Trazodone Withdrawal and Discontinuation Syndrome
Yes, abrupt discontinuation of trazodone can cause withdrawal symptoms, including sensory disturbances that may manifest as "shock-like" sensations (paresthesias), along with other neuropsychiatric symptoms. 1
Withdrawal Symptoms from Trazodone
The FDA-approved drug label explicitly warns that discontinuation syndrome can occur after stopping trazodone, particularly with abrupt cessation 1. The documented withdrawal symptoms include:
- Sensory disturbances (paresthesias, such as electric shock sensations) 1
- Nausea and sweating 1
- Dysphoric mood and irritability 1
- Agitation and anxiety 1
- Dizziness and tremor 1
- Confusion and headache 1
- Lethargy and emotional lability 1
- Insomnia and hypomania 1
- Tinnitus and seizures 1
Mechanism and Clinical Evidence
The withdrawal symptoms develop due to trazodone's effects on the serotonergic system and its metabolite m-chlorophenylpiperazine (mCPP), which can result in noradrenergic rebound after discontinuation 2. The relatively short half-lives of both trazodone and its active metabolite contribute to the rapid onset of withdrawal symptoms 2.
Clinical case reports have documented withdrawal symptoms occurring even with gradual discontinuation of therapeutic doses 2. These "shock-like" sensations you're asking about are consistent with the paresthesias described in antidepressant discontinuation syndrome 3, 1.
Proper Discontinuation Strategy
A gradual dose reduction is strongly recommended rather than abrupt cessation whenever possible 1. The FDA label specifically states this approach should be used to minimize withdrawal symptoms 1.
Tapering Recommendations:
- Taper very slowly - Clinical evidence suggests trazodone should be discontinued at a particularly slow rate compared to other antidepressants 2
- Avoid abrupt cessation in all cases 1
- Monitor for emergence of withdrawal symptoms during the taper 1
- If severe withdrawal symptoms develop, consider temporarily increasing the dose before resuming a slower taper 1
Clinical Context
While trazodone is not associated with addiction or dependence in the traditional sense (unlike benzodiazepines or opioids) 3, physical dependence with withdrawal symptoms upon discontinuation is well-established 1, 2. This is a pharmacological phenomenon distinct from substance use disorder 3.
The withdrawal syndrome typically begins within 24-48 hours after stopping the medication and can persist for 2-3 weeks if not managed appropriately 4. However, with proper gradual tapering, these symptoms can be largely prevented or minimized 1, 2.
Key Clinical Pitfall
Do not confuse withdrawal symptoms with relapse of the underlying condition 1. The sensory disturbances (electric shock sensations), anxiety, and sleep disturbances that occur with trazodone discontinuation are withdrawal phenomena, not necessarily a return of depression or insomnia 1.