279:, dizziness, and electric-shock-like experiences in the brain, often described by people who have them as brain zaps. These "brain zaps" have been described as an electric shock felt in the skull, potentially triggered by lateral eye movement, and at times accompanied by vertigo, pain, or dissociative symptoms. Some individuals consider it as a pleasant experience akin to an orgasm, however it is more often reported as an unpleasant experience that interferes with daily function. Mood disturbances such as
569:
371:. There is evidence that antidepressant discontinuation syndrome may be related to the half-life of SSRIs. Antidepressants with a lower half-life, such as Venlafaxine, have been implicated in higher incidences of withdrawal symptoms and more severe withdrawal symptoms. There may be a link between lower
401:
Treatment is dependent on the severity of the discontinuation reaction and whether or not further antidepressant treatment is warranted. In cases where further antidepressant treatment is prescribed, then the only option suggested may be restarting the antidepressant. If antidepressants are no longer
527:
doctrine" as the doctors prescribing the drug were warned of the potential problems and are an intermediary medical judgment between Lilly and patients; in
December 2013, Lilly's motion to dismiss was denied. In December 2014, class certification was denied. A second attempt at certification in 2015
337:
included severe symptoms and exceeded prevalence of both paroxetine and venlafaxine reports by over 250% (although acknowledged this may have been influenced by duloxetine being a much newer drug). It also found that the safety information provided by the manufacturer not only neglected important
299:
has been reported to have a higher incidence in withdrawal symptoms after discontinuation when compared to other SNRIs. Venlafaxine has also been implicated to create withdrawal symptoms regardless of dosage. Venlafaxine has been implicated in causing the most severe withdrawal symptoms after
266:
for at least four weeks and have recently stopped taking the medication, whether abruptly, after a fast taper, or each time the medication is reduced on a slow taper. Commonly reported symptoms include flu-like symptoms (nausea, vomiting, diarrhea, headaches, sweating) and sleep disturbances
249:
Approximately 15–50% of people who suddenly stop an antidepressant develop an antidepressant discontinuation syndrome. The condition is generally not serious, though about half of people with symptoms describe them as severe. Many restart antidepressants due to the severity of the symptoms.
502:
and negative outcomes. Due to pressure from pharmaceutical companies who make anti-depressants, the term "withdrawal syndrome" is no longer used by drug makers, and thus, most doctors, due to concerns that they may be compared to other drugs more commonly associated with withdrawal.
469:, interest grew as well in discontinuation syndromes. Some of the symptoms emerged from discussion boards where people with depression discussed their experiences with the disease and their medications; "brain zaps" or "brain shivers" was one symptom that emerged via these websites.
536:
The mechanisms of antidepressant withdrawal syndrome have not yet been conclusively identified. The leading hypothesis is that after the antidepressant is discontinued, there is a temporary, but in some cases, long-lasting, deficiency in the brain of one or more essential
402:
required, treatment depends on symptom severity. If symptoms of discontinuation are severe, or do not respond to symptom management, the antidepressant can be reinstated and then withdrawn more cautiously, or by switching to a drug with a longer half life (such as
425:
Postnatal adaptation syndrome (PNAS) (originally called "neonatal behavioral syndrome", "poor neonatal adaptation syndrome", or "neonatal withdrawal syndrome") was first noticed in 1973 in newborns of mothers taking antidepressants; symptoms in the infant include
476:, to evaluate all the research available prior to 2004. The group determined that the incidence of discontinuation symptoms are between 5% and 49%, depending on the particular SSRI, the length of time on the medicine and abrupt versus gradual cessation.
458:(MAOIs), SSRIs, and SNRIs. As of 2001, at least 21 different antidepressants, covering all the major classes, were known to cause discontinuation syndromes. The problem has been poorly studied, and most of the literature has been case reports or small
1559:. Second-Generation Antidepressants in the Pharmacologic Treatment of Adult Depression: An Update of the 2007 Comparative Effectiveness Review (Report). Comparative Effectiveness Reviews. Rockville, MD: Agency for Healthcare Research and Quality.
2193:
253:
Antidepressant discontinuation syndrome is a relatively new phenomenon, with its discovery in the 1950s. There is still little research on this syndrome; most of the research is conflicting or consists only of clinical trials.
422:, presenting a dilemma for pregnant women to decide whether to continue to take antidepressants at all, or if they do, considering if tapering and discontinuing during pregnancy could have a protective effect for the newborn.
