SSRI withdrawal syndrome
| Classification according to ICD-10 | |
|---|---|
| Y40-Y59 | Unwanted side effects with therapeutic use of drugs, drugs or biologically active substances |
| Y49.2 | Other and unspecified antidepressants |
| ICD-10 online (WHO version 2019) | |
As antidepressant discontinuation syndrome (Engl. SSRI Discontinuation Syndrome) and SSRI withdrawal syndrome are referred to the withdrawal symptoms upon discontinuation of selective serotonin and / or norepinephrine reuptake inhibitors ( SSRI , SNRI may occur).
description
Withdrawal symptoms usually occur in the first 24 hours to a week after discontinuation. The time at which the withdrawal symptoms occur depends, among other things, on the dose of the medication and the half-life of the active substance. The comparatively strong symptoms associated with SNRIs can be reduced by taking fluoxetine at the same time , which as an SSRI has a relatively long half-life.
Tests with animals that had free access to SSRIs did not result in an independent increase in the dose, but sudden discontinuation of the drug group can cause physical and psychological withdrawal symptoms, which creates a potential for dependence. For example, the package inserts explicitly advise against stopping the medication independently. Studies of placebo found that 35–78% of patients who took the drug for five weeks or more and stopped taking it suddenly developed one or more of the withdrawal symptoms.
Symptoms
Symptoms of stopping SSRIs include:
- Orthostatic disorders (circulatory problems), dizziness and balance disorders with head movements such as turning the head or horizontal movements of the eyes (looking to the left or right)
- Sensory disturbances dizziness as vertigo and sensations that are reminiscent of slight electric shock and usually starting radiate from the center of the body in the limbs or the entire body occur ( "brain zaps"), tinnitus
- Motor disorders (twitching, tics ) and difficulties with everyday movements (getting up, walking)
- Difficulty sleeping , vivid dreams, tiredness, sleepiness during the day (feeling like falling asleep suddenly)
- Digestive disorders (diarrhea, constipation), physical discomfort (headache, nasal congestion, fatigue, bone and joint pain, fever-like conditions)
- Mood changes , muscle spasms , tremors, aggressive behavior, mania , severe depression, and thoughts of suicide
- Post- SSRI-related sexual dysfunction
The medical diagnostic criteria for SSRI withdrawal syndrome are:
- Interrupting, discontinuing, or reducing the dose of SSRI or SNRI-led treatment for four weeks or more
- Symptoms that are noticeable in the social environment
- Symptoms that cannot be caused by the effects of other medications and drugs, or their withdrawal
- Symptoms that are different from when treatment with SSRI or SNRI was started
These symptoms go away when the dose is increased again to the usual amount. To make a clear diagnosis and ensure correct treatment, doctors prescribing SSRIs should address the symptoms of withdrawal.
mechanism
Symptoms of stopping antidepressants are the result of attempts by the human brain to re-establish neurochemical equilibrium. Serotonin reuptake inhibitors increase the concentration of serotonin in the tissue fluid in the brain. If the patient is stopped abruptly, there is therefore a serotonin deficiency, as the body has adapted to the oversupply of the substance due to the SSRI medication by downregulating the serotonin sensitivity. The withdrawal symptoms can usually be reduced or completely prevented by tapering (slowly reducing the dose) over a period of weeks or months. However, this method is also not always successful, especially for patients with long-term treatment. Alternatively, you can stop using 5-hydroxytryptophan , whereby the combination of both substances in particular carries the risk of serotonin syndrome .
Prevention and treatment
Patients should be informed about the long half-life of SSRIs. This point is particularly important when switching to drugs with a shorter half-life ( e.g. paroxetine ).
Although it cannot be guaranteed that the SSRI withdrawal will be symptom-free, resuming the maintenance dose and slowly tapering it off may alleviate the symptoms or make them disappear completely.
Treatment of symptoms depends on the severity of the withdrawal symptoms and whether antidepressants are continued after the SSRI is stopped. While in those cases in which further treatment with antidepressants is indicated, simply re-using the medication usually leads to success, the treatment of patients who do not use antidepressants at all depends on the severity of the symptoms and is usually carried out in mild cases Calming and relaxing the patient to success. Moderate withdrawal symptoms can be treated with benzodiazepines . In cases with severe symptoms or in cases where the patient does not respond to treatment of the symptoms, the medication can be restarted and withdrawn more slowly in smaller increments at a later time.
Tricyclic antidepressants ( e.g. amitriptyline ) can relieve mild to moderate withdrawal symptoms, particularly circulatory problems.
Individual evidence
- ↑ SSRI withdrawal syndrome despite slow tapering off? . Neuro-dispatch from the Society for Medical Information . 2007. Retrieved June 28, 2017.
- ↑ L. Tamam, N. Ozpoyraz: Selective serotonin reuptake inhibitor discontinuation syndrome: a review . In: Adv Ther . tape 19 , no. 1 , p. 17-26 , PMID 12008858 .
- ^ P. Haddad: Antidepressant discontinuation syndromes . In: Drug Saf . tape 24 , no. 3 , 2001, p. 183-197 , PMID 11347722 .
literature
- CH Warner, W. Bobo, C. Warner, S. Reid, J. Rachal: Antidepressant discontinuation syndrome. In: Am Fam Physician. 2006 Aug 1; 74 (3), pp. 449-456. Review. PMID 16913164
