Potential adverse effects of discontinuing psychotropic drugs: part 2: antidepressant drugs

Abstract

Understanding the particular pharmacology of different antidepressant drugs can help explain their adverse effects when they are discontinued. For all antidepressant drugs, abruptly stopping them can sometimes result in "rebound" hypomania or mania. Antidepressant drugs having anticholinergic effects often are associated with a discontinuation syndrome characterized by cholinergic rebound, with symptoms of nausea, vomiting, abdominal cramping, sweating, headache, and muscle spasms. Discontinuation of monoamine oxidase inhibitor drugs sometimes results in flu-like symptoms, dysphoria, restlessness, tachycardia, hypertension, and a delirium-like state. Serotonergic antidepressant drugs are sometimes associated with a distinct discontinuation syndrome characterized by dizziness, weakness, nausea, headache, lethargy, insomnia, anxiety, poor concentration, and paresthesias. Adverse discontinuation effects can occur with all types of antidepressant drugs, but only rarely would they be considered serious. To minimize adverse discontinuation effects and to reduce the risk of relapse or recurrence of the underlying treated condition, tapering antidepressant medication is prudent for all patients.