A depressed patient who abruptly stops his antidepressant after 8 months experiences only mild symptoms, whereas a colleague stopping another SSRI after the same duration develops dizziness, electric shock sensations, nausea, and insomnia. Which pair explains the greatest contrast in discontinuation symptom burden between two SSRIs?

• A Fluvoxamine versus fluoxetine
• B Sertraline versus citalopram
• C Escitalopram versus sertraline
• D Fluoxetine versus paroxetine ✓

Explanation

Fluoxetine has a half-life of 2 to 4 days and its active metabolite norfluoxetine has a half-life of 7 to 15 days, so receptor-level serotonergic activity declines slowly and discontinuation symptoms are minimal. Paroxetine has the shortest half-life among SSRIs with no active metabolite, producing the most severe withdrawal syndrome. Sertraline, citalopram, escitalopram, and fluvoxamine occupy intermediate ground and do not create this classic extreme contrast.

Reference: Katzung Basic and Clinical Pharmacology, 16th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.