Antidepressant discontinuation syndrome

Antidepressant discontinuation syndrome, or antidepressant withdrawal, is a condition that can occur following switching, reducing, or discontinuing an antidepressant medication following its continuous use of at least a month. The symptoms may include dizziness, vertigo, postural orthostatic tachycardia syndrome, tinnitus, insomnia, nausea, poor balance, sensory changes, "brain zaps", emotional lability or extreme emotional changes, rage, suicidal ideation, akathisia, intrusive thoughts, depersonalization, and derealization, mania, anxiety, depression, and flu-like symptoms. Psychosis may rarely occur. Depending on the specific antidepressant's half-life, withdrawal can begin within a few days or weeks, but late onset or delayed onset withdrawal can occur months after cessation. If stopped too quickly, a withdrawal injury can occur. This is referred to protracted withdrawal and may last for several months or years.

Discontinuation syndrome was coined by Eli Lilly as a way to distance antidepressants from other dependence-forming psychotropics with higher addiction risk profiles. However, the evidence supports that what has been mislabeled as discontinuation syndrome is a classical withdrawal syndrome similar to that of benzodiazepines. Antidepressants are not addictive and do not produce substance use disorders, but they do create physical dependence which occurs when the body makes neuroadaptations due to the presence of the drug.

Withdrawal can occur after stopping nearly every class of antidepressants including selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), monoamine oxidase inhibitors (MAOIs), and tricyclic antidepressants (TCAs). The risk is greater among those who have taken the medication for longer and when the medication in question has a short half-life. The diagnosis is based on the symptoms and timeline of drug cessation.

Methods of prevention include gradually decreasing the dose among those who wish to stop, though it is possible for symptoms to occur with tapering. Treatment may include restarting the medication and slowly decreasing the dose. People may also be switched to the long-acting antidepressant fluoxetine which can then be gradually decreased.

Approximately 15–50% of people who suddenly stop an antidepressant develop antidepressant discontinuation syndrome. About half of people with discontinuation symptoms describe them as severe, and the discontinuation period is associated with a 60% increase in suicide attempts compared to people who had previously used antidepressants but were outside the discontinuation period. Many restart antidepressants due to the severity of the symptoms.

Antidepressant discontinuation syndrome is a relatively new phenomenon, being identified and described from 1950s onwards, in parallel with discovery and introduction of modern antidepressant medications, with the first MAOIs, and TCAs introduced from the 1950s onwards and the first SSRIs from the 1980s onward. There is still little research on this syndrome; most of the research is conflicting or consists only of clinical trials.