Can vomiting occur during Selective Serotonin Reuptake Inhibitor (SSRI) discontinuation?

Vomiting as a Symptom of SSRI Discontinuation Syndrome

Yes, vomiting is a recognized symptom that can occur during SSRI discontinuation, particularly with shorter-acting SSRIs like paroxetine, fluvoxamine, and sertraline. 1 This symptom is part of the SSRI discontinuation syndrome, which includes various somatic and psychological manifestations.

SSRI Discontinuation Syndrome Overview

The discontinuation syndrome typically develops within 1-7 days after stopping or reducing the dose of an SSRI that has been used for at least one month. The syndrome is characterized by a cluster of symptoms that can cause significant distress or impairment.

Common Symptoms Include:

• Gastrointestinal symptoms:

  • Nausea
  • Vomiting
  • Diarrhea

• Neurological symptoms:

  • Dizziness (most common symptom)
  • Light-headedness
  • Vertigo
  • Shock-like sensations
  • Paresthesia
  • Headache
  • Gait instability

• Psychological symptoms:

  • Anxiety
  • Irritability
  • Insomnia
  • Agitation

• Other physical symptoms:

  • Fatigue
  • Lethargy
  • Tremor
  • Visual disturbances
  • Flu-like symptoms (myalgia, chills)

Risk Factors and Medication Differences

The risk of experiencing discontinuation symptoms varies by medication:

• Higher risk: Paroxetine, fluvoxamine, and sertraline have been specifically associated with discontinuation syndrome 1
• Lower risk: Fluoxetine has an extended half-life, making discontinuation symptoms less common 2

Clinical Course and Management

Without intervention, discontinuation symptoms can persist for more than a week in approximately half of cases. When the SSRI is restarted, symptoms typically resolve within 72 hours 3.

Management Recommendations:

1. Gradual tapering: All SSRIs except fluoxetine should be tapered gradually to minimize discontinuation symptoms 2

2. For mild symptoms: Reassurance that symptoms are usually transient and self-limiting

3. For severe symptoms: Consider reinstating the original antidepressant at the previous effective dose and implementing a slower taper schedule

4. Close monitoring: Particularly important during the first week after discontinuation or dose reduction

Important Clinical Considerations

• Discontinuation symptoms may be mistaken for physical illness or relapse of depression, potentially leading to unnecessary tests and treatments 2

• The syndrome is generally mild and self-limiting but can be distressing enough to affect daily functioning, including missed work and decreased productivity

• Symptoms can emerge not only after complete discontinuation but also during dose reduction or intermittent non-compliance

Prevention

To minimize the risk of discontinuation syndrome:

• Implement a gradual tapering schedule, especially for short-acting SSRIs
• Educate patients about potential discontinuation symptoms
• Advise patients not to miss doses or stop medication abruptly without medical consultation

The recognition and appropriate management of SSRI discontinuation syndrome, including symptoms like vomiting, are essential for providing optimal care to patients discontinuing these medications.