1910:
Schatzberg, A.F., Haddad, P., Kaplan, E.M., Lejoyeux, M., Rosenbaum, J.F., Young, A.H., Zajecka, J. (1997). "Serotonin reuptake inhibitor discontinuation syndrome: a hypothetical definition. Discontinuation
Consensus panel".
385:
In some cases, withdrawal symptoms may be prevented by taking medication as directed, and when discontinuing, doing so gradually, although symptoms may appear while tapering. When discontinuing an antidepressant with a short
490:, and some used the term "withdrawal syndrome" to describe the symptoms. While people taking antidepressants do not commonly exhibit drug-seeking behavior, stopping antidepressants leads to similar symptoms as found in
346:
Most cases of discontinuation syndrome may last between one and four weeks and resolve on their own. Occasionally symptoms can last up to one year. They typically resolve within a day of restoring the medication.
906:
Henssler, J.; Schmidt, Y.; Schmidt, U.; Schwarzer, G.; Bschor, T.; Baethge, C. (2024). "Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis". The Lancet
Psychiatry.
1997:
Nielsen, M., Hanse, E.H., Gøtzsche, P.C. (2012). "What is the difference between dependence and withdrawal reactions? A comparison of benzodiazepines and selective serotonin re-uptake inhibitors".
2240:
1396:
2139:
Damsa, C., Bumb, A., Bianchi-Demicheli, F., et al. (August 2004). "'Dopamine-dependent' side effects of selective serotonin reuptake inhibitors: a clinical review".
2235:
486:
In the late 1990s, some investigators thought that the fact that symptoms emerged when antidepressants were discontinued might mean that antidepressants were causing
220:
1575:"Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: a review of the clinical evidence and the possible mechanisms involved"
1072:"Selective serotonin reuptake inhibitor antidepressant treatment discontinuation syndrome: a review of the clinical evidence and the possible mechanisms involved"
1634:"Withdrawal Syndrome Following Discontinuation of 28 Antidepressants: Pharmacovigilance Analysis of 31,688 Reports from the WHO Spontaneous Reporting Database"
472:
Heightened media attention and continuing public concerns led to the formation of an expert group on the safety of selective serotonin reuptake inhibitors in
338:
information about managing discontinuation syndrome, but also explicitly advised against opening capsules, a practice required to gradually taper dosage.
242:. Treatment may include restarting the medication and slowly decreasing the dose. People may also be switched to the long acting antidepressant
1632:
Gastaldon C, Schoretsanitis G, Arzenton E, Raschi E, Papola D, Ostuzzi G, Moretti U, Seifritz E, Kane JM, Trifirò G, Barbui C (December 2022).
216:
367:
The underlying reason for its occurrence is unclear, though the syndrome appears similar to withdrawal from other psychotropic drugs such as
238:
Methods of prevention include gradually decreasing the dose among those who wish to stop, though it is possible for symptoms to occur with
498:, and other psychotropic drugs. As such, some researchers advocate the term withdrawal over discontinuation, to communicate the similar
615:
582:
368:
2091:
839:
792:"A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?"
1979:
523:
label omitted important information about "brain zaps" and other symptoms upon cessation. Eli Lilly moved for dismissal per the "
231:(TCAs). The risk is greater among those who have taken the medication for longer and when the medication in question has a short
438:
problems. The symptoms usually develop from birth to days after delivery and usually resolve within days or weeks of delivery.
356:
2255:
1512:
Tamam L, Ozpoyraz N (January–February 2002). "Selective
Serotonin Reuptake Inhibitor Discontinuation Syndrome: A Review".
1268:"27.3 The Effectiveness of SSRIs for Treatment of OCD in Children and Adolescents: A Systematic Review and Meta-Analysis"
398:) and then tapering, and eventually discontinuing, from that drug can decrease the severity of symptoms in some cases.
455:
288:
224:
454:(TCA), in the late 1950s, and each new class of antidepressants has brought reports of similar conditions, including
1885:
165:
267:(insomnia, nightmares, constant sleepiness). Sensory and movement disturbances have also been reported, including
2121:
228:
169:
103:
1886:"Report of the CSM Expert Working Group on the Safety of Selective Serotonin Reuptake Inhibitor Antidepressants"
1884:
Expert Group on the Safety of
Selective Serotonin Reuptake Inhibitors (SSRIs) (December 2004). Weller IV (ed.).
333:
A 2009 Advisory
Committee to the FDA found that online anecdotal reports of discontinuation syndrome related to
2245:
499:
451:
284:
554:
607:
2073:
977:
686:
Warner CH, Bobo W, Warner C, Reid S, Rachal J (1 August 2006). "Antidepressant discontinuation syndrome".
