitution, there were no significant differences.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [45] source
- Findingcitation
Withdrawal symptoms were more likely to occur in patients who discontinued paroxetine abruptly than in those who tapered the drug.
“Furthermore, withdrawal symptoms were more likely to occur in patients who discontinued paroxetine abruptly than in those who tapered the drug.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [54] source
- Findingcitation
In a tapered discontinuation condition, changes in total DESS score were significantly greater for paroxetine than escitalopram after 1 week of alternate-day dosing (p < 0.01) and a subsequent posttreatment week with placebo (p < 0.01).
“In the tapered condition, results showed that the changes in the total DESS score were significantly greater for paroxetine than escitalopram after 1 week of alternate-day dosing (p < 0.01) and a subsequent (posttreatment) week with placebo (p < 0.01).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [45] source
- Findingcitation
Discontinuation syndrome was more common in young patients than in the elderly.
“Discontinuation syndrome was also more common in young patients than in the elderly.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [53] source
- Findingcitation
Of the dysthymic disorder patients who reported withdrawal symptoms, 84.6% were treated with paroxetine.
“Of these, 84.6% were treated with paroxetine.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] source
- Findingcitation
Patients with an earlier onset of dysthymic disorder were more likely to report withdrawal symptoms.
“Further, patients with an earlier onset of dysthymic disorder were more likely to report withdrawal symptoms.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [49] source
- Findingcitation
In 87 depressed patients whose maintenance therapy with paroxetine, fluoxetine, sertraline, and citalopram was interrupted for 4-7 days, paroxetine caused significantly more discontinuation symptoms than other SSRI did (p < 0.05).
“Specifically, Hindmarch et al. [40] , in 87 patients suffering from depression who had their maintenance therapy with paroxetine, fluoxetine, sertraline, and citalopram interrupted for 4-7 days, reported that, although DESS scores increased in all treatment groups, paroxetine caused significantly more discontinuation symptoms than other SSRI did (p < 0.05).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40] source
- Findingown data
Eight case reports highlighted the presence of withdrawal reactions in subjects discontinuing sertraline.
“Eight case reports highlighted the presence of withdrawal reactions in subjects discontinuing sertraline.”
Quote in the paperNot a substantial claim - Findingcitation
Subjects taking venlafaxine XR reported discontinuation symptoms from minimal to very severe (minimal = 17.7%; mild = 27.4%; moderate = 38.7%; severe = 3.2%; very severe = 1.6%).
“Subjects taking venlafaxine XR also reported discontinuation symptoms from minimal to very severe (minimal = 17.7%; mild = 27.4%;moderate = 38.7%;severe = 3.2%; very severe = 1.6%).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] source
- Findingown data
We identified 18 case reports of withdrawal symptoms in adult patients (aged 22-73 years) taking paroxetine.
“We identified 18 case reports of withdrawal symptoms in adult patients (aged 22-73 years) taking paroxetine.”
Quote in the paperNot a substantial claim - Findingreasoning
The prevalence of the withdrawal syndrome was variable.
“The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies.”
Quote in the paperNot a substantial claim - Findingcitation
Many variations in the timing of withdrawal syndrome are possible, including late onset and/or longer persistence of disturbances.
“However, many variations are possible, including late onset and/or longer persistence of disturbances [9,16,68,76] .”
Quote in the paperNot a substantial claim0 of 4 sources checked - Findingnone given
The estimation of the prevalence of the withdrawal syndrome was hindered by a lack of case identification in many studies.
“The prevalence of the syndrome was variable, and its estimation was hindered by a lack of case identification in many studies.”
Quote in the paperNot a substantial claim - Findingnone given
The withdrawal syndrome typically lasts a few weeks.
“The withdrawal syndrome typically occurs within a few days from drug discontinuation and lasts a few weeks.”
Quote in the paperNot a substantial claim - Findingcitation
Symptoms when paroxetine was discontinued were significantly superior to placebo in most of the RCTs that were performed.
“Symptoms when paroxetine was discontinued were significantly superior to placebo in most of the RCT that were performed [22,32,[37][38][39][40][43][44][45] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites 22,32,[37][38][39][40][43][44][45]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingnone given
The withdrawal syndrome typically occurs within a few days from drug discontinuation.
“The withdrawal syndrome typically occurs within a few days from drug discontinuation and lasts a few weeks.”
Quote in the paperNot a substantial claim - Findingcitation
There is more limited overlap between SSRI withdrawal phenomena and those occurring with tricyclic antidepressants.
“There are many similarities with withdrawal phenomena that characterize second-generation antidepressants such as venlafaxine and duloxetine [79,80] and benzodiazepines [27] but more limited overlap with those occurring with tricyclic antidepressants [81] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [81]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
There are many similarities between SSRI withdrawal phenomena and those of second-generation antidepressants such as venlafaxine and duloxetine.
“There are many similarities with withdrawal phenomena that characterize second-generation antidepressants such as venlafaxine and duloxetine [79,80] and benzodiazepines [27] but more limited overlap with those occurring with tricyclic antidepressants [81] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [79]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [80]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingcitation
There are many similarities between SSRI withdrawal phenomena and those of benzodiazepines.
“There are many similarities with withdrawal phenomena that characterize second-generation antidepressants such as venlafaxine and duloxetine [79,80] and benzodiazepines [27] but more limited overlap with those occurring with tricyclic antidepressants [81] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [27] source
- Findingown data
Withdrawal symptoms may occur with any type of SSRI (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline).
“Despite the limited literature available, the results of this systematic review indicate that withdrawal symptoms may occur with any type of SSRI (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), even though they are exceedingly more frequent with paroxetine.”
Quote in the paperSubstantial claim - Findingown data
Withdrawal symptoms are exceedingly more frequent with paroxetine than with other SSRIs.
“Despite the limited literature available, the results of this systematic review indicate that withdrawal symptoms may occur with any type of SSRI (citalopram, escitalopram, fluoxetine, fluvoxamine, paroxetine, and sertraline), even though they are exceedingly more frequent with paroxetine.”
Quote in the paperSubstantial claim - Findingcitation
A significant advantage of gradual tapering compared to abrupt discontinuation did not emerge.
“Indeed, a significant advantage of gradual tapering compared to abrupt discontinuation did not emerge [45,46] .”
Quote in the paperSubstantial claim0 of 2 sources checked - Findingcitation
Three clinical cases reporting withdrawal reactions in patients receiving citalopram were found.
“Three clinical cases reporting withdrawal reactions in patients receiving citalopram were also found [74][75][76] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [74][75][76]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Findingnone given
We do not have a clear and specific set of sociodemographic and clinical characteristics that may be associated with increased vulnerability to SSRI withdrawal.
“We do not have a clear and spe-cific set of sociodemographic and clinical characteristics that may be associated with increased vulnerability.”
Quote in the paperNot a substantial claim - Findingreasoning
The results of this review indicate that SSRI need to be added to the list of drugs potentially inducing withdrawal phenomena.
“The results of this review indicate that they need to add SSRI to the list of drugs potentially inducing withdrawal phenomena.”
Quote in the paperSubstantial claim - Premisecitation
Discontinuation symptoms occur also after gradual tapering, not only after abrupt suspension.
“Even though discontinuation symptoms were mostly reported after abrupt suspension, they were found to occur also after gradual tapering [17][18][19]”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17][18][19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
A discontinuation syndrome consisting of a cluster of somatic and psychological symptoms can occur after SSRI discontinuation.
“one of the earliest reviews [17] suggested that a discontinuation syndrome consisting of a cluster of somatic and psychological symptoms could indeed occur.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [17] source
- Premisecitation
Case reports in the 1990s documented withdrawal reactions following the discontinuation of SSRIs.
“In the 1990s, case reports [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] started documenting withdrawal reactions following the discontinuation of selective serotonin reuptake inhibitors (SSRI).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
SSRI withdrawal symptoms may be easily misidentified as signs of impending relapse.
“Symptoms may be easily misidentified as signs of impending relapse.”
Quote in the paperSubstantial claim - Study design and conductreasoning
A meta-analysis was not deemed appropriate because of highly heterogeneous patient populations and differences in the design of RCT.
“In view of the highly heterogeneous patient populations and differences in the design of RCT, a meta-analysis was not deemed to be appropriate.”
Quote in the paperSubstantial claim - Premisecitation
Rebound phenomena (a rapid return and worsening of the patient's original symptoms) may also take place with SSRI.
“The clinical picture may be complicated by the fact that rebound phenomena (a rapid return and worsening of the patient's original symptoms) may also take place with SSRI [86] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [86]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationnone given
Symptoms of SSRI withdrawal may be easily misidentified as signs of impending relapse.
“Symptoms may be easily misidentified as signs of impending relapse.”
Quote in the paperSubstantial claim - Interpretationcitation
Defining 'withdrawal syndromes' as those pertaining to benzodiazepines, antipsychotic drugs, and tricyclic antidepressants and 'discontinuation syndromes' as those of SSRI does not appear to reflect the evidence in the literature.
“Defining 'withdrawal syndromes' as those pertaining to benzodiazepines [27] , antipsychotic drugs [93] , and tricyclic antidepressants [80] and 'discontinuation syndromes' as those of SSRI does not appear to reflect the evidence in the literature.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [27] source
- cites [93]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [80]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
Trial designs that assess the effects of discontinuation of antidepressants for inferring efficacy are flawed by a lack of consideration of withdrawal events.
