Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria

Objective: To establish specific criteria by which selective serotonin reup take inhibitor (SSRI) discontinuation syndrome may be identified. Data sour ces: MEDLINE and PSYCHLIT databases were searched for case reports publishe d from 1986 to 1997 inclusive, and references of relevant articles were als o searched. Study selection: Forty-six case reports of symptoms following t he discontinuation of fluoxetine, fluvoxamine, paroxetine or sertraline wer e selected. Three studies of SSRI discontinuation were also reviewed. Data extraction: Demographic and treatment information, as well as the timing, d uration, number, nature and frequency of dicontinuation symptoms. Data synt hesis: Paroxetine was most frequently implicated. The drug had been tapered in half of the cases. In some cases, symptom onset began during taper, whe reas, in most cases, symptoms began within 1 to 3 days of drug discontinuat ion. Fifty-three different symptoms were reported, with dizziness being the most common. Other common symptoms were nausea or emesis, fatigue, headach e, gait instability and insomnia. Shock-like sensations, paresthesia and vi sual disturbances were the most rare. Without intervention, symptoms persis ted for more than a week in half of the cases. In cases in which the SSRI w as restarted, symptoms resolved within 72 hours. In some cases, withdrawal symptoms recurred when the same SSRI was again discontinued. Conclusions: F indings were used to construct diagnostic criteria for the SSRI discontinua tion syndrome. These criteria are 2 or more of the following symptoms devel oping within 1 to 7 days of discontinuation or reduction in dosage of an SS RI after at least 1 month's use, when these symptoms cause clinically signi ficant distress or impairment and are not due to a general medical conditio n or recurrence of a mental disorder: dizziness, light-headedness, vertigo or feeling faint; shock-like sensations or paresthesia; anxiety; diarrhea; fatigue; gait instability; headache; insomnia; irritability; nausea or emes is; tremor; and visual disturbances.