Frågedatum: 1999-10-29
RELIS database 1999; id.nr. 16168, DRUGLINE
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Is there any documentation that withdrawal effects of paroxetine last more than ten days?/nClinical



Fråga: Is there any documentation that withdrawal effects of paroxetine last more than ten days? Clinical background: A 40-year-old woman has been treated with paroxetine for six months because of depression. She discontinued paroxetine treatment by successively decreasing the dose from 20 mg to 10 mg and to 0 during a week. She had experienced dizziness for more than 10 days.

Sammanfattning: Withdrawal symptoms of paroxetine may last up to three weeks according to the current literature.

Svar: Paroxetine withdrawal symptoms have been discussed in previous Drugline questions (1-4).

The incidence of withdrawal symptoms related to paroxetine discontinuation have been reported up to 30 per cent of the patients especially in obsessive compulsive disorders (3). Dizziness is one of the most common side effect of paroxetine (5).

Withdrawal symptoms with SSRIs seem to be related to the half-life and the presence of active metabolite of the drug (6). SSRIs that have shorter half-life and no active metabolite, like paroxetine are suggested to have long lasting and higher risk of withdrawal symptoms (6). Such symptoms typically include dizziness, light-headedness, insomnia, anxiety, nausea, headache, and sensory disturbances. These discontinuation symptoms may last up to three weeks with shorter-acting SSRIs (7).

It was reported in a Drugline question (4) that withdrawal symptoms with paroxetine usually disappeared within four or five days. On the other hand, accumulating case reports suggest that withdrawal symptoms of paroxetine and sertraline generally have lasted 1-2 weeks after discontinuation of drug (8).

The exact mechanisms of withdrawal symptoms are still unknown. It has been postulated that these symptoms result from a sudden decrease in the availability of synaptic serotonin on the down-regulated serotonin receptors (6). Other neurotransmitters like dopamine, norepinephrine, or GABA may also be involved (6).

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