“Similarly, trial designs, such as in a recent paper on AD in dementia [92] , that assess the effects of discontinuation of AD for inferring efficacy (i.e., a significant increase in depressive symptoms in the patients whose AD are discontinued compared to those who continue with treatment) are flawed by a lack of consideration of withdrawal events.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [92]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Nielsen et al. have demonstrated that there are impressive similarities between SSRI and benzodiazepines in this respect.
“However, Nielsen et al. [27] have demonstrated that there are impressive similarities between SSRI and benzodiazepines in this respect.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] source
- Classified as probably not a substantial claim. 29
- May combine two claims. 40
- The quote only partly states this claim. 3
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
FindingreasoningThe authors of the fluoxetine case reports did not report information on the duration of the withdrawal syndromes, probably because symptoms were treated by reintroducing fluoxetine or administering other drugs.
“The authors did not report information on the duration of the withdrawal syndromes, probably because symptoms were treated reintroducing fluoxetine [10,57,58] or administering other drugs [1,5] .”
Quote in the paperNot a substantial claim2 of 5 sources checked- cites [10] source
- cites [57] source
- cites [58] source
- cites [1] source
The case report (Abstract and Additional information; page unavailable) concerns withdrawal from fluvoxamine, not fluoxetine. It describes when symptoms appeared and says the patient continued fluvoxamine, but does not address the duration or treatment of the claimed fluoxetine withdrawal cases. Searches for fluoxetine withdrawal, symptom duration, reintroduction, and other drugs found no supporting passage. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [5] source
The Abstract (page unavailable) explicitly reports that withdrawal symptoms persisted for approximately seven days in all five cases, contrary to the claim that duration was not reported. It also says two patients received lorazepam, but these were paroxetine—not fluoxetine—withdrawal cases. (LLM, conf=0.88)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe prevalence of discontinuation symptoms differs according to the pharmacological profile of SSRI.
“and to differ in prevalence according to the pharmacological profile of SSRI [20,21]”
Quote in the paperNot a substantial claim1 of 2 sources checkedMay combine two claims.
FindingcitationLess common paroxetine withdrawal reactions were 'electric-shock' sensation, visual and auditory hallucination, nocturnal enuresis, pruritus, and emesis.
“Less common reactions were 'electric-shock' sensation [9,59,61,62] , visual and auditory hallucination [63] , nocturnal enuresis [64] , pruritus [65] , and emesis [6] .”
Quote in the paperNot a substantial claim2 of 6 sources checked- cites [9] source
- cites [59] source
The Withdrawal Reactions section lists vomiting among symptoms of antidepressant withdrawal, supporting the emesis portion to which this citation is attached. It does not identify vomiting as a less common reaction or specifically link it to paroxetine; its separate list of less common physical symptoms does not include vomiting. (LLM, conf=0.88)
Experimental — accuracy not yet measured - cites [61] source
- cites [62] source
Citation [6] is attached specifically to emesis. Section 2.1 discusses withdrawal reactions generally, and section 4.1 describes withdrawal after citalopram, but neither identifies emesis as a paroxetine withdrawal reaction. Searches for emesis, vomiting, and paroxetine found no passage addressing that point. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [63] source
- cites [64] source
May combine two claims.
FindingcitationIn all sertraline case reports, withdrawal reactions appeared within 1-5 days following either abrupt or tapered discontinuation and lasted from 1-2 weeks to 6 weeks or even longer (13-14 weeks).
“In all reports, withdrawal reactions appeared within 1-5 days following either abrupt [68,69] or tapered [9,14,13,16,70,71] discontinuation and lasted from 1-2 weeks [13,14,69,70] to 6 weeks [16] or even longer (13-14 weeks) [9,68] .”
Quote in the paperNot a substantial claim2 of 8 sources checked- cites [68] source
- cites [69]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [9] source
- cites [14] source
The PRISMA Statement’s sections on reporting biases and review protocols address systematic-review reporting, not sertraline withdrawal. Searches for sertraline, discontinuation, and the claimed onset and duration found no passage addressing those points in our copy. (LLM, conf=0.78)
Experimental — accuracy not yet measured - cites [13] source
The Clinical Evidence of SSRI Discontinuation Syndrome section reports sertraline discontinuation symptoms and describes diagnostic criteria for SSRI symptoms developing within 1–7 days after stopping or reducing a dose. It does not establish that all sertraline case reports had onset within 1–5 days, or give the claimed durations of 1–2, 6, or 13–14 weeks. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [16] source
- cites [70]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [71]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationBelaise et al. described 3 cases of persistent post-withdrawal disorders induced by paroxetine.
“Belaise et al. [62] described 3 cases of what they defined as 'persistent post-withdrawal disorders induced by paroxetine'.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites [62] source
Section 2.2 discusses persistent symptoms after SSRI withdrawal, and §4.1 describes one case involving citalopram. Searches for Belaise, paroxetine, and three paroxetine cases found no passage in our copy addressing the specific claim. Page numbers were not available in the indexed passages. (LLM, conf=0.76)
Experimental — accuracy not yet measured
May combine two claims.
FindingcitationDiscontinuation of SSRI may trigger complex phenomena, such as hypomania or mania and persistent postwithdrawal disorders.
“Third, discontinuation of SSRI may trigger complex phenomena, which may or may not be related to the onset of withdrawal symptomatology, such as hypomania or mania [85,88] and persistent postwithdrawal disorders [62] .”
Quote in the paperSubstantial claim1 of 3 sources checked- cites [85]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [88]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [62] source
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThere are anecdotal reports on the use of clonazepam and other benzodiazepines or mood stabilizers for SSRI withdrawal.
“There are anecdotal reports on the use of clonazepam and other benzodiazepines or mood stabilizers, which, however, need to be properly tested [15,50,59,62,72] .”
Quote in the paperNot a substantial claim3 of 5 sources checked- cites [15] source
- cites [50] source
In “Citalopram withdrawal symptoms” (page unavailable), the case report describes a patient taking alprazolam and valproate when citalopram was discontinued and withdrawal symptoms appeared. It does not describe those drugs as treatments for withdrawal, mention clonazepam, or assess whether such treatments need testing. (LLM, conf=0.82)
Experimental — accuracy not yet measured - cites [59] source
The Withdrawal Reactions section says antidepressant discontinuation can trigger hypomania or mania that may require specific antimanic treatment. It does not report anecdotal use of clonazepam, other benzodiazepines, or mood stabilizers to treat SSRI withdrawal; the clonazepam discussion in AD in Anxiety Disorders concerns social-anxiety treatment instead. The cited copy provides no page number for these passages. (LLM, conf=0.79)
Experimental — accuracy not yet measured - cites [62] source
Section 4.1 describes alprazolam being prescribed alongside citalopram, then tapered before citalopram; it does not describe its use to treat SSRI withdrawal. Section 4.3 discusses withdrawal from both antidepressants and benzodiazepines, but the passages found for clonazepam, mood stabilizers, and withdrawal treatment do not report anecdotal use of those drugs for SSRI withdrawal. Page numbers were not available in our copy. (LLM, conf=0.76)
Experimental — accuracy not yet measured - cites [72]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationDuring discontinuation, the paroxetine treatment group reported significant increases in depressive symptoms and clinical global severity scores as well as difficulty in social functioning.
“During discontinuation, the paroxetine treatment group also reported significant increases in depressive symptoms and clinical global severity scores as well as difficulty in social functioning.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [38] source
May combine two claims.
FindingcitationAfter treatment interruption, discontinuation symptoms measured by DESS were more frequently reported by patients treated with paroxetine (p < 0.001) and sertraline (p < 0.001) than by those receiving fluoxetine.
“After treatment interruption, discontinuation symptoms, as measured through the DESS, were more frequently reported by patients treated with paroxetine (p < 0.001) and sertraline (p < 0.001) than by those receiving fluoxetine.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
May combine two claims.
FindingcitationAt weeks 4 and 6 after fluoxetine discontinuation, subjects in the placebo group reported dizziness more frequently than patients in the continuation group (7 vs. 4%, p < 0.05 and 5 vs. 1%, p < 0.05, respectively).
“At weeks 4 and 6, subjects in the placebo group reported dizziness more frequently than patients in the continuation group (7 vs. 4%, p < 0.05 and 5 vs. 1%, p < 0.05, respectively).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] source
May combine two claims.
Findingnone givenSSRI withdrawal symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering.
“Symptoms typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.
Findingown dataThe literature search identified 437 potentially relevant papers, and 61 investigations met the criteria for inclusion.
“The literature search identified 437 potentially relevant papers about SSRI withdrawal/discontinuation syndrome; 275 were left after the removal of duplicates.”
- Also stated in: § Characteristics of Included Studies · plain
“A total of 61 investigations met the criteria for inclusion in the study”
Quote in the paperNot a substantial claim- Also stated in: § Characteristics of Included Studies · plain
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Findingown dataOther included studies were 4 open trials, 4 retrospective investigations, and 38 clinical reports.