120:
1164:"Withdrawal Symptoms after Serotonin-Noradrenaline Reuptake Inhibitor Discontinuation: Systematic Review"
919:"Prevalence and cardiometabolic correlates of ketohexokinase gene variants among UK Biobank participants"
465:
With the explosion of use and interest in SSRIs in the late 1980s and early 1990s, focused especially on
516:
2034:"Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review"
1783:
1397:"Cymbalta (Duloxetine) Discontinuation Syndrome: Issues of Scope, Severity, Duration & Management"
1737:
930:
524:
387:
1980:
WHO Expert
Committee on Drug Dependence – Thirty-third Report / WHO Technical Report Series 915
1306:
406:), and then tapering and discontinuing that drug. In severe cases, hospitalization may be required.
359:(post-acute-withdrawal syndrome, or PAWS) lasting over 18 months has been reported with paroxetine.
557:, and since neurotransmitters are an interrelated system, dysregulation of one affects the others.
372:
239:
17:
2250:
1537:
1494:
1013:
70:
31:
1940:"Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria"
283:, anxiety, or agitation are also reported, as are cognitive disturbances such as confusion and
235:. The underlying reason for its occurrence is unclear. The diagnosis is based on the symptoms.
2156:
2055:
2014:
1961:
1920:
1764:
1710:
1702:
1671:
1653:
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1596:
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1444:
1375:
1326:
1287:
1248:
1230:
1191:
1183:
1144:
1103:
1005:
997:
948:
889:
835:
813:
757:
695:
574:
538:
268:
205:
189:
185:
173:
110:
75:
58:
2148:
2045:
2006:
1951:
1861:
1853:
1820:
1754:
1746:
1661:
1645:
1604:
1586:
1521:
1478:
1434:
1365:
1357:
1318:
1279:
1238:
1222:
1175:
1134:
1093:
1083:
1047:
989:
956:
938:
879:
871:
803:
747:
739:
480:
479:
With the lack of a definition based on consensus criteria for the syndrome, a panel met in
2117:
495:
491:
1307:"Antidepressant Discontinuation Syndrome: A Common but Underappreciated Clinical Problem"
418:
and have the potential to affect the fetus and newborn, including an increased chance of
208:. The problem usually begins within three days and may last for several weeks or months.
934:
1983:
1956:
1939:
1866:
1841:
1759:
1733:"Antidepressant use in pregnancy: a critical review focused on risks and controversies"
1732:
1666:
1633:
1609:
1574:
1370:
1345:
1243:
1098:
1071:
961:
918:
884:
859:
752:
727:
550:
459:
263:
2229:
2010:
1482:
193:
1498:
1017:
1541:
1123:"Neurological complications of psychiatric drugs: clinical features and management"
427:
917:
Johnston JA, Nelson DR, Bhatnagar P, Curtis SE, Chen Y, MacKrell JG (2021-02-23).
943:
808:
791:
215:
A discontinuation syndrome can occur after stopping any antidepressant including
1267:
435:
431:
419:
352:
296:
1691:"Physiologic mechanisms underlying the antidepressant discontinuation syndrome"
1649:
1556:
1283:
568:
2212:
2207:
2202:
1439:
1422:
1052:
1035:
564:
483:, in 1997 to form a draft definition, which other groups continued to refine.
466:
447:
403:
395:
391:
375:
receptor availability and symptoms of antidepressant discontinuation syndrome.
348:
334:
243:
63:
1857:
1706:
1657:
1600:
1591:
1448:
1291:
1234:
1187:
1088:
1001:
952:
875:
542:
487:
292:
280:
232:
209:
181:
2160:
2059:
2018:
1965:
1768:
1714:
1690:
1675:
1618:
1533:
1490:
1379:
1330:
1252:
1195:
1163:
1148:
1107:
1009:
978:"Brain Zaps: An Underappreciated Symptom of Antidepressant Discontinuation"
893:
817:
761:
699:
172:
following its continuous use of at least a month. The symptoms may include
27:
Flu-like symptoms that happen after discontinuing antidepressant medication
1924:
1322:
834:(5th ed.). American Psychiatric Association. 2013. pp. 712–714.
