Citation

Olver JS, Burrows GD, Norman TR. CNS Drugs 1999; 12(3): 171-177.

Copyright

(Copyright © 1999, Adis International)

DOI

10.2165/00023210-199912030-00001

PMID

unavailable

Abstract

Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), like the tricyclic antidepressants and monoamine oxidase inhibitors, are associated with a well recognised syndrome following discontinuation or dose reduction. There appear to be differences in the incidence of discontinuation syndromes within the class of SSRIs. Published case reports and adverse drug reaction reports both suggest the highest incidence of the syndrome with paroxetine and the lowest incidence with fluoxetine, while other SSRIs are associated with an intermediate incidence. Open label comparison and placebo-controlled double-blind studies support this contention. There is little evidence to separate discontinuation syndromes with different SSRIs on the basis of clinical presentation. Although the pathogenesis of SSRI discontinuation syndromes is unknown, both pharmacodynamic and pharmacokinetic factors may explain differences in incidence with individual SSRIs. SSRI discontinuation syndromes are usually mild and transient, and prevention is the most effective management strategy.

Language: en

Keywords

amitriptyline; anxiety; clinical feature; clomipramine; depression; drug clearance; drug half life; drug metabolism; fluoxetine; fluvoxamine; headache; human; imipramine; manic depressive psychosis; mirtazapine; monoamine oxidase inhibitor; nausea; nervousness; obsession; panic; paresthesia; paroxetine; pathogenesis; priority journal; review; serotonin uptake inhibitor; sertraline; suicide attempt; tricyclic antidepressant agent; venlafaxine; vertigo; withdrawal syndrome