“Other studies included 4 open trials and 4 retrospective investigations (online suppl.table 2).A total of 38 clinical reports were also examined (online suppl.table 3).”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationAmong patients treated with paroxetine, sertraline, or fluoxetine, those treated with paroxetine reported the greatest number of DESS symptoms compared to those treated with sertraline (p < 0.05) and fluoxetine (p < 0.001).
“When treatments were compared, individuals treated with paroxetine reported the greatest number of DESS symptoms compared to those treated with sertraline (p < 0.05) and fluoxetine (p < 0.001).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [22] source
May combine two claims.
FindingcitationIncreased dreaming, trouble sleeping, nervousness or anxiety, irritability, and sudden worsening of mood occurred with an incidence >10% in the escitalopram group.
“Increased dreaming, trouble sleeping, nervousness or anxiety, irritability, and sudden worsening of mood occurred with an incidence >10% in the escitalopram group.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41] source
May combine two claims.
FindingcitationIn a randomized trial of short (3 days) versus long (14 days) taper, 46% of subjects reported discontinuation symptoms, and the incidence was similar in both conditions (47 vs. 46% in the short vs. long taper groups).
“Results showed that 46% of subjects reported discontinuation symptoms and that the incidence was similar in both conditions (47 vs. 46% in the short vs. long taper groups).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [46] source
May combine two claims.
FindingcitationIn a retrospective chart study of 171 patients who discontinued clomipramine and different SSRI, symptoms occurred significantly more frequently in patients treated with shorter half-life SSRI (fluvoxamine or paroxetine, 17.2%) or clomipramine (30.8%) than in patients taking SSRI with longer half-life metabolites such as sertraline or fluoxetine (1.5%).
“Symptoms occurred significantly more frequently in patients who were treated either with one of the shorter half-life SSRI, fluvoxamine or paroxetine (17.2%), or with clomipramine (30.8%) than in patients taking SSRI with longer half-life metabolites such as sertraline or fluoxetine (1.5%).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [52] source
May combine two claims.
FindingcitationIn all retrieved fluoxetine case reports, subjects abruptly discontinued their medications, and withdrawal symptoms mostly appeared within 2 days, except for 1 patient who reported symptoms 2 weeks after discontinuation.
“In all cases, subjects abruptly discontinued their medications, and withdrawal symptoms mostly appeared within 2 days, except for 1 patient who reported symptoms 2 weeks after discontinuation.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1,5,10,[56][57][58]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationAfter a tapered discontinuation, 34.3% of patients treated with sertraline experienced a discontinuation syndrome from moderate to severe; 23.9% experienced a mild discontinuation reaction, and 23.9% reported a minimal one.
“After a tapered discontinuation, 34.3% of patients treated with sertraline experienced a discontinuation syndrome from moderate to severe; 23.9% of them experienced a mild discontinuation reaction, while 23.9% reported a minimal one.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42] source
May combine two claims.
FindingcitationCommon symptoms in fluoxetine case reports were dizziness, light-headedness, and sleep disturbances.
“Common symptoms were dizziness, light-headedness, and sleep disturbances.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [1,5,10,[56][57][58]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationRates of withdrawal symptoms were significantly greater in patients who discontinued paroxetine than in those continuing on medication (p < 0.001), while no significant differences were found in the agomelatine patient group.
“Rates of withdrawal symptoms were significantly greater in patients who discontinued paroxetine than in those continuing on medication (p < 0.001), while no significant differences were found in the agomelatine patient group (3.0 ± 4.2 and 4.4 ± 5.7).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39] source
May combine two claims.
FindingcitationIn generalized anxiety disorder patients, those who discontinued paroxetine showed a significantly higher mean DESS score compared to controls (p < 0.001), while patients treated with escitalopram did not differ in adverse events from placebo controls.
“At discontinuation, while patients treated with escitalopram did not differ in terms of adverse events from placebo controls, those who discontinued paroxetine showed a significantly higher mean DESS score compared to controls (p < 0.001).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [44] source
May combine two claims.
FindingcitationAn association between the occurrence of discontinuation syndrome and age emerged, although it seemed to be moderated by younger patients being more inclined to abruptly stop the medication.
“Interestingly, an association between the occurrence of discontinuation syndrome and age emerged, although such an associa-tion seemed to be moderated by the fact that younger patients were more inclined to abruptly stop the medication.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [54] source
May combine two claims.
FindingcitationAmong patients with MDD, the average mean DESS score was 5.7 (SD = 7.36) for those who discontinued paroxetine, ranged from 2.4 to 3.2 for escitalopram, and was 0.2 (SD = 3.86) for fluoxetine.
“In conclusion, among patients with MDD, the average mean DESS score was 5.7 (SD = 7.36) for those who discontinued treatment with paroxetine [22,38,39,45] , whereas for escitalopram [41,45] it ranged from 2.4 to 3.2, and in both studies investigating fluoxetine discontinuation [22,38] , it was 0.2 (SD = 3.86).”
Quote in the paperSubstantial claim0 of 5 sources checkedMay combine two claims.
Findingown dataParoxetine discontinuation symptoms were reported independently of treatment duration (from few weeks to years) and type of discontinuation (abrupt vs. tapered).
“Discontinuation symptoms were reported independently of treatment duration (from few weeks to years) and type of discontinuation (abrupt vs. tapered).”
Quote in the paperNot a substantial claimMay combine two claims.
FindingcitationThe 3 patients whose discontinuation syndromes did not subside within a month all received paroxetine and displayed alternation of worsened mood, fatigue, and emotional instability with trouble sleeping, irritability, and hyperactivity, meeting DSM-IV criteria for cyclothymic disorder except for duration.
“These 3 patients all received paroxetine and displayed alternation of worsened mood, fatigue, and emotional instability with trouble sleeping, irritability, and hyperactivity, meeting the DSM-IV criteria [51] for cyclothymic disorder except for duration.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [51] source
May combine two claims.
FindingcitationTwenty-three percent of obsessive-compulsive disorder patients and 85.7% of panic disorder patients experienced dizziness, nausea, headache, confusion, low energy, and weakness that abated in about 2-3 weeks.
“Twenty-three percent of obsessive-compulsive disorder patients [48] and 85.7% of PD patients [3] experienced dizziness, nausea, headache, confusion, low energy, and weakness that abated in about 2-3 weeks.”
Quote in the paperNot a substantial claim0 of 2 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationWithdrawal reactions with paroxetine constituted a greater proportion of spontaneous reports than with other SSRI.
“Authors pointed out that withdrawal reactions with paroxetine constituted a greater proportion of the reports than with the other SSRI.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [53] source
Probably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationCase reports of escitalopram discontinuation syndrome involved 2 patients.
“Case reports of escitalopram discontinuation syndrome involved 2 patients [77,78] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [77]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [78]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationBoth escitalopram case report patients experienced electric-shock sensations a few days after drug stoppage, which lasted from 5 days to 4 weeks.
“Both experienced electric-shock sensations a few days after drug stoppage, which lasted from 5 days [77] to 4 weeks [78] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [77]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [78]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationOne sertraline case report patient experienced orthostatic hypotension.
“Furthermore, 1 patient experienced orthostatic hypotension [71] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [71]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationThree case reports of fluvoxamine discontinuation syndrome were published.
“Three case reports of fluvoxamine discontinuation syndrome were also published [2,72,73] .”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2] source
- cites [72]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [73]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationCitalopram withdrawal symptoms appeared within 1-5 days after the last dose and lasted from 1 week to 2 months.
“Symptoms appeared within 1-5 days after the last dose and lasted from 1 week [74] to 2 months [76] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [74]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [76]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationFluvoxamine withdrawal symptoms were managed with fluvoxamine resumption or treated with clonazepam.
“Symptoms were managed with fluvoxamine resumption [2,73] or treated with clonazepam [72] .”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2] source
- cites [73]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [72]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims. The quote only partly states this claim.
FindingreasoningThe evidence collected in this review indicates that antidepressant discontinuation reactions are not preventable and simple to treat.
“An editorial published in the late 1990s claimed that AD discontinuation reactions were preventable and simple to treat [47] .The evidence that we have just collected indicates the contrary.”
Quote in the paperSubstantial claimMay combine two claims.
Findingnone givenWithdrawal symptoms are likely to have an early onset, while recurrent symptoms generally present with a gradual return.
“Withdrawal symptoms are likely to have an early onset, while recurrent symptoms generally present with a gradual return.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
FindingcitationFatigue, instability, vertigo, and flu-like symptoms were the more frequently reported adverse reactions in sertraline case reports.
“Fatigue, instability, vertigo, and flu-like symptoms were the more frequently reported adverse reactions.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationAll citalopram case report subjects showing withdrawal syndromes gradually discontinued citalopram.
“All subjects showing withdrawal syndromes gradually discontinued citalopram.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [74][75][76]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
FindingcitationOne citalopram case report subject also experienced hypersensitivity of the genitals and premature ejaculation.
“One subject also experienced hypersensitivity of the genitals and premature ejaculation [76] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [76]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
FindingcitationExtrapyramidal symptoms and electric-shock sensations were also reported in sertraline case reports.
“Extrapyramidal symptoms and electric-shock sensations were also reported [9,70] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [9] source
- cites [70]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The quote only partly states this claim.
FindingcitationCommon citalopram withdrawal symptoms were dizziness, anxiety, and irritability.
