Antidepressant Discontinuation: A Review of the Literature

Sudden or tapered withdrawal from treatment with antidepressants, including monoamine oxidaseinhibitors (MAOIs), tricyclic antidepressants (TCAs), and serotonin selective reuptake inhibitors(SSRIs), can produce phenomena consisting of somatic and psychological symptoms. The literatureabout these discontinuation phenomena consists mainly of case reports and a limited number of controlledprospective studies. The symptoms are generally mild and transient for the TCAs and theSSRIs but may be serious for the MAOIs. They are much more common with a shorter acting SSRI,such as paroxetine, than with the longer acting agent fluoxetine. Because the symptoms of antidepressantdiscontinuation include changes in mood, affect, appetite, and sleep, they are sometimes mistakenfor signs of a relapse into depression. Thus, it is important to directly question patients aboutnew symptoms that occur during antidepressant discontinuation to optimally manage treatment discontinuation.