From the Guidelines
SSRI withdrawal symptoms can be minimized by tapering the medication gradually under medical supervision, usually over weeks or months, to allow the brain to readjust to the decreased serotonin levels. SSRI withdrawal, also known as SSRI discontinuation syndrome, can cause several uncomfortable symptoms when stopping selective serotonin reuptake inhibitors like fluoxetine, sertraline, paroxetine, or escitalopram. Common symptoms include:
- Dizziness
- Fatigue
- Lethargy
- General malaise
- Myalgias
- Chills
- Headaches
- Nausea
- Vomiting
- Diarrhea
- Insomnia
- Imbalance
- Vertigo
- Sensory disturbances
- Paresthesias
- Anxiety
- Irritability
- Agitation as noted in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1. These symptoms typically begin within days of reducing or stopping the medication, especially if discontinued abruptly. The severity varies based on the specific medication, dosage, duration of use, and individual factors. Paroxetine, fluvoxamine, and sertraline have been associated with discontinuation syndrome, with paroxetine being the most notable 1. To minimize withdrawal, patients should always taper SSRIs gradually under medical supervision. The withdrawal symptoms occur because the brain has adapted to the increased serotonin levels from the medication, and needs time to readjust when the drug is removed. If experiencing severe withdrawal symptoms, contact a healthcare provider immediately as they may need to adjust your tapering schedule.
From the Research
Symptoms of SSRI Withdrawal
- The symptoms of SSRI withdrawal are not well-addressed in clinical practice guidelines, with none of the 21 included guidelines providing guidance on dose reductions, distinguishing withdrawal symptoms from relapse, or managing withdrawal symptoms 2.
- Common adverse reactions to SSRIs include gastrointestinal symptoms (especially nausea) and neuropsychiatric symptoms (particularly headache and tremor) 3.
- Discontinuation reactions, including symptoms such as dizziness, insomnia, and flu-like symptoms, have been reported with SSRIs, particularly with paroxetine 3.
- Fluoxetine, a commonly prescribed SSRI, has been associated with symptoms such as nausea, nervousness, and insomnia, but these are usually not severe 4.
- The risk of withdrawal symptoms may be higher with certain SSRIs, such as paroxetine, and lower with others, such as citalopram and sertraline 3.
- Psychological challenges, such as agitation and anxiety, may also occur during SSRI withdrawal, but are not well-addressed in clinical practice guidelines 2.