“Common symptoms were dizziness, anxiety, and irritability.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [74][75][76]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
FindingcitationGradual tapering does not eliminate the risk of withdrawal reactions or prevent the onset of withdrawal phenomena.
“Gradual tapering does not eliminate the risk of withdrawal reactions.”
- Also stated in: § Discussion · hedged
“First, gradual tapering of SSRI appears to be a reasonable clinical strategy but does not prevent the onset of withdrawal phenomena.”
Quote in the paperSubstantial claim- Also stated in: § Discussion · hedged
May combine two claims.
FindingcitationEven though one patient gradually discontinued fluvoxamine and another missed only few doses, they both experienced withdrawal symptoms such as dizziness, nausea, paresthesia, loss of concentration, restless feelings, and agitation.
“Even though one patient gradually discontinued fluvoxamine [72] and another missed only few doses [73] , they both experienced withdrawal symptoms such as dizziness, nausea, paresthesia, loss of concentration, restless feelings, and agitation.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [72]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [73]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).
Findingnone givenThe term 'discontinuation syndrome' has progressively replaced 'withdrawal syndrome' in the SSRI literature.
“The term 'discontinuation syndrome' has progressively replaced 'withdrawal syndrome' in the SSRI literature.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe SSRI discontinuation syndrome can last up to 3 weeks and can be improved by restarting the same or a similar antidepressant drug.
“The clinical data suggested that the syndrome could last up to 3 weeks and could be improved by restarting the same or a similar antidepressant drug (AD).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [17] source
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenData were independently extracted by both reviewers with the use of a precoded form.
“Data were independently extracted by both reviewers with the use of a precoded form.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductreasoningThe citalopram study's duration of treatment was brief, and its assessment methods were not geared to detecting withdrawal symptoms.
“However, the duration of treatment was brief, and the assessment methods were not geared to detecting withdrawal symptoms.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductown dataSearch was carried out independently by two investigators, and disagreements were resolved by consensus among primary raters and other investigators.
“Search was carried out independently by two investigators (A.G. and C.B.); disagreements were resolved by consensus among these primary raters and the other investigators (G.A.F., J.G., and E.O.).”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenThe pathophysiological mechanisms of withdrawal phenomena are still hypothetical.
“The pathophysiological mechanisms of withdrawal phenomena are still hypothetical and in need of proper neurobiological investigations.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationcitationThe appearance of withdrawal symptoms after SSRI discontinuation may be potentially related to a number of important clinical phenomena.
“The appearance of withdrawal symptoms after SSRI discontinuation may thus be potentially related to a number of important clinical phenomena [86] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [86]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationThe general tendency of early onset for withdrawal symptoms and gradual return for recurrent symptoms does not apply to the widespread use of SSRI in anxiety disorders.
“However, this is only a general tendency with mood disorders and not a rule, which in any event does not apply to the widespread use of SSRI in anxiety disorders [87] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [87]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationPersistent post-withdrawal disturbances appear to be quite common on patients' websites.
“Such disturbances appear to be quite common on patients' websites [30] but await adequate exploration in clinical studies.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30] source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationContinued drug treatment may recruit processes that oppose the initial acute effects of a drug and may lead to a loss of efficacy and/or to a treatment-unresponsive course.
“Continued drug treatment may recruit processes that oppose the initial acute effects of a drug and may lead to a loss of efficacy and/or to a treatment-unresponsive course.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [85]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationWhen drug treatment ends, oppositional processes may operate for some time, resulting in the appearance of withdrawal symptoms and/or an increased vulnerability to relapse and/or resistance to treatment (if it is reinstituted) and/or switching to a bipolar course.
“When drug treatment ends, oppositional processes may operate for some time, resulting in the appearance of withdrawal symptoms and/or an increased vulnerability to relapse and/or resistance to treatment (if it is reinstituted) and/or switching to a bipolar course [85] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [85]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
InterpretationcitationThe shift from 'withdrawal syndrome' to 'discontinuation syndrome' was heavily supported by the pharmaceutical industry and was aimed at emphasizing that SSRI do not cause addiction or dependence, and symptoms are substantially different from the phenomena that take place with benzodiazepines.
“This shift was heavily supported by the pharmaceutical industry [27,88] and was aimed at emphasizing that SSRI do not cause addiction or dependence, and symptoms are substantially different from the phenomena that take place with benzodiazepines [24] .”
Quote in the paperSubstantial claim0 of 3 sources checkedClassified as probably not a substantial claim.
InterpretationreasoningEven when withdrawal symptoms are properly recognized, their clinical management is hindered by the complexity of the involved variables and the lack of appropriate research.
“Fourth, even when withdrawal symptoms are properly recognized, their clinical management is hindered by the complexity of the involved variables and the lack of appropriate research.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationClinicians are familiar with the withdrawal phenomena that may occur from alcohol, benzodiazepines, barbiturates, opioids, and stimulants.
“Clinicians are familiar with the withdrawal phenomena that may occur from alcohol, benzodiazepines, barbiturates, opioids, and stimulants [96] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [96]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.
InterpretationcitationThe use of the term 'discontinuation syndrome' has minimized the potential vulnerabilities induced by SSRI and has provided the ground for misleading indications.
“Indeed, the use of this latter term has minimized the potential vulnerabilities induced by SSRI and has provided the ground for misleading in-dications (e.g., AD are to be preferred to benzodiazepines in anxiety disorders due to a lack of dependence) [94,95] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [94]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [95]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable), S4 (based).
InterpretationreasoningThe term 'discontinuation syndrome' minimizes the vulnerabilities induced by SSRI.
“The term 'discontinuation syndrome' minimizes the vulnerabilities induced by SSRI and should be replaced by 'withdrawal syndrome'.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
InterpretationcitationAnother neglected area of research is the role of withdrawal symptoms in assessing switching strategies that are increasingly utilized in the treatment resistance of mood and anxiety disorders.
“Another neglected area of research is concerned with the role of withdrawal symptoms in assessing switching strategies that are increasingly utilized in the treatment resistance of mood and anxiety disorders [86,91] .”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [86]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [91]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S4 (based).
InterpretationreasoningDrug effects are attributed without adequate consideration of the confounding role of withdrawal symptoms.
“Drug effects are attributed without adequate consideration of the confounding role of withdrawal symptoms.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
The withdrawal symptoms reported in the included studies are attributable to SSRI discontinuation rather than to relapse or other causes.
“Symptoms may be easily misidentified as signs of impending relapse.”
The paper relies on this without support.
Knowledge about the clinical aspects of SSRI discontinuation is important because of the widespread use of SSRI in medical practice.
“Yet, such knowledge is important because of the widespread use of SSRI in medical practice.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Antidepressants have been associated with withdrawal symptoms since 1960 for TCAs and MAOs, and since the 1990s for SSRIs and SNRIs.
“Antidepressants have been associated with withdrawal symptoms since 1960 for TCAs and MAOs (Nilsen 2012), and since the 1990s for SSRIs and SNRIs (Fava 2015; Fava 2018b).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Fava 2015
The Introduction says case reports began documenting SSRI withdrawal reactions in the 1990s. The Multiple Drug Comparisons section also reports withdrawal symptoms with venlafaxine XR, an SNRI, but does not establish that SNRI withdrawal was documented in the 1990s. The TCA/MAOI portion is attributed to a different citation and is not assessed here; page numbers were not supplied for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe HAM-D has been criticised for problems in differentiating between withdrawal and depressive symptoms.
“However, this scale has been criticised because of its problems in differentiating between withdrawal and depressive symptoms (Fava 2015: Haddad 2007).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Fava 2015
The Discussion says withdrawal symptoms can be mistaken for signs of depressive relapse, supporting the general difficulty in distinguishing them. It does not identify the HAM-D or criticise that scale specifically (searched: HAM-D and Hamilton Depression Rating Scale). The indexed passages provide no page number. (LLM, conf=0.85)
Experimental — accuracy not yet measuredWithdrawal symptoms may be misdiagnosed as relapse when relapse is assessed with the HAM-D scale.
“Withdrawal symptoms may be misdiagnosed as relapse when relapse is assessed with the HAM-D scale (see above, Overall completeness and applicability of evidence) (Fava 2015: Haddad 2007).”
From Approaches for discontinuation versus continuation of long-term antidepressant use for depressive and anxiety disorders in adults (2021) · cites this paper as Fava 2015
The Discussion (page not provided) says SSRI withdrawal symptoms may be misidentified as signs of impending relapse. It does not link that risk specifically to assessing relapse with the HAM-D scale; searches for “HAM-D” and “Hamilton” found no such passage. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe incidence and severity of SSRI withdrawal appears to be influenced by half-life and receptor affinities, duration and dose of usage, method of tapering, and individual patient characteristics.
“The incidence and severity appears to be influenced by half-life and receptor affinities, duration and dose of usage, as well as method of tapering, and individual patient characteristics 3,9 .”
From Tapering of SSRI treatment to mitigate withdrawal symptoms (2019) · cites this paper as [9]
The Introduction (p. 72) says withdrawal prevalence differs by SSRI pharmacological profile, and Withdrawal Symptoms in Retrospective Studies (page not provided) reports more symptoms with shorter-half-life SSRIs and with abrupt rather than tapered discontinuation. The Discussion (page not provided) mentions possible genetic vulnerability but says specific patient characteristics associated with vulnerability are not established. The copy does not establish receptor affinities, treatment duration, or dose as influences on withdrawal incidence or severity. (LLM, conf=0.87)
Experimental — accuracy not yet measuredSSRI withdrawal has been attributed to a relative deficiency of serotonin in the context of widespread adaptation of serotonergic receptors.
