What are the symptoms of Sertraline (selective serotonin reuptake inhibitor) withdrawal?

From the Guidelines

Sertraline withdrawal should be managed through a gradual tapering process rather than abrupt discontinuation to minimize withdrawal symptoms and reduce the risk of morbidity and mortality. The most recent and highest quality study 1 suggests that a discontinuation syndrome characterized by dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation has been reported following missed doses or acute discontinuation of sertraline. To minimize these symptoms, a gradual tapering process is recommended, with dose reductions of 25-50mg every 1-2 weeks, and even slower reductions at lower doses (e.g., 12.5mg decrements below 50mg) 1.

Tapering Schedule

A typical tapering schedule might involve:

• Reducing from 100mg to 75mg for two weeks
• Then to 50mg for two weeks
• Then to 25mg for two weeks
• And finally to 12.5mg for two weeks before stopping completely This schedule can help minimize withdrawal symptoms, which can include dizziness, headaches, nausea, irritability, sensory disturbances (like "brain zaps"), insomnia, and mood changes 1.

Managing Withdrawal Symptoms

During withdrawal, patients may experience a range of symptoms, including:

• Dizziness
• Headaches
• Nausea
• Irritability
• Sensory disturbances (like "brain zaps")
• Insomnia
• Mood changes These symptoms typically begin within days of dose reduction and can last 1-3 weeks 1. Staying hydrated, maintaining regular sleep patterns, exercising moderately, and practicing stress-reduction techniques can help manage symptoms. If withdrawal symptoms become severe, slowing the taper further is recommended. Withdrawal occurs because the brain has adapted to sertraline's effects on serotonin levels, and needs time to readjust when the medication is reduced. Patients should always consult their healthcare provider before changing their medication regimen 1.

From the FDA Drug Label

Do not stop sertraline without first talking to your healthcare provider Stopping sertraline too quickly may cause serious symptoms including: anxiety, irritability, high or low mood, feeling restless or changes in sleep habits headache, sweating, nausea, dizziness electric shock-like sensations, shaking, confusion During marketing of sertraline and other SSRIs and SNRIs (Serotonin and Norepinephrine Reuptake Inhibitors), there have been spontaneous reports of adverse events occurring upon discontinuation of these drugs, particularly when abrupt, including the following: dysphoric mood, irritability, agitation, dizziness, sensory disturbances (e. g. paresthesias such as electric shock sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible. If intolerable symptoms occur following a decrease in the dose or upon discontinuation of treatment, then resuming the previously prescribed dose may be considered.

Sertraline withdrawal symptoms may include anxiety, irritability, and changes in mood or sleep habits.

• Key points to consider when stopping sertraline:
  • Do not stop sertraline without first talking to your healthcare provider.
  • Stopping sertraline too quickly may cause serious symptoms.
  • A gradual reduction in the dose is recommended whenever possible.
  • If intolerable symptoms occur, resuming the previously prescribed dose may be considered 2, 2.

From the Research

Sertraline Withdrawal Symptoms

• Discontinuation symptoms of sertraline, a selective serotonin reuptake inhibitor (SRI), can be mild, short-lived, and self-limiting, but may also be distressing and lead to missed work days and decreased productivity 3.
• Symptoms of sertraline withdrawal may include somatic symptoms such as dizziness, nausea, vomiting, fatigue, and sensory disturbances, as well as psychological symptoms like anxiety, agitation, and irritability 3.
• These symptoms can be mistaken for physical illness or relapse into depression, highlighting the need for healthcare professionals to be educated about the potential adverse effects of SRI discontinuation 3.

Tapering Sertraline to Mitigate Withdrawal Symptoms

• Guidelines recommend tapering sertraline gradually over a period of weeks or months to minimize withdrawal symptoms 4, 5.
• A hyperbolic tapering regimen, which reduces the dose of sertraline in a linear manner, may be effective in minimizing withdrawal symptoms 4.
• Tapering sertraline to doses much lower than the minimum therapeutic dose may be necessary to reduce withdrawal symptoms 4.
• Current clinical practice guidelines provide little support for clinicians wishing to help patients discontinue or taper antidepressants, including sertraline, in terms of mitigating and managing withdrawal symptoms 5.

Comparison of Sertraline with Other Antidepressants

• Sertraline has been compared with other selective serotonin reuptake inhibitors (SSRIs) like fluoxetine in terms of efficacy and adverse effects 6, 7.
• While sertraline and fluoxetine have similar efficacy, fluoxetine may have a slower onset of action and more adverse effects like agitation and weight loss 7.
• Sertraline may have a lower risk of drug interactions compared to other SSRIs like fluvoxamine and paroxetine 7.