Discontinuation symptoms
Someone who is benefiting from an antidepressant should continue taking it for at least six months after their symptoms have resolved. All patients should be told about the risk of discontinuation symptoms if they stop their medication. This includes missing doses and sometimes when reducing the dosage, particularly with short half-life agents such as paroxetine. Symptoms can include dizziness, nausea, paraesthesia (an abonormal sensation like ‘pins and needles’), anxiety, diarrhoea, flu-like symptoms, and headaches. Although generally mild and self-resolving over approximately one week, these can sometimes be severe and debilitating.
In order to reduce the risk of discontinuation symptoms, the antidepressant dose should be gradually reduced over a four-week period. Drugs such as paroxetine and venlafaxine which have shorter half-lives may require more gradual titration, while longer half-life agents such as fluoxetine tend to be less problematic.