“Although the details remain to be elucidated, SSRI withdrawal has been attributed to a relative deficiency of serotonin in the context of widespread adaptation of serotonergic receptors 9,49,64 .”
From Tapering of SSRI treatment to mitigate withdrawal symptoms (2019) · cites this paper as [9]
The Discussion (page unavailable in our copy) lists decreased serotonin availability after treatment ends as a suggested mechanism of withdrawal, while emphasizing that the mechanisms remain hypothetical. It does not describe widespread adaptation of serotonergic receptors or link such adaptation to the proposed serotonin decrease. (LLM, conf=0.86)
Experimental — accuracy not yet measured
We can extrapolate from our review that antidepressant withdrawal symptoms may last for many months and even years in some patients.
“Thus far, we can extrapolate from our review that antidepressant withdrawal symptoms may last for many months and even years in some patients, as previously noted in the literature (Davies and Read, 2019; Fava et al., 2015; Hengartner et al., 2019).”
From Post-acute withdrawal syndrome (PAWS) after stopping antidepressants: a systematic review with meta-narrative synthesis (2025) · cites this paper as Fava et al., 2015
The Discussion (page not provided) reports withdrawal symptoms persisting for up to one year after paroxetine discontinuation, supporting the possibility of many months. It does not document symptoms lasting multiple years, and its evidence concerns SSRIs rather than antidepressants generally. (LLM, conf=0.87)
Experimental — accuracy not yet measuredThe most common withdrawal symptoms include dizziness, vertigo, tremor, nausea, insomnia, fatigue, mood dysregulation, anxiety, panic, irritability and agitation.
“The most common symptoms include dizziness, vertigo, tremor, nausea, insomnia, fatigue, mood dysregulation, anxiety, panic, irritability and agitation (Fava et al., 2015; Haddad and Anderson, 2007; Jha et al., 2018).”
From Post-acute withdrawal syndrome (PAWS) after stopping antidepressants: a systematic review with meta-narrative synthesis (2025) · cites this paper as Fava et al., 2015
Table 1 in the Discussion lists all the named symptoms as possible signs of SSRI withdrawal, with “mood swings” corresponding to mood dysregulation. It does not identify that entire list as the most common symptoms; the frequency figures in Multiple Drug Comparisons concern a narrower set of symptoms in a particular trial. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe withdrawal syndrome can be differentiated from recurrence of the underlying disorder by its quickness of onset (days rather than weeks), rapid response to re-introduction of the antidepressant (generally within hours, certainly within days), and the presence of somatic and psychological symptoms quite distinct from the original illness.
“However, the withdrawal syndrome can be distinguished from a relapse or recurrence of the underlying disorder by its quickness of onset (days rather than weeks) 3,7,8 , rapid response to re-introduction of the antidepressant (generally within hours, certainly within days) 3,7,9 , and the presence of somatic and psychological symptoms quite distinct from the original illness (including, dizziness,”
From Tapering of SSRI treatment to mitigate withdrawal symptoms (2019) · cites this paper as [9]
The Discussion says withdrawal symptoms tend to appear early while recurrent symptoms return gradually, but limits this distinction to a general tendency in mood disorders, not a rule applicable to anxiety disorders. The Data Extraction section defines withdrawal symptoms as new symptoms absent before treatment, and the Introduction says restarting an antidepressant can improve them. The paper does not establish the claimed response within hours or certainly within days. (LLM, conf=0.86)
Experimental — accuracy not yet measuredWithdrawal effects from other medications do not observe threshold effects, and withdrawal effects have been observed at many doses during tapering of SSRIs, suggesting withdrawal is likely to be a continuous entity.
“However, withdrawal effect from other medications do not observe threshold effects 47,50 , and withdrawal effects have been observed at many doses during tapering of SSRIs 9,36 , suggesting withdrawal is likely to be continuous entity.”
From Tapering of SSRI treatment to mitigate withdrawal symptoms (2019) · cites this paper as [9]
The Introduction and Discussion report that SSRI withdrawal symptoms can occur despite gradual tapering, supporting the portion cited to this review. They do not establish that symptoms were observed at many distinct doses during tapering. The statement about threshold effects in other medications has separate citations, and the continuous-entity suggestion is the citing authors’ inference. (LLM, conf=0.83)
Experimental — accuracy not yet measuredSeverity of SSRI withdrawal varies according to the SSRI, paroxetine being the most likely to be associated with severe depressive and somatic symptoms, and fluoxetine being the least likely.
“Severity varies according to the SSRI, paroxetine being the most likely to be associated with severe depressive and somatic symptoms, and fluoxetine being the least likely to be associated with severe depressive and somatic symptoms [5, 111].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
The Multiple Drug Comparisons section reports that paroxetine produced the most discontinuation symptoms among paroxetine, sertraline, and fluoxetine, while depressive and somatic symptoms were greater with both paroxetine and sertraline than with fluoxetine. It does not establish that paroxetine is uniquely most likely, or fluoxetine least likely among all SSRIs, to cause *severe* depressive and somatic symptoms. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPeaks of onset of SSRI withdrawal symptoms occur 36 h to 10 days after dose decrease or discontinuation.
“Peaks of onset occur 36 h to 10 days after dose decrease or discontinuation,”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
The Discussion (page not available in our copy) says SSRI withdrawal typically begins within a few days of discontinuation, and the Introduction notes that symptoms can occur after gradual tapering. Neither passage gives a peak-onset window of 36 hours to 10 days; searches for that range and for peak onset after dose reduction did not find one. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSNRI withdrawal symptoms occur irrespective of whether gradual or abrupt discontinuation is implemented and are similar to those observed after discontinuation of SSRIs.
“They occur irrespective of whether gradual or abrupt discontinuation is implemented and are similar to those observed after discontinuation of SSRIs [5].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
In Multiple Drug Comparisons (page not specified), the review reports withdrawal symptoms after venlafaxine XR discontinuation and no difference in the reported symptoms compared with sertraline, an SSRI. It also reports symptoms after tapered venlafaxine discontinuation and during a runout period, but does not establish the claim for SNRIs as a class or directly compare gradual with abrupt SNRI discontinuation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSSRI withdrawal symptoms are usually reversible and last from a few hours to 6 weeks.
“they are usually reversible and last from a few hours to 6 weeks [5, 16, 97].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
The Discussion says SSRI withdrawal typically lasts a few weeks, and the Paroxetine section reports sertraline cases lasting up to six weeks, with symptoms disappearing spontaneously in most of those cases. The paper does not establish a duration as short as a few hours, and it documents symptoms persisting beyond six weeks, including up to a year. Page numbers were not provided for these passages. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThe frequency and duration of SSRI withdrawal symptoms depend on the drug discontinued.
“Their frequency and duration depend on the drug discontinued [5, 16, 97].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
The Multiple Drug Comparisons section reports that withdrawal symptoms were more frequent after paroxetine or sertraline than after fluoxetine. The Discussion and drug-specific case reports describe durations ranging from days to prolonged persistence, but do not establish that duration depends on which SSRI was discontinued. No page number is provided in our copy. (LLM, conf=0.83)
Experimental — accuracy not yet measuredWithdrawal syndromes after decrease or discontinuation of antidepressants may be associated with additional clinical manifestations, including modifications of the illness course such as switching to mania or other forms of excessive behavioral activations, loss of clinical effects, and refractoriness to treatment.
“Withdrawal syndromes after decrease or discontinuation of antidepressants may be associated with additional clinical manifestations. They include modifications of the illness course, such as switching to mania or other forms of excessive behavioral activations [24], but also loss of clinical effects and refractoriness to treatment; they have been reported with SSRI and SNRI [5, 6, 27].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
The Discussion (page not specified) says SSRI discontinuation may be related to hypomania or mania, loss of efficacy, and resistance to treatment if the drug is reinstituted. It also cautions that these phenomena may or may not be related to withdrawal symptoms. The cited review does not establish the claimed association with SNRI withdrawal. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe long time for fluoxetine to reach steady state is likely responsible for observations that its withdrawal symptoms can arise weeks after cessation.
“Fluoxetine should take 35-75 days to reach steady state 49 , a fact that is likely responsible for observations that its withdrawal symptoms can arise weeks after cessation 9,20 .”
From Tapering of SSRI treatment to mitigate withdrawal symptoms (2019) · cites this paper as [9]
Withdrawal symptoms are reported to last for several weeks or longer after medication discontinuation in a significant proportion of patients.
“Withdrawal symptoms are reported to last for several weeks (or longer) after medication discontinuation in a significant proportion of patients 9,13 .”
From Tapering of SSRI treatment to mitigate withdrawal symptoms (2019) · cites this paper as [9]
Discontinuation of antidepressant medications such as SSRIs, duloxetine, and venlafaxine represents a major clinical challenge.
“Discontinuation of antidepressant medications such as selective serotonin reuptake inhibitors, duloxetine and venlafaxine represents a major clinical challenge 99,100 .”
