Withdrawal when Stopping Serotonin Boosters
The withdrawal reactions from SSRI's which may be seen within 8-hours, often includes:
a spontaneously experience of a "flu-like" syndrome, feeling "crummy", tired, achy, etc.
In addition to the flu-like symptoms, visual phenomena (e.g., "moustaches on men and women
but only smudges on the upper lips of babies") are not rare.
anxiety
dizziness
fatigue
headache
insomnia
nausea
restlessness
tremors
visual hallucinations/illusions
ringing in ears and throbbing in head
"electrical shock" like phenomena/electrical surges
tinnitus and a vertiginous-like experience
depressive (suicidal) thoughts
A patient said:
"I took Effexor only for a month. I was very surprised at the intensity of
the withdrawal. The worst withdrawal effect for me was a sense of my nerves jangling when I
moved my eyes and continuous indigestion, sort of a migraine-like feeling without the
headache. The withdrawal took almost six weeks to get through, but I am now drug-free with
tolerable levels of neck and back pain".
A doctor said:
"I was tapering a patient off Effexor a few weeks ago and he had what I
considered a severe
withdrawal reaction with nausea and vomiting and flu-like symptoms although he was already
started on fluoxetine. A slower tapering worked better".
A doctor said:
"I have been treating a teenaged boy who presented with some symptoms of depression and also
psychological problems, especially difficulty with authority figures that goes way beyond
the usual adolescent stuff. I decided to try him on sertraline, and the dose was gradually
increased to 150 mg, with modest benefit. He decided abruptly to stop taking the medication
and didn't tell me or his parents. Three days later he got in a disagreement with a
security guard at his high school. The patient didn't remove his cap upon entering the
school, as is required by the school to limit gang-associated clothing, and the guard
knocked the cap off his head. The patient reacted by knocking the guard's eyeglasses off,
breaking them. The guard pressed charges, and the patient now has an assault charge
pending. The patient has no history of any aggressive behavior and admits that he
"overreacted". After this incident, he resumed the medication until a month or so later,
when he again stopped taking it and this time he told me and his parents. The patient and
his parents noticed a marked irritability and a tendency to overreact and generally to be
too emotional beginning 2 or 3 days after stopping the sertraline. The patient then began
to wonder if his previous episode was in any way related to going "cold turkey".
His lawyers as well as his family would like to use this in his defense".
A doctor said:
"I have had several patients -- all children and adolescents -- who have developed extreme
irritability, often very unlike their usual personality, beginning a few days after
abruptly discontinuing a short-acting serotonergic antidepressant. I'm aware of reports of
withdrawal symptoms from paroxetine and sertraline, but I've not seen anything about
exclusively behavioral symptoms in the absence of physical sxs".
A doctor said:
"I see all sorts of strange complaints from stopping SSRIs too soon. These include mood
disturbance, psychotic features such as illusions or frank hallucinations, extreme
agitation, and severe malaise".
A doctor said:
"Irritability and "over-reacting" don't suprise me in the least, and I find the story as
you present it quite consistent with SSRI sudden-withdrawal syndrome. Having learned the
hard way how terrible the effects of suddenly stopping SSRIs and venlafaxine (Effexor) can
be I now routinely urge all my patients to come off these drugs gradually. I have seen the
worst reactions from paroxetine (Paxil), but I have seen them in all the SSRIs.
I have seen the withdrawal syndrome at low doses, like Paxil 20 mg and even Zoloft 50 mg".
A doctor said:
"I too have had experience with sertraline withdrawal. The two patients that come to mind
complained of general dysphoria, derealization, and somatic sensations that led to a panic
attack in one of them".
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