Discontinuing Antidepressants @ יואל קסלר .com
Discontinuing Antidepressants @ יואל קסלר .com

How to safely discontinue antidepressants יואל קסלר .com

The development of antidepressant medications, particularly SSRI /SNRI have revolutionized the treatment of depression and anxiety. However, duration of treatment in patients with improvement in symptoms remains an ongoing area of investigation. At Discontinuing Antidepressants @ יואל קסלר .com we explore some of the data about how physicians can best decrease or discontinue medication with the least amount of side effects for patients.

Antidepressant Discontinuation Syndrome

Discontinuation of antidepressants, particularly SSRI / SNRI with shorter half-lives can lead to a constellation of symptoms that are referred to as either withdrawal or Antidepressant Discontinuation Syndrome. The following are some of the more common symptoms:

Symptoms of Antidepressant Discontinuation Syndrome @ יואל קסלר .com

ystemSSRIsSNRIsTCAsMAOIsAtypicals
GeneralFlu-like symptomsFlu-like symptomsFlu-like symptomsFlu-like symptomsFlu-like symptoms
FatigueFatigueFatigueFatigue
DiaphoresisFatigue
CardiovascularTachycardiaTachycardiaTachycardiaTachycardia(Limited data)
FlushingHypertension, hypotension
Syncope
ArrhythmiaArrhythmia
GastrointestinalNausea, vomitingNausea, vomitingNausea, vomitingNausea, vomitingNausea, vomiting
DiarrheaDiarrheaDiarrheaDiarrheaDiarrhea
AnorexiaAnorexiaAnorexiaAnorexiaAnorexia (mirtazapine)
NeurologicHeadacheHeadacheHeadacheHeadacheHeadache
Gait instabilityGait instabilityParesthesiasParesthesiasDizziness
DizzinessDizzinessTremor, ataxiaTremor, ataxiaParesthesias
Paresthesias, brain zapsParasthesias, brain zapsSeizureSeizure, myoclonus, muscle jerkingTremor
Tremor, ataxiaTremor, ataxiaParkinsonismDystonia (bupropion)
Myclonus, muscle jerkingStroke-like symptomsParkinsonism
ParkinsonismSeizure, myoclonus, muscle jerkingDystonia
Catatonia
PsychiatricAnxiety, panicAnxiety, panicAnxiety, panicDepression, labilityAnxiety, panic
Depression, maniaDepression, maniaDepression, maniaSuicidal ideationDepression, mania
Suicidal ideationSuicidal ideationSuicidal ideationAnger, irritabilitySuicidal ideation
Anger, irritabilityAnger, irritabilityAnger, irritabilityAggression, agitationAnger, irritability
Mood swingsMood swingsMood swingsMood swings
Depersonalization, derealizationDepersonalization, derealizationDerealizationHallucinationsDepersonalization, derealization
HallucinationsDelusions
HallucinationsHallucinationsDelusions
CognitiveConfusion, deliriumConfusion, deliriumConfusion, deliriumConfusion, delirium(Limited data)
InattentionInattentionInattentionInattention
SleepSleep disturbancesSleep disturbancesSleep disturbancesSleep disturbancesSleep disturbances
Nightmares, vivid dreamsNightmares, vivid dreamsNightmares, vivid dreamsNightmares, vivid dreamsNightmares, vivid dreams
VisualVision changesVision changesVision changesVision changes(Limited data)
SexualDysfunctionDysfunctionDysfunctionDysfunctionDysfunction
  • MAOIs = monoamine oxidase inhibitors; SNRIs = serotonin-norepinephrine reuptake inhibitors; SSRIs = selective serotonin reuptake inhibitors; TCAs = tricyclic and tetracyclic antidepressants

In the Cleveland Clinic Journal of Medicine this month a great review article describing the symptoms/ syndrome and ways to minimize it was published. The link to the full article is here.

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