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, reduce the dose by 25-50mg every 1-2 weeks, with even slower reductions as you approach lower doses 1. For example, someone taking 100mg daily might reduce to 75mg for two weeks, then 50mg for two weeks, then 25mg for two weeks before stopping completely.

Key Considerations

• Common withdrawal symptoms include:
  • Dizziness
  • Headaches
  • Nausea
  • Irritability
  • Sensory disturbances (like "brain zaps")
  • Insomnia
  • Mood changes
• These symptoms typically begin within days of dose reduction and may last 1-3 weeks 1.
• If withdrawal symptoms become severe, temporarily returning to the previous higher dose and then tapering more slowly 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.
• Always consult with a healthcare provider before changing your sertraline dosage, as some symptoms might represent a relapse of the original condition rather than withdrawal 1.

Tapering Process

• The tapering process should be individualized based on the patient's response and tolerance.
• A conservative approach may involve reducing the dose by smaller increments (e.g., 12.5-25mg) every 1-2 weeks.
• Patients should be closely monitored for withdrawal symptoms and adjusted as needed.
• The goal is to minimize withdrawal symptoms while allowing the patient to safely discontinue the medication.

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.

• Stopping sertraline too quickly can cause serious symptoms, such as headache, sweating, nausea, and dizziness.
• A gradual reduction in dose is recommended to minimize the risk of withdrawal symptoms.
• 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.