164:, is a condition that can occur following the interruption, reduction, or
2152:
993:
546:
520:
415:
304:
177:
1825:
1808:
743:
1750:
1525:
1361:
1346:"Recognition and management of antidepressant discontinuation syndrome"
1211:"Status Cataplecticus Precipitated by Abrupt Withdrawal of Venlafaxine"
1210:
860:"A review of the management of antidepressant discontinuation symptoms"
473:
276:
201:
125:
2185:
2050:
2033:
1226:
1179:
2197:
295:
has been observed. Over fifty symptoms have been reported. The SNRI
272:
133:
1469:
Haddad PM (March 2001). "Antidepressant discontinuation syndromes".
1272:
Journal of the
American Academy of Child & Adolescent Psychiatry
1139:
1122:
262:
People with antidepressant discontinuation syndrome have been on an
2122:"Learned intermediary doctrine doesn't bar claim at pleading stage"
1162:
Fava GA, Benasi G, Lucente M, Offidani E, Cosci F, Guidi J (2018).
1423:"Recognising and managing antidepressant discontinuation symptoms"
1036:"Recognising and managing antidepressant discontinuation symptoms"
832:
Diagnostic and statistical manual of mental disorders : DSM-5
197:
129:
1555:
Gartlehner G, Hansen RA, Morgan LC, et al. (December 2011).
446:
Antidepressant discontinuation symptoms were first reported with
2092:"Lilly Fights Cymbalta 'Brain Zaps' Suit, Saying It Warned Docs"
303:
To simplify identifying the principal signs and symptoms, the
1982:(Report). World Health Organization. 2003. Archived from
78:, trouble sleeping, nausea, poor balance, sensory changes
2032:
Fava, G.A., Gatti, A, Belaise, C., et al. (2015).
1305:
Rizcalla M, Kowalkovski B, Prozialeck WA (2020-02-20).
300:
cessation of use, possibly due to its short half-life.
1402:. U.S. Food and Drug Administration (FDA). 9 June 2009
355:
seem to be particularly difficult to discontinue, and
287:. In cases associated with sudden discontinuation of
1938:
Black, K., Shea, C., Dursun, S., Kutcher, S. (2000).
1891:. Medicines and Healthcare Products Regulatory Agency
1464:
1462:
1460:
1458:
2175:
462:; incidence is hard to determine and controversial.
390:, switching to a drug with a longer half-life (e.g.
2179:
147:
139:
119:
109:
98:
90:
82:
69:
57:
49:
44:
2090:
1731:Byatt N, Deligiannidis KM, Freeman MP (Feb 2013).
414:Antidepressants, including SSRIs, can cross the
1065:
1063:
1029:
1027:
8:
2241:Serotonin–norepinephrine reuptake inhibitors
2075:Jennifer L Saavedra v. Eli Lilly and Company
1879:
1877:
982:The Primary Care Companion for CNS Disorders
513:Jennifer L Saavedra v. Eli Lilly and Company
326:Sensory disturbances, including “brain zaps”
221:serotonin–norepinephrine reuptake inhibitors
2210:Monoamine-oxidase-inhibitor antidepressants
1809:"'Brain shivers': from chat room to clinic"
2176:
1421:Haddad PM, Anderson IM (1 November 2007).
864:Therapeutic Advances in Psychopharmacology
681:
679:
677:
675:
673:
671:
669:
667:
665:
663:
661:
659:
657:
655:
653:
511:In 2013, a proposed class action lawsuit,
41:
2205:Tricyclic and tetracyclic antidepressants
2049:
1955:
1865:
1824:
1758:
1665:
1608:
1590:
1438:
1369:
1242:
1138:
1097:
1087:
1051:
960:
942:
883:
853:
851:
807:
785:
783:
781:
779:
777:
775:
773:
771:
751:
728:"Antidepressant discontinuation syndrome"
721:
719:
717:
715:
713:
711:
709:
651:
649:
647:
645:
643:
641:
639:
637:
635:
633:
180:, nausea, poor balance, sensory changes,
1726:
1724:
1350:Journal of Psychiatry & Neuroscience
602:
600:
598:
2236:Selective serotonin reuptake inhibitors
1034:Haddad PM, Anderson IM (October 2007).
594:
246:which can then be gradually decreased.
217:selective serotonin reuptake inhibitors
158:Antidepressant discontinuation syndrome
45:Antidepressant discontinuation syndrome
1568:
1566:
2215:Other and unspecified antidepressants
1391:
1389:
790:Davies J, Read J (4 September 2018).
7:
732:Canadian Medical Association Journal
608:"Antidepressant Withdrawal Syndrome"
858:Wilson E, Lader M (December 2015).
726:Gabriel M, Sharma V (29 May 2017).
1695:The Journal of Clinical Psychiatry
1215:Journal of Clinical Sleep Medicine
1209:Wang J, Greenberg H (2013-07-15).
