From the Guidelines
Withdrawal symptoms occur in a significant proportion of patients who discontinue sertraline, with symptoms such as dizziness, fatigue, and anxiety being commonly reported. The frequency of withdrawal symptoms when discontinuing sertraline is notable, particularly with paroxetine, fluvoxamine, and sertraline being associated with discontinuation syndrome 1. According to the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders, a discontinuation syndrome characterized by various symptoms has been reported following missed doses or acute discontinuation of shorter-acting SSRIs, including sertraline 1.
Key Considerations for Withdrawal Symptoms
- The severity and frequency of withdrawal symptoms are generally related to higher doses, longer duration of treatment, and abrupt discontinuation rather than gradual tapering.
- Common withdrawal symptoms include dizziness, headache, nausea, fatigue, irritability, sensory disturbances, insomnia, and anxiety.
- To minimize these effects, sertraline should be tapered gradually over at least 2-4 weeks, with slower tapering recommended for patients who have been on higher doses or longer treatment durations.
Tapering Recommendations
- Reducing the dose by 25-50mg per week from typical therapeutic doses (50-200mg daily) is often recommended.
- Patients should be advised to contact their healthcare provider if withdrawal symptoms become severe or intolerable during the tapering process, as the tapering schedule may need adjustment.
- Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications, including tapering sertraline 1.
From the Research
Frequency of Withdrawal Symptoms
- The frequency of withdrawal symptoms when discontinuing sertraline, a selective serotonin reuptake inhibitor (SSRI), has been studied in various research papers 2, 3, 4.
- According to a retrospective chart review of 352 patients, the most common symptoms experienced during medication tapering and discontinuation were dizziness, lethargy, paresthesia, nausea, vivid dreams, irritability, and lowered mood 2.
- The study found that these symptoms occurred significantly more frequently in patients who had been treated with shorter half-life SSRIs, such as fluvoxamine or paroxetine (17.2%), or with clomipramine (30.8%), compared to patients taking longer half-life SSRIs, such as sertraline or fluoxetine (1.5%) 2.
Case Reports and Studies
- A case report described two brothers who experienced sertraline withdrawal symptoms, including dysequilibrium, dysesthesias, dizziness, and a flushing sensation 3.
- Another case report documented a patient who developed orthostatic hypotension induced by sertraline withdrawal, which was proved to be secondary to sertraline by repeated rechallenges 4.
- A study assessing selective serotonin reuptake inhibitor discontinuation symptoms with citalopram found that most events that occurred during the first 2 weeks following randomization to placebo were mild in intensity and none resulted in discontinuation from the study 5.
Comparison with Other SSRIs
- A study compared the tolerance and efficacy of sertraline in patients who had failed fluoxetine therapy or were unable to tolerate the medication, and found that patients who had previously discontinued fluoxetine because of side effects were significantly more likely to have side effects during sertraline treatment and to have discontinued sertraline at follow-up 6.
- The study suggests that sertraline may be modestly efficacious and associated with numerous side effects and discontinuation rates in patients who had previously discontinued fluoxetine 6.