From the Guidelines
Sertraline should be discontinued gradually, over several weeks to months, under the guidance of a healthcare provider to minimize the risk of withdrawal symptoms, as recommended in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. When considering discontinuation of sertraline, it is essential to weigh the benefits and risks of continued treatment. The decision to stop sertraline should be based on individual patient factors, such as stability of symptoms, presence of side effects, and potential risks associated with long-term treatment. Some key considerations for discontinuing sertraline include:
- Stability of symptoms: Patients who have been stable for 6-12 months may be considered for discontinuation 1.
- Intolerable side effects: If the patient is experiencing significant side effects, discontinuation may be necessary 1.
- Lack of efficacy: If sertraline is not effective for the patient's condition, alternative treatments should be considered 1.
- Pregnancy planning: The risks and benefits of continued treatment during pregnancy should be carefully evaluated 1. During the tapering process, regular monitoring for returning symptoms of depression or anxiety, as well as withdrawal effects, is crucial. The tapering schedule should be individualized, taking into account the patient's current dose and duration of treatment. For example, a patient on 100mg of sertraline might reduce their dose by 25mg every 2-4 weeks, as a general guideline. However, the specific tapering schedule may vary depending on the patient's response and the healthcare provider's clinical judgment. It is also important to note that sertraline, like other SSRIs, can cause discontinuation syndrome, characterized by symptoms such as dizziness, fatigue, and nausea, if stopped abruptly 1. Therefore, a gradual tapering schedule is essential to minimize the risk of these symptoms.
From the FDA Drug Label
Discontinuation of Treatment with Sertraline 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. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms. Patients should be monitored for these symptoms when discontinuing treatment with sertraline 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. Subsequently, the physician may continue decreasing the dose but at a more gradual rate
Discontinuation of sertraline should be considered in the following situations:
- Emergent suicidality: If a patient experiences emergent suicidality or symptoms that might be precursors to worsening depression or suicidality, especially if these symptoms are severe, abrupt in onset, or were not part of the patient’s presenting symptoms.
- Worsening depression: If a patient's depression is persistently worse.
- Serotonin syndrome: If a patient develops serotonin syndrome, which can be life-threatening.
- Concomitant use of MAOIs: If a patient is being treated with MAOIs intended to treat psychiatric disorders, as the concomitant use of sertraline with MAOIs is contraindicated.
- Abrupt discontinuation symptoms: If a patient experiences serious discontinuation symptoms, such as dysphoric mood, irritability, agitation, dizziness, sensory disturbances, anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania.
It is recommended to gradually reduce the dose rather than abrupt cessation whenever possible, and to monitor patients for symptoms when discontinuing treatment with sertraline 2.
From the Research
Discontinuation of Sertraline
The decision to discontinue sertraline, a selective serotonin reuptake inhibitor (SSRI), should be based on individual patient response and medical history.
- There is no specific guideline on when to discontinue sertraline, as it depends on the patient's condition and response to treatment 3, 4.
- Studies have shown that sertraline is effective in the treatment of depression and anxiety disorders, and its efficacy is unaffected by psychiatric comorbidity 4.
- In patients with major depressive disorder or obsessive-compulsive disorder, sertraline has been shown to improve symptoms and quality of life 5, 6.
- The treatment response to sertraline can vary, with some patients responding quickly and others taking longer to show improvement 7.
- In general, it is recommended to continue treatment with sertraline for at least 6 months to 1 year after symptoms have improved, to prevent relapse 3, 4.
- Discontinuation of sertraline should be done gradually, under medical supervision, to minimize the risk of withdrawal symptoms 3, 4.
Factors to Consider
When considering discontinuation of sertraline, the following factors should be taken into account:
- The patient's response to treatment and improvement in symptoms 5, 6.
- The presence of any underlying medical conditions or psychiatric comorbidities 4.
- The risk of relapse and the potential benefits of continued treatment 3, 4.
- The patient's ability to tolerate the medication and any potential side effects 3, 4.
Dosage and Treatment Regimen
The dosage and treatment regimen of sertraline can also impact the decision to discontinue treatment.