From the Guidelines
Abruptly stopping sertraline can lead to withdrawal symptoms, and it is strongly recommended to taper off the medication gradually under medical supervision. The withdrawal symptoms, also known as SSRI discontinuation syndrome, can include dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 1. These symptoms can occur when sertraline is stopped suddenly, and they are more likely to happen with shorter-acting SSRIs like sertraline.
Key Considerations
- The symptoms typically begin within 1-3 days after reduction or discontinuation and may last for 1-2 weeks, though some people experience effects for longer periods.
- The severity of symptoms often relates to how long you've been taking the medication, your dosage, and individual factors.
- Withdrawal occurs because your brain has adapted to the increased serotonin levels from the medication; when sertraline is suddenly removed, your brain needs time to readjust its serotonin regulation.
- A typical tapering schedule might reduce the dose by 25-50mg every 1-2 weeks, with even smaller reductions as you reach lower doses, but this should always be personalized by your healthcare provider based on your specific situation.
Important Factors to Consider
- Medical education, training, and experience are necessary to safely and effectively prescribe antidepressant medications and manage their discontinuation.
- Parental oversight of medication regimens is of paramount importance in children and adolescents.
- Systematic assessment of treatment response using standardized symptom rating scales can be considered as a supplement to monitor the effects of tapering off sertraline.
- It is essential to work closely with a healthcare provider to determine the best tapering schedule and to monitor for any withdrawal symptoms, as they can provide guidance and support throughout the process 1.
From the FDA Drug Label
Discontinuation of Treatment with Sertraline hydrochloride During marketing of Sertraline hydrochloride 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.
Patients should be monitored for these symptoms when discontinuing treatment with sertraline hydrochloride A gradual reduction in the dose rather than abrupt cessation is recommended whenever possible.
The withdrawal symptoms when stopping sertraline abruptly include:
- Dysphoric mood
- Irritability
- Agitation
- Dizziness
- Sensory disturbances (e.g. paresthesias such as electric shock sensations)
- Anxiety
- Confusion
- Headache
- Lethargy
- Emotional lability
- Insomnia
- Hypomania 2
It is recommended to gradually reduce the dose rather than stopping abruptly to minimize these symptoms. 2
From the Research
Withdrawal Symptoms of Sertraline
When stopping sertraline (a selective serotonin reuptake inhibitor, SSRI) abruptly, patients may experience various withdrawal symptoms. These symptoms can be categorized into two main types: somatic and psychological.
Somatic Symptoms
- Dizziness and light-headedness 3
- Nausea and vomiting 3
- Fatigue, lethargy, myalgia, chills, and other flu-like symptoms 3
- Orthostatic hypotension 4
- Sensory and sleep disturbances 3
Psychological Symptoms
Management of Withdrawal Symptoms
To minimize the symptoms of antidepressant discontinuation, gradual tapering is necessary for all serotonin reuptake inhibitors (SRIs) except fluoxetine, which has an extended half-life 3. Agents with shorter half-lives, such as sertraline, should be tapered gradually to avoid withdrawal symptoms. If symptoms occur, they can often be treated by reassuring the patient that they are usually transient, but for more severe symptoms, it may be necessary to reinstitute the dosage of the original antidepressant and slow the rate of taper 3.
Importance of Gradual Tapering
Gradual tapering of sertraline is crucial to prevent withdrawal symptoms, as abrupt discontinuation can lead to distressing and potentially severe symptoms 5, 6. Patients should be informed about the risk of withdrawal symptoms when stopping sertraline, and healthcare professionals should be educated about the potential adverse effects of SRI discontinuation 3, 5.