RE SERTRALINE WITHDRAWAL REACTIONS

DATE      CITATION           DRUG                     REPORT                                      

1994 Louie et al Sertraline Single case report of middle-aged woman, treated for 9 weeks with SRN, who experienced marked symptoms following both abrupt and gradual withdrawal. Patient experienced flu-like symptoms, also fatigue, insomnia headache and sore eyes. Symptoms resolved on restarting drug and a protracted withdrawal regimen was then begun. Patient reported similar but milder symptoms shortly after each of three dosage reductions; she was finally able to stop SRN treatment and became symptom free 14 weeks after the initial attempt at discontinuation.
1995 Fava & Grandi Paroxetine (3 cases) and sertraline (1) Authors discuss four cases where depressed patients experienced symptoms similar to those in the cases reported in OCD patients, by Barr et al (1994) and Keuthen et al (1994) - indicating that withdrawal symptoms are therefore not specific in OCD.  These cases emerged from a total of four PRX patients, four on SRN and 19 patients treated with FLX. Authors conclude that "these serotonergically mediated  withdrawal syndrome raise concern about the possibility of the sensitizing of serotonergic systems by selective reputake inhibitors, leading to increased vulnerability to depressive relapse in the long run" (Fava, 1994)
1995 Frost & Lall Paroxetine (2 cases) Sertraline (1) Three cases are reported in this letter of withdrawal involving severe 'electric shock' like withdrawal symptoms similar to those reported by Ellison (1994). In one case, "five months of gradual paroxetine withdrawal led to cessation of the shocks"; in another case, "sertraline treatment was tapered over 8 weeks ... One day after the last 50mg dose of sertraline, he complained of 'electric shocks' ... They each lasted a second or so and occurred every 5-10 minutes. When his first attack occurred while he was in a swimming pool, he thought he 'was being electrocuted'. At times, his 'whole body would fly back', which once led to a brief loss of control of his car's steering wheel .... Less intense shocks persisted for 4 weeks and ceased 13 weeks after sertraline cessation."
1995 Kent & Laidlaw Sertraline Single case report of dependence seen in a neonate whose mother had taken SRN 200mg/day throughout her pregnancy and for three weeks after the birth, when it was stopped abruptly. "The baby, previously feeding and developing well, after one day developed symptoms of agitation, restlessness, poor feeding, constant crying, insomnia and an enhanced startle reaction. These symptoms were intense for 48 hours and then began to subside over the next few days. The mother remained well with no adverse symptoms after stopping sertraline." Comment. Fascinating, the contrast between what happened to mother and child. The mother was no longer depressed (perhaps elated by the birth) - while the never-depressed baby becomes hooked on an antidepressant drug. Makes you wonder what's going on
1995 Leiter al al Sertraline Report of two cases of withdrawal symptoms following SRN discontinuation, in one case after two weeks of dose tapering. Patients experienced deterioration of mood, cognition, energy levels, gait and balance, as well as headaches and gastrointestinal symptoms.Both patients "experienced significant discomfort due to paresthesias" (tingling, burning sensations under the skin).
1996 Amsden & Georgian Sertraline Single case report: patient was a 29-year old man, who had taken SRN for 13 weeks before requesting discontinuation.  Dosage was then gradually decreased, to 50mg/day for five weeks, then 50mg every other day for six days, and stopped. Thereafter, patient developed dizziness and marked orthostatic hypotension on repeated attempts to withdraw the drug, using increasingly gradual regimens. After extensive examinations, all other organic factors were ruled out. Patient was finally successfully withdrawn, taking reducing doses over eight weeks.
1996 Hamner & Huber Sertraline Letter discusses the implications of the common practice of discontinuing antidepressant drugs before giving ECT, in the light of experience with a patient whose depression markedly worsened (with development of spontaneous suicidal ideation) three days after discontinuing sertraline, prior to ECT. Patient "remained severely depressed after the first two ECT. Sertraline was then resumed and increased to 200mg daily. He progressively improved and by the fourth ECT had returned to his clinical status before discontinuing sertraline. With combined ECT and sertraline, he had full remission in major depressive symptoms after 10 additional treatments ..."
1996 Mathew (Ed) Paroxetine Sertraline Fluoxetine Note from the Australian Adverse Drug Reactions Advisory Committee re reports received of withdrawal reactions with PRX (22 reports), SRN (7) and FLX (3). A total of 51 different symptoms had been reported. In addition to hallucinations (3 cases) and depersonalisation (3), there was "a wide range of other neurological and psychiatric symptoms including amnesia, ataxia, blurred vision, confusion, dysarthria, delirium, fatigue, hyperacusis, hypertonia, meningism, mood swings, neurosis, nervousness, nightmares, paresthesia, rigors, sensory disturbance, tinnitus and twitching. There was also a report of a neonatal withdrawal reaction."
1996 Rosenstock Sertraline Two brothers, coincidentally being treated for depression with SRN up to 100mg/day, "experienced similar but unusual symptoms", in spite of gradual withdrawal. The main symptom was a "nearly immobilising disequilibrium". 
1997 Wolfe Sertraline Venlafaxine Review including brief reports of two patients who had experienced withdrawal symptoms on discontinuing SRN and VFX respectively. The patient on VFX experienced severe restlessness (akathisia) which abated within hours of restarting the drug. The drug was later gradually tapered and withdrawn. 
1998 Benazzi (4) Sertraline Patient was a 57 year old woman who had been taking sertraline 50mg/day for 10 months for recurrent major depressive disorder and panic disorder. Sertraline was slowly tapered but, after two days with sertraline 12.5mg/day, "she noted anxiety, irritability, compulsions (frequent cleaning and hand washing, which she had never had before), light/sound sensitivity, insomnia, nausea and headache."  Symptoms worsened during the second week: "she also noted depressed mood, fatigue, apathy (she spent many hour in bed), pessimistic and guilt ruminations, loss of appetite, difficulty concentrating and suicidal thoughts, of an intensity never had in the past". Symptoms soon cleared on restitution of sertraline 25mg/day.
1998 Benazzi Sertraline, venlafaxine

