From the Guidelines
To manage SSRI withdrawal, a gradual tapering of the medication under medical supervision is the most effective approach, typically over several weeks to months depending on how long you've been taking the medication. SSRI withdrawal, also known as SSRI discontinuation syndrome, occurs when someone stops taking selective serotonin reuptake inhibitors (SSRIs) suddenly or reduces their dose too quickly 1. Common SSRIs that can cause withdrawal include paroxetine, fluvoxamine, and sertraline, which have been associated with discontinuation syndrome 1.
Some key points to consider when managing SSRI withdrawal include:
- 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 shorter-acting SSRIs 1.
- Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications and manage withdrawal 1.
- A conservative medication trial for mild to moderate anxiety presentations may entail increasing the dose as tolerated within the therapeutic dosage range in the smallest available increments at approximately 1- to 2-week intervals when prescribing shorter half-life SSRIs 1.
It is essential to note that never stopping an SSRI abruptly without medical guidance can intensify withdrawal symptoms and potentially lead to a relapse of the condition being treated. If you're experiencing severe withdrawal, your doctor might recommend returning to a lower dose and tapering more slowly, or switching to fluoxetine which has a longer half-life and tends to cause less severe withdrawal 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
SSRI Withdrawal Symptoms
- SSRI withdrawal syndrome occurs often and can be severe, compelling patients to recommence their medication 2
- Withdrawal symptoms can be differentiated from recurrence of the underlying disorder, but may also be mistaken for recurrence, leading to long-term unnecessary medication 2
- Guidelines recommend short tapers, of between 2 weeks and 4 weeks, down to therapeutic minimum doses, or half-minimum doses, before complete cessation, but studies have shown that these tapers show minimal benefits over abrupt discontinuation 2
Tapering Strategies
- Tapers over a period of months and down to doses much lower than minimum therapeutic doses have shown greater success in reducing withdrawal symptoms 2
- Hyperbolic tapering by exponential dose reduction appears to be a promising strategy for psychiatric drug discontinuation, including SSRIs 3
- Hyperbolically reducing doses of SSRIs reduces their effect on serotonin transporter inhibition in a linear manner, suggesting that SSRIs should be tapered hyperbolically and slowly to doses much lower than those of therapeutic minimums 2
Clinical Practice Guidelines
- Current major clinical practice guidelines provide little support for clinicians wishing to help patients discontinue or taper antidepressants in terms of mitigating and managing withdrawal symptoms 4
- Guidelines recommend gradual or slow tapering, but none provide guidance on dose reductions, how to distinguish withdrawal symptoms from relapse, or how to manage withdrawal symptoms 4
- The quality of clinical practice guidelines as they pertain to tapering and discontinuation is overall low 4
Managing Withdrawal Symptoms
- Reintroducing the antidepressant that was initially used or switching from one antidepressant to another to suppress symptomatology may actually aggravate the state of behavioral toxicity and be detrimental in the long run 5
- Alternative strategies that do not encompass continuation of antidepressant treatment are required, but there is currently a lack of adequate research for guiding the clinical approach 5