SSRI Discontinuation Syndrome (Withdrawal)

SSRI discontinuation syndrome, also known as SSRI withdrawal syndrome or SSRI cessation syndrome, is a condition that can occur during or following the interruption or discontinuation of regular SSRI or SNRI antidepressant drug usage. The condition often begins between 24 hours to one week after reduction in dosage or complete discontinuation, depending on the half-life of the drug. The prescribing labels of SSRIs acknowledge the possibility of "intolerable" discontinuation reactions, and some patients have extreme difficulty discontinuing use from SSRI drugs.

 

The indicators of SSRI discontinuation syndrome are the following:

• Interruption, cessation, or reduction of dosage in an SSRI treatment that has lasted four or more weeks.
• Symptoms interfere with normal social, occupational, or other functioning.
• Symptoms are not due to another medical condition, drug use, or discontinuation.
• Symptoms are not due to a relapse of the condition for which the SSRI was originally prescribed.

 

Symptoms

Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated SSRIs. Just because a side effect is stated here, it does not mean that all people using one of these medicines will experience that or any side effect. The discontinuation (specifically when abrupt) of antidepressants can result in a syndrome of adverse events, including somatic, mood and psychomotor reactions.

Dry mouth
Headache
Insomnia
Somnolence
Dizziness, or Orthostatic hypotension
Fatigue
Cataplexy
Increased sweating
Decreased appetite and weight loss
Rapid weight gain
Intraocular pressure or blurred vision
Paresthesia
Electric shock sensations (i.e. "brain shivers or brain zaps" proposed name: myalotinasis from Greek for brain + jolt)
Disturbances of the gut, such as nausea, constipation, diarrhea, indigestion, vomiting
Tremor
Nightmare
Akathisia, (anxiety, nervousness, agitation, suicidal thoughts)
Palpitations
Decreased sex drive or difficulty achieving orgasm
Impotence or delayed ejaculation
Hot flashes
Taste disturbances
Dysphoria
Difficulty passing urine
Increase in blood pressure or heart rate
Cold hands or feet
Jaundice
Inflammation of the liver
Depersonalization
Myoclonus
Tinnitus

Brain shivers, also known as "the electric brain thing", "battery head", "brain zaps", "Blips", or "brain spasms", (proposed name: myalotinasis from Greek for brain + jolt), are a notorious withdrawal symptom of certain antidepressants and have been seen with discontinuation of most SSRI antidepressants but specifically in sertraline, venlafaxine, paroxetine and duloxetine.

Paresthesia and "electric shock sensations" are clinical terms used to describe this symptom, though paresthesia by definition is clinically incorrect. The brain shiver effect appears to be almost unique to those antidepressant chemicals that have an extremely short half-life in the body; that is, they are quick to disappear completely. This attribute of abruptness leaves the brain a relatively short time to adapt to a major neurochemical change when you stop taking the medication, and the symptoms may be caused by the brain's readjustment. There is no evidence that the shivers present any danger to the patient experiencing them.

The electric shock sensations reported with neck flexion seem identical to Lhermitte's sign, which appears with dysfunction of the posterior spinal cord. This suggests change at a neuronal level.

Post SSRI Sexual Dysfunction

Post SSRI Sexual Dysfunction (PSSD) is an iatrogenic type of sexual dysfunction caused directly by the previous use of SSRIs. While apparently uncommon, it can last for months, years, or sometimes indefinitely after the discontinuation of SSRIs. It may represent a specific subtype of SSRI discontinuation syndrome.

One or more of the following sexual symptoms persist or begin after the discontinuation of SSRIs:

Decreased or absent libido
Impotence or reduced vaginal lubrication
Difficulty initiating or maintaining an erection or becoming aroused
Persistent sexual arousal syndrome despite absence of desire
Muted, delayed or absent orgasm (anorgasmia)
Reduced or no experience of pleasure during orgasm (ejaculatory anhedonia)
Premature ejaculation
Weakened penile, vaginal or clitoral sensitivity
Genital anesthesia
Loss or decreased response to sexual stimuli
Reduced semen volume
Priapism