Side Effects of Abruptly Stopping 150mg Sertraline
Abruptly discontinuing sertraline 150mg can cause significant discontinuation syndrome symptoms including dysphoric mood, irritability, agitation, dizziness, sensory disturbances (such as electric shock-like sensations), anxiety, confusion, headache, lethargy, emotional lability, insomnia, and hypomania. 1
Common Discontinuation Symptoms
Sertraline discontinuation syndrome typically includes:
Neurological symptoms:
- Electric shock-like sensations (brain zaps)
- Dizziness
- Vertigo
- Paresthesias
- Tremor
- Sensory disturbances
Psychological symptoms:
- Anxiety and agitation
- Irritability
- Confusion
- Mood swings
- Depression
- Emotional lability
Physical symptoms:
- Flu-like symptoms (fatigue, muscle aches)
- Headache
- Nausea and vomiting
- Sweating
- Sleep disturbances
Severity and Duration
The severity of discontinuation symptoms is influenced by several factors:
- Dose: At 150mg, which is a moderate-to-high dose of sertraline, discontinuation symptoms are likely to be more pronounced than at lower doses 2
- Duration of treatment: Longer treatment periods (>6 weeks) increase risk of discontinuation syndrome 2
- Half-life: Sertraline has a half-life of approximately 26 hours 3, which means symptoms typically begin 1-3 days after stopping and can last 1-2 weeks
Risk Factors for Severe Discontinuation Syndrome
Certain factors increase the risk of experiencing more severe discontinuation symptoms:
- Higher dosage (150mg is considered a moderate-to-high dose)
- Longer duration of treatment
- History of discontinuation symptoms with previous medications
- History of anxiety disorders
Proper Discontinuation Approach
The FDA label for sertraline explicitly warns against abrupt discontinuation and recommends:
- A gradual reduction in dose rather than abrupt cessation 1
- Monitoring for discontinuation symptoms during the tapering process
- If intolerable symptoms occur, resuming the previously prescribed dose and then decreasing at a more gradual rate 1
Management of Discontinuation Symptoms
If discontinuation symptoms occur after abrupt cessation:
- Reinstitution of medication: Restarting sertraline at a lower dose can rapidly extinguish symptoms 2
- Symptomatic treatment: For mild symptoms, supportive care including reassurance that symptoms are temporary
- Medical attention: Seeking medical attention if symptoms are severe or intolerable
Prevention
To avoid discontinuation syndrome:
- Never stop sertraline abruptly without medical supervision
- Work with a healthcare provider to create a tapering schedule
- Typical tapering schedules for 150mg might involve:
- Reducing by 25-50mg increments every 1-2 weeks
- Slower reductions at lower doses (e.g., from 50mg to 25mg to 0)
- Extended tapering periods for patients who have been on sertraline long-term
Special Considerations
- Pregnancy: Discontinuation requires special consideration and medical supervision
- Comorbid conditions: Patients with anxiety disorders may experience more pronounced discontinuation symptoms
- Medication interactions: Discontinuation effects may be compounded if taking other serotonergic medications
The evidence strongly supports a gradual tapering approach rather than abrupt discontinuation of sertraline, especially at higher doses like 150mg, to minimize the risk and severity of discontinuation syndrome.