Case study

• Stuart is a 25-year-old man with a diagnosis of generalised anxiety disorder (GAD) 
• Medication: Paroxetine 30mg OD

Stuart was diagnosed with generalised anxiety disorder (GAD) three years ago. Originally his GP prescribed sertraline but Stuart was unable to tolerate this due to nausea and diarrhoea. The sertraline was stopped and his GP started paroxetine. Stuart tolerated this well and the dose was eventually increased to 30mg OD. He has continued on this dose for two years.

Stuart feels that his anxiety is well managed and over the past two years he has learnt and developed coping strategies to manage his anxiety. He now feels that it is the right time to try reducing and stopping the paroxetine. Stuart’s GP agrees and recommends reducing the dose to 20mg OD immediately and to stop completely the following week. 

Stuart followed this advice but on reducing the dose he started to experience flu-like symptoms. Stuart assumed he just had a cold and continued with the withdrawal plan and stopped the paroxetine completely as directed by his GP but then began to experience strange electronic-shock like sensations in the back of his neck and scalp. 

The electric-shock sensations became more intense and Stuart found them distressing as he did not know what they were and was concerned that he may be having a stroke or some type of medical emergency. Stuart felt his only option was to attend A&E where the medical team eventually identified the sensations as antidepressant discontinuation symptoms. They recommended that Stuart increase his paroxetine dose back up to 30mg OD. 

Stuart was so distressed by this experience he has decided to continue taking the same dose of paroxetine indefinitely.