The DOI matches its Crossref record; 100 of the 100 references it cites were found in a registry or an index.
Antidepressant Discontinuation Syndromes: Clinical Relevance, Prevention and Management
Abstract
Discontinuation symptoms are recognised with tricyclic antidepressants, monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs) and miscellaneous antidepressants. A wide variety of symptoms have been described, differing somewhat between antidepressant classes, and several symptom clusters or discontinuation syndromes appear to exist. A common feature is onset within a few days of stopping the antidepressant or, less commonly, reducing the dosage. Discontinuation syndromes are clinically relevant as they are common, can cause significant morbidity, can be misdiagnosed leading to inappropriate treatment and can adversely effect future antidepressant compliance. Preventative strategies include tapering antidepressants prior to stoppage and educating patients and healthcare professionals to ensure that antidepressants are taken consistently and not stopped abruptly. Most reactions are mild and short-lived and require no treatment other than patient reassurance. Severe cases can be treated symptomatically or the antidepressant can be reinstated before being gradually withdrawn. Reinstatement usually leads to symptom resolution within 24 hours. Some individuals require very conservative tapering schedules to prevent the re-emergence of symptoms. With SSRIs and venlafaxine another strategy to consider is switching to fluoxetine, which may suppress the discontinuation symptoms, but which has little tendency to cause such symptoms itself. Neonatal discontinuation symptoms can follow maternal use of antidepressants during pregnancy and possibly breast feeding. The patient and doctor must take this into consideration when making prescribing decisions. Discontinuation symptoms have received little systematic study with the result that most of the recommendations made here are based on anecdotal data or expert opinion. Research is needed to provide a firm evidence base for future recommendations.
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In the citing paper
“In addition, it has been suggested that gradual discontinuation can reduce both rebound insomnia [84, 85] and rebound anxiety [1].”
From Acute and Persistent Withdrawal Syndromes Following Discontinuation of Psychotropic Medications (2020) · cites this paper as [84]
In the citing paper
“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 [24]
In the citing paper
“With new-generation antidepressants, it has been widely observed that risk of withdrawal emerges after the drugs have been taken for 1 to 2 months.24,39”
From Protracted withdrawal syndrome after stopping antidepressants: a descriptive quantitative analysis of consumer narratives from a large internet forum (2020) · cites this paper as [24]
In the citing paper
“We now have increasing evidence for postwithdrawal disorders with SSRI long-term use [6,15,16,26,37] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“Persistent postwithdrawal disorders have been described with different classes of CNS drugs (e.g.protracted insomnia for alcohol and benzodiazepine withdrawal [10,36] and major depression/dysphoria for cocaine and amphetamine withdrawal [10,23] ), and even more so with specific drugs (e.g.quetiapine and paroxetine) within a drug class [6,15,16,33] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“Data from controlled trials [15,20,29] , case reports [16] , and online patient reports [26] show that paroxetine is most likely to be associated with new withdrawal symptoms, and fluoxetine the least.”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“Rebound anxiety [2,14] and rebound panic [15] were then reported with abrupt benzodiazepine discontinuation [9] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“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 [15]
In the citing paper
“They may resemble rebound symptoms being more severe than the original symptoms, but these disorders persist at least 6 weeks in contrast to rebound symptoms and [6,15,16,26,37] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“Given the evidence for the high risk of disabling withdrawal with paroxetine”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“thought to be related to noradrenergic and cholinergic supersensitivity [15,35]”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
In the citing paper
“Persistent postwithdrawal panic disorder [15,38] has been shown to occur following withdrawal of paroxetine, and paroxetine has also been associated with other postwithdrawal disorders [6,15,16] .”
From New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal (2015) · cites this paper as [15]
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Cited by
Sorted by citations
Adverse Effects of Atypical Antipsychotics
Haddad, P. M., & Sharma, S. G. (2007) · CNS Drugs · doi:10.2165/00023210-200721110-00004 · Cited by 468
Self-citationDavies, J., & Read, J. (2019) · Addictive Behaviors · doi:10.1016/j.addbeh.2018.08.027 · Cited by 387
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Ripperger-Suhler, J., & Rockhill, C. (2020) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2020.05.005 · Cited by 335
Efficacy and Tolerability of Desvenlafaxine Succinate Treatment for Menopausal Vasomotor Symptoms
Speroff, L., Gass, M. L. S., Constantine, G. D., & Olivier, S. (2008) · Obstetrics and Gynecology · doi:10.1097/01.aog.0000297371.89129.b3 · Cited by 333
Maternal Selective Serotonin Reuptake Inhibitor Use During Pregnancy and Newborn Neurobehavior
Zeskind, P. S., & Stephens, L. E. (2004) · PEDIATRICS · doi:10.1542/peds.113.2.368 · Cited by 279
Metadata
- Authors
- Haddad, P. M.
- Corresponding author
- Haddad, Peter M.
- ORCID
- Haddad, Peter M.
- Venue
- Drug Safety
- Published
- 2001
- Volume
- 24
- Issue
- 3
- Pages
- 183-197
- ISSN
- 0114-5916 (ISSN-L)
- OpenAlex
- W1593032895
- Cited by
- 214
- References
- 99
- Citations by year
- 2026: 7 · 2025: 6 · 2024: 7 · 2023: 5 · 2022: 10 · 2021: 5 · 2020: 5 · 2019: 5 · 2018: 9 · 2017: 8 · 2016: 7 · 2015: 10 · 2014: 7 · 2013: 24 · 2012: 4
- FWCI
- 1.13
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Drug Safety (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Toxicology › Pharmacovigilance and Adverse Drug Reactions
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- antidepressant discontinuation syndrome, antidepressant withdrawal symptoms, selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, antidepressant tapering, fluoxetine, venlafaxine, breastfeeding
- MeSH terms
- Animals, Antidepressive Agents, Antidepressive Agents, Tricyclic, Humans, Monoamine Oxidase Inhibitors, Patient Compliance, Substance Withdrawal Syndrome, Syndrome, Selective Serotonin Reuptake Inhibitors
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