 

 In this letter, author describes two patients who had been unable to withdraw from SRN and VFX, because of severe withdrawal symptoms - who were later able to stop taking SSRIs "by adding, and later discontinuing, fluoxetine". 
1998 Macdonald Paroxetine (17), sertraline (4), fluoxetine (3), fluvoxamine (2). This short report summarises the 26 reports of withdrawal reactions reported to the Canadian Adverse Drug Reaction Monitoring Programme, for the four available SSRIs.  In 15 cases, drug was restarted; in 10 cases symptoms abated. Of particular interest: three of the 26 cases (drug not specified) resulted in hospitalisation or prolonged hospitalisation;  and in one case, "electric shock-like" symptoms (paresthesia) persisted for four years after discontinuation of paroxetine.
1998 Rosenbaum, Fava et al Sertraline This paper is the subject of detailed review. Briefly, it gives excellent evidence about withdrawal sertraline (and paroxetine).
1999 Goldstein et al Sertraline (2), fluoxetine (1), venlafaxine (1)

 

 Manic symptoms following antidepressant withdrawal have mainly been reported in unipolar depression. These cases involved bipolar patients, treated for an average 6.5 months, before taper (average 20 days, range 1-43). The first manic symptoms emerged, on average, 2 weeks into the taper period (range 1-23 days), and mean length of manic episode was 28 days (range 12-49 days).
2001

 

 Carrazana et al Sertraline Letter reporting case in which 62-year old woman experienced withdrawal symptoms, quitting after 6 months on sertraline 100mg/day - which she then attempted to treat with an anti-anxiety drug, buspirone. This apparently intensified symptoms of withdrawal, producing 'intense nausea, anxiety, dizziness and vertigo'.
2001

 

 Favaro et al Sertraline Long letter reporting a small retrospective study details sertraline withdrawal syndrome observed in 6/24 (25%) patients treated for anorexia nervosa (AN). Authors note that "neither high doses of medication nor specifically, abrupt discontinuation, seem to be linked to the presence of discontinuation symptoms ... Our data suggest that discontinuation syndrome in AN is related more to the psychologic and temperamental characteristics of the patients than to their underweight condition."
2002new.bmp (454 bytes) Diler & Avci Paroxetine, Fluvoxamine Sertraline Six case reports describing withdrawal symptoms (following abrupt and gradual discontinuation) in children (mean age 11.33 +/- 1.75 years) taking paroxetine (3 cases), fluvoxamine (2 cases) and sertraline. The withdrawal syndrome in children is described as similar to that experienced by adults; supportive strategies are discussed.

The following are the recommendations and warnings relating to withdrawal reactions for SSRI antidepressants in the Data Sheet Compendium 1998/99:

Sertraline (Lustral/Zoloft): "Rare cases of withdrawal reactions have been reported"

 

Contents page
  Pencil_and_PaperE190.gif (245 bytes) References
Table: all reports of SSRI withdrawal