From The pursuit of euthymia (2020) · cites this paper as [99]
New withdrawal symptoms following decrease or discontinuation of SSRIs have been widely documented and include a wide range of symptoms.
“New withdrawal symptoms following decrease or discontinuation of SSRIs have been widely documented and include a wide range of symptoms [5] which are listed in detail in Table 4.”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
Discontinuation symptoms were found to occur after gradual tapering.
“Even though discontinuation symptoms were mostly reported after abrupt discontinuation, they were found to occur after gradual tapering [5, 6]”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
The first systematic review of SSRIs withdrawal reactions was published in 2015.
“The first systematic review of SSRIs withdrawal reactions was published in 2015 [5]”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [5]
Risk factors such as sexual trauma and bullying are common to a wide range of mental health problems.
“Risk-factors such as sexual trauma and bullying are common to a wide range of mental health problems, 495,496”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [495]
Stopping antidepressants commonly causes withdrawal symptoms, which can be severe and long-lasting.
“Recent systematic reviews of withdrawal symptoms from antidepressants have drawn attention to the fact that withdrawal symptoms are more common, more severe and longer-lasting than previously supposed,5,7,8”
Common symptoms following SSRI withdrawal include dizziness, nausea, fatigue, anxiety, headache, electric shock-like symptoms, sweating, insomnia and nightmares.
“Common symptoms following SSRI withdrawal include dizziness, nausea, fatigue, anxiety, headache, electric shock-like symptoms, sweating, insomnia and nightmares [6].”
From SSRI and SNRI withdrawal symptoms reported on an internet forum (2018) · cites this paper as [6]
Psychiatric literature has started to report cases with longer durations of symptoms.
“However, psychiatric literature has started to report cases with longer durations of symptoms [6,8].”
From SSRI and SNRI withdrawal symptoms reported on an internet forum (2018) · cites this paper as [6]
Three recent systematic reviews indicated that the NICE and US guideline estimates of withdrawal duration are gross underestimates.
“Three recent systematic reviews have, however, indicated that these are gross underestimates.21–23”
From A survey of UK general practitioners about depression, antidepressants and withdrawal: implementing the 2019 Public Health England report (2020) · cites this paper as [22]
A possible driver of unnecessary long-term medication could be the propensity of antidepressants to cause physical dependence and withdrawal symptoms upon dose reduction or cessation discouraging discontinuation.
“A possible driver of unnecessary long-term medication could be the propensity of antidepressants to cause physical dependence (i.e., pharmacodynamic neurophysiological adaptations) and withdrawal symptoms upon dose reduction or cessation discouraging discontinuation.11–18”
From Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020) · cites this paper as [13]
Antidepressant withdrawal syndrome is more common and severe than earlier presumed, affecting roughly 30-50% of those who attempt to stop their treatment.
“It is now suspected that antidepressant withdrawal syndrome is more common and severe than earlier presumed, affecting roughly 30–50% of those who attempt to stop their treatment.12,13,23,24”
From Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020) · cites this paper as [13]
When withdrawal symptoms emerge in the acute phase of antidepressant withdrawal, reinstatement of the drug to treat them is recommended throughout the scientific literature and in many new-generation antidepressant package inserts.
“When withdrawal symptoms emerge in the acute phase of antidepressant withdrawal, reinstatement of the drug to treat them is recommended throughout the scientific literature and in many new-generation antidepressant package inserts.11,13,23,28,44”
From Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020) · cites this paper as [13]
These symptoms are also frequent acute withdrawal symptoms.
“Moreover, these symptoms are also frequent acute withdrawal symptoms,11,13,14,28”
From Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020) · cites this paper as [13]
The clinical phenomena of antidepressant discontinuation pertain to withdrawal syndromes and do not differ from those that occur with other psychotropic drugs.
“However, this position is no longer tenable in view of current evidence that indicates that the clinical phenomena pertain to withdrawal syndromes and do not differ from those that occur with other psychotropic drugs.”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
Psychological symptoms may occur as well: agitation, anxiety, panic attacks, dysphoria, irritability, confusion, and worsening of mood.
“Psychological symptoms may occur as well: agitation, anxiety, panic attacks, dysphoria, irritability, confusion, and worsening of mood.”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
The withdrawal syndrome encompasses a broad range of somatic symptoms (e.g. headache, dizziness, flu-like symptoms, nausea).
“The withdrawal syndrome encompasses a broad range of somatic symptoms (e.g. headache, dizziness, flu-like symptoms, nausea).”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
Untreated withdrawal symptoms may be mild and resolve spontaneously in 1-3 weeks; in other cases they may persist for months or even years, leading to persistent post-withdrawal disorder.
“Untreated symptoms may be mild and resolve spontaneously in 1–3 weeks; in other cases they may persist for months or even years,40–45 leading to what has been defined as persistent post-withdrawal disorder.”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
Withdrawal symptoms following discontinuation of antidepressant treatment have been described with any type of AD, but particularly with SSRI, venlafaxine, and duloxetine.
“They have been described with any type of AD, but particularly with SSRI, venlafaxine, and duloxetine.”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
After their introduction, more pronounced problems occurred with most of the newer antidepressants.
“However, in due course after their introduction, more pronounced problems occurred with most of the newer antidepressants.40–46”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
With both benzodiazepines and antidepressants, withdrawal reactions and post-withdrawal syndromes may ensue despite slow tapering.
“It would seem that, with both types of drugs, that withdrawal reactions and post-withdrawal syndromes may ensue, despite slow tapering.”
From May antidepressant drugs worsen the conditions they are supposed to treat? The clinical foundations of the oppositional model of tolerance (2020) · cites this paper as [40]
Withdrawal symptoms can occur after abrupt or gradual discontinuation of major psychiatric drugs.
“Moreover, withdrawal symptoms can occur after abrupt or gradual discontinuation of major psychiatric drugs (6,(11)(12)(13).”
From Discontinuing Psychiatric Medications: A Survey of Long-Term Users (2017) · cites this paper as [12]
Behavioral toxicity can be subtle and detected only by specific assessment, such as cognitive impairment with all psychotropic drugs or apathy with antidepressants.
“Other times, behavioral toxicity may entail subtle manifestations, which may be detected only with specific assessment strategies, such as with cognitive impairment associated with all psychotropic drugs [34] or with apathy related to the use of antidepressant drugs [35].”
From Iatrogenic Factors in Psychopathology (2019) · cites this paper as [34]
An understanding of users' own experiences of antidepressant use is increasingly important in the context of growing doubts about the effectiveness of antidepressant treatment, concerns about side effects, and withdrawal effects.
“An understanding of users’ own experiences of antidepressant use is increasingly important in the context of growing doubts about the effectiveness of antidepressant treatment [5, 26], concerns about side effects [27] and withdrawal effects [28].”
From ‘In my life antidepressants have been…’: a qualitative analysis of users’ diverse experiences with antidepressants (2016) · cites this paper as [28]
Several papers have identified the occurrence of withdrawal signs/symptoms relating to a range of antidepressants, and especially SSRIs.
“Indeed, several papers have identified the occurrence of withdrawal signs/symptoms relating to a range of ADs, and especially SSRIs (Addictionblog.org, 2012; Harvey and Slabbert, 2014; Fava et al., 2015).”
From Is There a Potential of Misuse for Venlafaxine and Bupropion? (2018) · cites this paper as Fava et al., 2015
The occurrence of a withdrawal syndrome may be interpreted as being associated with a dependence condition, but this may not necessarily indicate that an index drug possesses misuse/recreational value.
“Although, similar to what described with the SSRIs, the occurrence of a withdrawal syndrome may be interpreted as being associated with a “dependence” condition (Fava et al., 2015), this may not necessarily be an indication, per se, of an index drug possessing a misuse/recreational value (Shang et al., 2007).”
From Is There a Potential of Misuse for Venlafaxine and Bupropion? (2018) · cites this paper as Fava et al., 2015
Withdrawal symptoms after SSRIs may be easily misidentified as signs of impending relapse.
“and may be easily misidentified as signs of impending relapse.52”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [52]
Withdrawal symptoms may be alleviated by reinstating treatment with the antidepressant that triggered the symptoms.
“Withdrawal symptoms may be alleviated by reinstating treatment with the antidepressant that triggered the symptoms”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [52]
It may be difficult for some patients to stop taking antidepressants once the treatment has started.
“and it may for this, and many other reasons, be difficult for some patients to stop taking antidepressants once the treatment has started.52”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [52]
Withdrawal symptoms after SSRIs typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering.
“Withdrawal symptoms after SSRIs typically occur within a few days from drug discontinuation and last a few weeks, also with gradual tapering”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [52]
Withdrawal symptoms after SSRIs might include late onset and longer persistence of disturbances.
“but the withdrawal symptoms might include late onset and longer persistence of disturbances”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [52]
There are many similarities between the withdrawal symptoms associated with SSRIs and the withdrawal symptoms associated with antidepressants such as venlafaxine and duloxetine.
“There are many similarities between the withdrawal symptoms associated with SSRIs and the withdrawal symptoms associated with antidepressants such as venlafaxine and duloxetine.52”
From Should antidepressants be used for major depressive disorder? (2020) · cites this paper as [52]
New SSRI withdrawal symptoms have been found to occur after drug discontinuation with variable frequency and duration, depending on the SSRI which is discontinued.
