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How to avoid antidepressant syndromes - Principles
Sometimes recurrences of depressive symptoms are confused with antidepressant discontinuation
syndrome - however, onset of discontinuation syndrome is rapid and resolves quickly on
reinstatement of medication unlike depressive relapse.
1. Drugs with a short half life are more difficult to withdraw e.g. Paroxetine, Venlafaxine
 and Lofepramine. Fluoxetine has a very long half life and can be stopped abruptly at
20mg daily.
2. Warn patient not to stop abruptly or miss doses.
3. Warn patient of discontinuation symptoms and explain these are tapered like
anticonvulsants and antihypertensives.
4. Gradually taper off dose over 4 - 8 weeks after standard 6 month treatment.
5. After courses lasting 8 weeks discontinue over 1 - 2 weeks to minimise delay if a change
previous discontinuation problems, or is on a drug more likely to cause withdrawal
effects taper more slowly e.g. 1/4 dose every 4 to 6 weeks.
6. If discontinuation symptoms are severe increase dose and taper more slowly
(use liquid if available to ease measuring dose).
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