SELECTIVE SEROTONIN REUPTAKE INHIBITOR DISCONTINUATION SYNDROME: THREE CASES PRESENTING TO A NEUROLOGIC PRACTICE

BACKGROUNDDiscontinuation syndromes have been noted for various classes of psychotropic medication and have now been observed for selective serotonin reuptake inhibitors (SSRIs) and other new serotonergic antidepressants. REVIEW SUMMARYSSRIs and other new antidepressants are increasingly being used for neurologic disorders as well as for depression and anxiety, which frequently coexist with these illnesses. Recently, a discontinuation syndrome was identified after abrupt and even tapered withdrawal from these agents. The syndrome presents with somatic symptoms of disequilibrium, gastrointestinal symptoms, flu-like symptoms, disrupted sleep, and sensory disturbances as well as psychological symptoms of irritability, crying spells, and anxiety or agitation. These symptoms, which usually appear within 1 to 3 days after the last dose, are usually mild and transient but can be more severely distressing and debilitating and lead to disruption of social or occupational activities. When intervention is required, the primary strategy entails reinstituting the SSRI and, if appropriate, commencing a slow and gradual tapering schedule. We review the cases of three patients with SSRI discontinuation syndrome who presented to the clinic with neurologic complaints. CONCLUSIONThe primary prevention strategy for discontinuation syndrome is to avoid abrupt discontinuation of antidepressant medication, particularly for agents demonstrating a pharmacologic profile of a short half-life and no active metabolites. Awareness of SSRI discontinuation syndrome facilitates rapid identification and effective intervention as well as improved prevention through patient education.