“New SSRI withdrawal symptoms have been found to occur after drug discontinuation with variable frequency and duration, depending on the SSRI which is discontinued [1,12,22] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
New withdrawal symptoms reported with SSRIs include a wide range of symptoms, both physical and psychological, and are found throughout different systems in the body.
“New withdrawal symptoms reported with SSRIs include a wide range of symptoms, both physical and psychological [1] , and are found throughout different systems in the body ( table 2 ).”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
New withdrawal symptoms described in the literature include flu-like symptoms, headaches, nausea, diarrhea, dizziness, decreased concentration, sleep disturbances, dysphoria, irritability, and restlessness.
“New withdrawal symptoms described in the literature include flu-like symptoms, headaches, nausea, diarrhea, dizziness, decreased concentration, sleep disturbances, dysphoria, irritability, and restlessness [1,12,22] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
New SSRI withdrawal symptoms usually reach a peak of onset between 36 and 96 h after SSRI reduction or discontinuation, and are reversible, lasting from a few hours up to 6 weeks.
“They usually reach a peak of onset between 36 and 96 h after SSRI reduction or discontinuation, and are reversible, lasting from a few hours up to 6 weeks [1,12,22] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
A recurrent disabling withdrawal symptom described in the literature and online by patients is a sensory symptom of electric shock sensations and electric-like waves.
“A recurrent disabling withdrawal symptom described in the literature and online by patients is a sensory symptom of electric shock sensations and electric-like waves [1,12,22,26] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness.
“Withdrawal from SSRIs and other CNS drugs produces psychiatric symptoms that can be confounded with true relapse or recurrence of the original illness [1,2,7] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
Severity of new SSRI withdrawal symptoms may vary mainly according to the SSRI used.
“Severity may also vary mainly according to the SSRI used [1,20] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
According to most studies, even with gradual tapering, withdrawal symptoms still occur.
“According to most studies [1,15,16,20,29] , even with gradual tapering, withdrawal symptoms still occur.”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [1]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Listed symptoms fall below the stated reporting threshold
MinorThe text says only symptoms occurring in more than 10% of patients were reported, but the ensuing list includes symptoms reported in 5.6%, 6.9%, and 4.2%.
“The authors reported only ADDS symptoms that occurred in more than 10% of patients, showing no differences between those who received sertraline compared to venlafaxine XR.”
“Dizziness (33.3%), vivid dreams (26.4%), fatigue (22.2%), vertigo (5.6%), rapid changing mood (6.9%), and tachycardia (4.2%) were the most frequently reported symptoms [42] .”
Percentage for persistent symptoms does not match the affected group
MinorNine patients experienced a discontinuation syndrome. If symptoms persisted in three of them, the proportion is 33.3%, not 27%.
Reported 27 · recomputed 33.333333
“Nine of 20 patients (45%) experienced a discontinuation syndrome according to specific criteria based on the DESS.Discontinuation syndromes subsided within a month in all but 3 patients (27%).”
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Is there a serotonergic withdrawal syndrome?
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An assessment of selective serotonin reuptake inhibitor discontinuation symptoms with citalopram
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More cases of paroxetine withdrawal syndrome
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Withdrawal Hypomania Associated With Paroxetine
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Electric Sensations: Neglected Symptom of Escitalopram Discontinuation
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Self-citationSelective serotonin reuptake inhibitors and withdrawal symptoms: a review of the literature
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Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., Hasnain, M., Jollant, F., Levitt, A. J., MacQueen, G. M., et al. (2016) · The Canadian Journal of Psychiatry · doi:10.1177/0706743716659417 · Cited by 1,150 · see citing works
“Discontinuation symptoms, described by the FINISH mnemonic (flu-like symptoms, insomnia, nausea, imbalance, sensory disturbances, hyperarousal), may be experienced by up to 40% of patients when antidepressants are stopped abruptly.(87,88) These are generally mild and transient, but more severe symptoms have been descr…”
BackgroundTime for united action on depression: a Lancet–World Psychiatric Association Commission
Herrman, H., Patel, V., Kieling, C., Berk, M., Buchweitz, C., Cuijpers, P., Furukawa, T. A., Kessler, R. C., Kohrt, B. A., Maj, M., et al. (2022) · The Lancet · doi:10.1016/s0140-6736(21)02141-3 · Cited by 1,104 · see citing works
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“…withdrawal can occur without discontinuation (e.g. between two doses of rapid-onset and short-acting drugs and with a decrease in medication) (Fava et al., 2015), while the term ‘syndrome’ subtly medicalises withdrawal by associating it with a disorder endogenous to the person than with a…”
BackgroundResultInfluentialCurrent Psychosomatic Practice
Fava, G. A., Cosci, F., & Sonino, N. (2017) · Psychotherapy and Psychosomatics · doi:10.1159/000448856 · Cited by 302 · see citing works
Self-citationHow addictive are gabapentin and pregabalin? A systematic review
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“The described withdrawal symptoms resembled those of benzodiazepines (including withdrawal seizures and delirium) (Tyrer et al., 1990) or SSRIs (Fava et al., 2015) and appeared to respond poorly to benzodiazepines but improved after reinstating a gabapentinoid taper (Smith et al., 2016; Mersfelder and Nichols; 2016, S…”
BackgroundTapering of SSRI treatment to mitigate withdrawal symptoms
Horowitz, M. A., & Taylor, D. (2019) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30032-x · Cited by 280 · see citing works
Antipsychotic-Induced Dopamine Supersensitivity Psychosis: Pharmacology, Criteria, and Therapy
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Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications
Cosci, F., & Chouinard, G. (2020) · Psychotherapy and Psychosomatics · doi:10.1159/000506868 · Cited by 265 · see citing works
ACOG Committee on Clinical Practice Guidelines–Obstetrics (2023) · Obstetrics & Gynecology · doi:10.1097/aog.0000000000005202 · Cited by 252 · see citing works
“Abrupt discontinuation of SSRIs or SNRIs is associated with symptoms including gastrointestinal upset, dizziness, fatigue, headache, sleep disruption, agitation or anxiety, myalgias, tremors, headaches, and electric-like shocks (62).”
BackgroundManagement of Depression in Adults: A Review
Simon, G. E., Moise, N., & Mohr, D. C. (2024) · JAMA · doi:10.1001/jama.2024.5756 · Cited by 234 · see citing works
More treatment but no less depression: The treatment-prevalence paradox
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Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents
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“A recent review [54] found that they typically ‘last a few weeks’ but identified ‘many variations.”
BackgroundFeduccia, A. A., Jerome, L., Yazar-Klosinski, B., Emerson, A., Mithoefer, M. C., & Doblin, R. (2019) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2019.00650 · Cited by 172 · see citing works
“Discontinuation of paroxetine and sertraline may be accompanied by adverse effects (55), likely caused by neuroadaptations of decreased levels of serotonin transporters in neuronal membranes after use of SSRIs (56).”
BackgroundGuidi, J., Tomba, E., & Fava, G. A. (2016) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2015.15040476 · Cited by 167 · see citing works
Self-citationNew Classification of Selective Serotonin Reuptake Inhibitor Withdrawal
Chouinard, G., & Chouinard, V.-A. (2015) · Psychotherapy and Psychosomatics · doi:10.1159/000371865 · Cited by 164 · see citing works
Should antidepressants be used for major depressive disorder?
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“52 There are many similarities between the withdrawal symptoms associated with SSRIs and the withdrawal symptoms associated with antidepressants such as venlafaxine and duloxetine.”
InfluentialGuidi, J., & Fava, G. A. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2020.3650 · Cited by 155 · see citing works
Self-citationMunkholm, K., Paludan-Müller, A. S., & Boesen, K. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-024886 · Cited by 151 · see citing works
“symptoms during the placebo run-in that are alleviated by the study drug.(44) It could be misinterpreted as an improvement of the depression (increased benefits in the drug group).”
BackgroundFava, G. A., & Guidi, J. (2020) · World Psychiatry · doi:10.1002/wps.20698 · Cited by 143 · see citing works
Self-citationBockting, C. L. H., Klein, N. S., Elgersma, H. J., van Rijsbergen, G. D., Slofstra, C., Ormel, J., Buskens, E., Dekker, J., de Jong, P. J., Nolen, W. A., et al. (2018) · The Lancet Psychiatry · doi:10.1016/s2215-0366(18)30100-7 · Cited by 130 · see citing works
Complementary therapies for clinical depression: an overview of systematic reviews
Haller, H., Anheyer, D., Cramer, H., & Dobos, G. J. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-028527 · Cited by 128 · see citing works
Evidence-based pharmacotherapy of treatment-resistant unipolar depression
Dold, M., & Kasper, S. F. (2016) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2016.1248852 · Cited by 121 · see citing works
“It should be considered that the termination of the medication with an antidepressant compound can provoke withdrawal symptoms (Fava et al. 2015) and these are often misinterpreted as adverse effects of the newly dispensed antidepressant drug hampering the possibility to assess the effectiveness of…”
BackgroundAntidepressant Withdrawal and Rebound Phenomena
Henssler, J. F., Heinz, A., Brandt, L., & Bschor, T. (2019) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2019.0355 · Cited by 116 · see citing works
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Psychiatrization of Society: A Conceptual Framework and Call for Transdisciplinary Research
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Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis
Henssler, J., Schmidt, Y., Schmidt, U., Schwarzer, G., Bschor, T., & Baethge, C. (2024) · The Lancet Psychiatry · doi:10.1016/s2215-0366(24)00133-0 · Cited by 106 · see citing works
Strategies to reduce use of antidepressants
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“Anxiety, mood swings and sleep disturbance may appear to be a recurrence of the original problem requiring treatment.(20) Restarting medication, before withdrawal”
BackgroundSelective serotonin reuptake inhibitors for fibromyalgia syndrome
Walitt, B. T., Urrútia, G., Nishishinya, M. B., Cantrell, S. E., & Häuser, W. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011735 · Cited by 108 · see citing works
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Self-citationAntidepressants in inflammatory bowel disease
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“These in- clude drugs both scheduled and non-scheduled in the Controlled Substances Act, which categorizes drugs in five schedules based on their relative abuse potentials and dependence liabilities and for regulatory purposes.”
