Abrupt Discontinuation of Sertraline 150 mg Daily: SSRI Withdrawal Syndrome
Abruptly stopping sertraline 150 mg daily will likely cause SSRI discontinuation syndrome, characterized by dysphoric mood, irritability, dizziness, sensory disturbances (electric shock sensations), anxiety, headache, and insomnia—symptoms that are generally self-limiting but can be serious and should be avoided through gradual dose tapering. 1
Primary Withdrawal Symptoms
The FDA label for sertraline explicitly warns that abrupt discontinuation produces a constellation of adverse events, including: 1
- Mood disturbances: Dysphoric mood, irritability, agitation, emotional lability, anxiety, confusion
- Neurological symptoms: Dizziness, sensory disturbances (particularly paresthesias described as "electric shock sensations"), headache, lethargy
- Sleep disruption: Insomnia
- Psychiatric symptoms: Hypomania (rare but documented)
Sertraline is specifically identified as one of the shorter half-life SSRIs with higher withdrawal rates, alongside paroxetine and fluvoxamine. 2 These symptoms typically occur following missed doses or abrupt cessation. 2
Severity and Duration
While withdrawal symptoms are generally self-limiting, serious discontinuation symptoms have been reported with sertraline. 1 The American Academy of Pediatrics emphasizes that all SSRIs require slow tapering to prevent withdrawal effects. 3, 4 A systematic review confirms that symptoms typically occur within a few days of drug discontinuation and last a few weeks, even with gradual tapering, though many variations exist including late onset and longer persistence. 5
Cardiovascular Effects (Rare but Documented)
Although uncommon, case reports document orthostatic hypotension developing on repeated attempts to discontinue sertraline, which resolved only after extended titration periods. 6 While this case involved sertraline, similar SSRI withdrawal has been associated with sustained hypertension severe enough to require medical intervention. 7
Critical Management Principle
A gradual reduction in dose rather than abrupt cessation is recommended whenever possible. 1 The American College of Physicians notes that older guidelines suggesting 10-14 day tapers are inadequate for long-term therapy. 8 If intolerable symptoms occur following dose reduction or discontinuation, resuming the previously prescribed dose should be considered, followed by decreasing the dose at a more gradual rate. 1
Practical Tapering Approach
Based on cross-tapering protocols for similar SSRIs at comparable doses, a reasonable approach for sertraline 150 mg would involve: 4
- Reduce by 25-50 mg decrements every 1-2 weeks
- Example schedule: 150 mg → 100 mg → 75 mg → 50 mg → 25 mg → discontinue
- Total taper duration: minimum 6-10 weeks for long-term therapy
- Monitor weekly during the first month, then monthly until stable
Common Pitfall to Avoid
Do not allow rapid discontinuation over 10-14 days—this timeframe is inadequate for patients on long-term therapy and increases risk of withdrawal syndrome. 8 Symptoms may be easily misidentified as signs of impending relapse of the underlying psychiatric condition. 5
Monitoring Requirements
Patients should be monitored for withdrawal symptoms when discontinuing sertraline, with particular attention to: 1
- Emergence of dizziness, sensory disturbances, or mood changes within days of dose reduction
- Differentiation between withdrawal symptoms (typically improve with dose resumption) and relapse of underlying condition
- Immediate reporting of severe or intolerable symptoms requiring dose adjustment