907:doi:10.1016/S2215-0366(24)00133-0.
616:The University of British Columbia
583:Benzodiazepine withdrawal syndrome
162:antidepressant withdrawal syndrome
53:Antidepressant withdrawal syndrome
25:
18:Antidepressant withdrawal syndrome
1427:Advances in Psychiatric Treatment
1040:Advances in Psychiatric Treatment
2011:10.1111/j.1360-0443.2011.03686.x
1483:10.2165/00002018-200124030-00003
1344:Bhat V, Kennedy S (2017-07-01).
1168:Psychotherapy and Psychosomatics
567:
1311:Journal of Osteopathic Medicine
976:Papp A, Onton JA (2018-12-20).
2089:Overley J (January 29, 2013).
1:
1121:Haddad PM, Dursun SM (2008).
357:prolonged withdrawal syndrome
151:15–50% (with sudden stopping)
1840:Aronson J (8 October 2005).
1689:Blier P, Tremblay P (2006).
944:10.1371/journal.pone.0247683
809:10.1016/j.addbeh.2018.08.027
541:that regulate mood, such as
456:monoamine oxidase inhibitors
225:monoamine oxidase inhibitors
614:. Therapeutics Initiative,
2272:
2126:Rebecca Tushnet's 43(B)log
1650:10.1007/s40264-022-01246-4
1284:10.1016/j.jaac.2020.09.006
29:
1579:Frontiers in Pharmacology
1440:10.1192/apt.bp.105.001966
1053:10.1192/apt.bp.105.001966
688:American Family Physician
507:2013 class action lawsuit
229:tricyclic antidepressants
170:antidepressant medication
104:antidepressant medication
1858:10.1136/bmj.331.7520.824
1807:Christmas, M.B. (2005).
1592:10.3389/fphar.2013.00045
1266:Khan AM (October 2020).
1089:10.3389/fphar.2013.00045
876:10.1177/2045125315612334
500:physiological dependence
452:tricyclic antidepressant
381:Prevention and treatment
30:Not to be confused with
2078:– via Justia.com.
555:gamma-aminobutyric acid
1782:Stutz B (2007-05-06).
515:, was brought against
410:Pregnancy and newborns
143:Gradual dose reduction
121:Differential diagnosis
1944:J Psychiatry Neurosci
1323:10.7556/jaoa.2020.030
2256:Withdrawal syndromes
2153:10.4088/JCP.v65n0806
2120:(December 9, 2013).
2038:Psychother Psychosom
1813:Psychiatric Bulletin
1784:"Self-Nonmedication"
1738:Acta Psychiatr Scand
994:10.4088/PCC.18m02311
525:learned intermediary
1986:on August 30, 2009.
1842:"Bottled lightning"
1826:10.1192/pb.29.6.219
1514:Advances in Therapy
1127:Hum Psychopharmacol
935:2021PLoSO..1647683J
796:Addictive Behaviors
744:10.1503/cmaj.160991
442:Culture and history
430:, rapid breathing,
373:5-hydroxytryptamine
94:Few weeks to months
1751:10.1111/acps.12042
1526:10.1007/BF02850015
1362:10.1503/jpn.170022
1133:(Suppl 1): 15–26.
519:claiming that the
258:Signs and symptoms
212:may rarely occur.
186:intrusive thoughts
32:Serotonin syndrome
2223:
2222:
2141:J Clin Psychiatry
2051:10.1159/000370338
1913:J Clin Psychiatry
1701:(Suppl 4): 8–13.
1644:(12): 1539–1549.
1573:Renoir T (2013).
1227:10.5664/jcsm.2848
1180:10.1159/000491524
1070:Renoir T (2013).
575:Psychiatry portal
539:neurotransmitters
314:Flu-like symptoms
190:depersonalization
174:flu-like symptoms
155:
154:
115:Based on symptoms
111:Diagnostic method
76:Flu-like symptoms
39:Medical condition
16:(Redirected from
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481:Phoenix, Arizona
460:clinical studies
178:trouble sleeping
42:
21:
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2246:Antidepressants
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1406:17 October
589:References
448:imipramine
404:fluoxetine
396:citalopram
392:fluoxetine
349:Paroxetine
335:duloxetine
244:fluoxetine
206:depression
140:Prevention
64:Psychiatry
2251:Syndromes
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1658:1179-1942
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488:addiction
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363:Mechanism
323:Imbalance
293:psychosis
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210:Psychosis
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547:dopamine
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291:, acute
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