BackgroundInfluentialSwitching and stopping antidepressants
Keks, N. A., Hope, J., & Keogh, S. (2016) · Australian Prescriber · doi:10.18773/austprescr.2016.039 · Cited by 90 · see citing works
Managing antidepressant discontinuation: a systematic review
Maund, E., Stuart, B., Moore, M., Dowrick, C., Geraghty, A. W. A., Dawson, S., & Kendrick, T. (2019) · The Annals of Family Medicine · doi:10.1370/afm.2336 · Cited by 82 · see citing works
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Self-citationIatrogenic Factors in Psychopathology
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Self-citationPharmacological treatment for generalized anxiety disorder in adults: an update
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“The risk and extent of weight gain varies within this class, as some compounds promote weight gain and some are considered weight-neutral [43].”
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Drug dependence is not addiction—and it matters
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Estimating Risk of Antidepressant Withdrawal from a Review of Published Data
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“However, withdrawal symptoms following the cessation of fluoxetine, the SSRI with the longest half-life (7–15 days for its active metabolite, nor-fluoxetine), has been observed to occur with a delay of onset of 4–6 weeks after discontinuation in one study [45], and 2 weeks after discontinuation in another [69].”
BackgroundHengartner, M. P., Schulthess, L., Sorensen, A., & Framer, A. (2020) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125320980573 · Cited by 74 · see citing works
Prodromal Symptoms in Depression: A Systematic Review
Benasi, G., Fava, G. A., & Guidi, J. (2021) · Psychotherapy and Psychosomatics · doi:10.1159/000517953 · Cited by 74 · see citing works
Self-citationAntidepressant discontinuation syndrome
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Evidence-based medicine was bound to fail: a report to Alvan Feinstein
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“In that study, patients requiring an SSRI+IPT to achieve remission experienced a 50% recurrence rate after tapering the SSRI, roughly double the 26% rate among those patients who remitted with IPT alone (45).”
InfluentialWhen Discontinuing SSRI Antidepressants Is a Challenge: Management Tips
Jha, M. K., Rush, A. J., & Trivedi, M. H. (2018) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2018.18060692 · Cited by 73 · see citing works
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“1 (Rosenbaum 1998; Fava 2015; Cosci 2020).”
Hengartner, M. P. (2020) · Therapeutic Advances in Psychopharmacology · doi:10.1177/2045125320921694 · Cited by 72 · see citing works
Breedvelt, J., Warren, F. C., Segal, Z. V., Kuyken, W., & Bockting, C. (2021) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2021.0823 · Cited by 65 · see citing works
Role of Benzodiazepines in Anxiety Disorders
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“These estimates provide the first large body of real-world evidence, suggesting that SNRIs and SSRIs and also TCAs could be associated with a higher risk of withdrawal syndrome, compared to all other drugs [4, 5, 10, 14].”
BackgroundResultInfluentialDiscontinuing Psychiatric Medications: A Survey of Long-Term Users
Ostrow, L., Jessell, L., Hurd, M., Darrow, S. M., & Cohen, D. (2017) · Psychiatric Services · doi:10.1176/appi.ps.201700070 · Cited by 62 · see citing works
“Initial studies have documented the withdrawal effects of various classes of drugs (5,6,13,34).”
BackgroundYoshinaga, N., Matsuki, S., Niitsu, T., Sato, Y., Tanaka, M., Ibuki, H., Takanashi, R., Ohshiro, K., Oshima, F., Asano, K., et al. (2016) · Psychotherapy and Psychosomatics · doi:10.1159/000444221 · Cited by 60 · see citing works
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Antidepressant tapering strips to help people come off medication more safely
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The Isoxazole Ring and Its N‐Oxide: A Privileged Core Structure in Neuropsychiatric Therapeutics
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Behavioral Toxicity Revisited: Iatrogenic Comorbidity in Psychiatric Evaluation and Treatment
Fava, G. A., Cosci, F., Offidani, E., & Guidi, J. (2016) · Journal of Clinical Psychopharmacology · doi:10.1097/jcp.0000000000000570 · Cited by 55 · see citing works
“The following psychological symptoms may ensue as well: agitation, anxiety, panic attacks, dysphoria, confusion, and worsening of mood.(16,17) Symptoms typically appear within 3 days of stopping antidepressant medication or initiating a medication taper.”
BackgroundSelf-citationSSRI and SNRI withdrawal symptoms reported on an internet forum
Stockmann, T., Odegbaro, D., Timimi, S., & Moncrieff, J. (2018) · International Journal of Risk & Safety in Medicine · doi:10.3233/jrs-180018 · Cited by 54 · see citing works
“Common symptoms following SSRI withdrawal include dizziness, nausea, fatigue, anxiety, headache, electric shock-like symptoms, sweating, insomnia and nightmares [6].”
InfluentialHengartner, M. P. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00275 · Cited by 52 · see citing works
“Research has shown that antidepressants may cause severe withdrawal symptoms after discontinuation (61, 62), which in some cases persist for months and therefore are easily misdiagnosed as depression relapse (63).”
BackgroundEffects of Treatment Discontinuation in Clinical Psychopharmacology
Baldessarini, R. J., & Tondo, L. (2019) · Psychotherapy and Psychosomatics · doi:10.1159/000497334 · Cited by 52 · see citing works
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BackgroundAntidepressant withdrawal – the tide is finally turning
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“…Fava and colleagues maintained that even the common gradual tapers over a few weeks could not substantially reduce the risk of withdrawal reactions (Fava et al., 2015; Fava and Cosci, 2019), a view also supported by recent work published in Lancet Psychiatry, where withdrawal can span over…”
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“Both gradual and abrupt discontinuation from antidepressants and benzodiazepines in general populations can result in a variety of temporary distressing withdrawal symptoms, although absolute rates have proven difficult to establish, and there are few studies in pregnancy [13–15].”
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“There is a growing concern among users of psychiatric services that psychopharmacological drugs including antidepressant medication can cause drug dependence akin to benzodiazepines and other drugs of abuse.(1) Some authors claim that “clinicians are familiar with the withdrawal phenomena that may occur from alcohol,…”
BackgroundClinical guidelines on antidepressant withdrawal urgently need updating
Davies, J., Read, J., Hengartner, M. P., Cosci, F., Fava, G. A., Chouinard, G., van Os, J., Nardi, A. E., Gøtzsche, P. C., Groot, P. C., et al. (2019) · BMJ · doi:10.1136/bmj.l2238 · Cited by 45 · see citing works
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“This is also the case with certain anti-depressants [194].”
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“Indeed, several papers have identified the occurrence of withdrawal signs/symptoms relating to a range of ADs, and especially SSRIs (Addictionblog.org, 2012; Harvey and Slabbert, 2014; Fava et al., 2015).”
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“Three systematic reviews have now established that such statements and guidelines have been minimising the problem (Davies & Read, 2019a; Fava et al., 2015; 2018).”
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“However, withdrawal reactions may ensue with either BZs or SSRIs (Belaise et al., 2012; Bhanji et al., 2006; Fava, 2006; Fava et al., 2015; Greenblatt et al., 1990; Nardi et al., 2010; Nielsen et al., 2012; Rickels et al., 1990; Schweizer et al., 1990).”
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- Authors
- Fava, G. A., Gatti, A., Belaise, C., Guidi, J., & Offidani, E.
- Affiliations
- University of Bologna (IT)
- Weill Cornell Medicine (US)
- Venue
- Psychotherapy and Psychosomatics
- Publisher
- S. Karger AG
- Published
- 2015
- Volume
- 84
- Issue
- 2
- Pages
- 72-81
- ISSN
- 0033-3190 (ISSN-L)
- 1423-0348
- OpenAlex
- W4292338862
- Cited by
- 421
- References
- 68
- Citations by year
- 2026: 23 · 2025: 37 · 2024: 40 · 2023: 30 · 2022: 39 · 2021: 39 · 2020: 45 · 2019: 60 · 2018: 29 · 2017: 35 · 2016: 25 · 2015: 13
- FWCI
- 5.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychotherapy and Psychosomatics (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Health Sciences › Medicine › Neurology › Alcoholism and Thiamine Deficiency
- Keywords
- selective serotonin reuptake inhibitors, SSRI discontinuation, withdrawal syndrome, antidepressant discontinuation, paroxetine, fluoxetine, sertraline, fluvoxamine
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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