A 34-year-old woman who has taken paroxetine 20 mg daily for two years stops it abruptly because she feels well. Five days later she reports dizziness, electric shock sensations in her limbs, nausea, irritability, and vivid dreams. Which statement is correct?

• A This presentation indicates relapse of her underlying depression
• B Symptoms typically persist for several months without treatment
• C The symptoms indicate serotonin toxicity requiring cyproheptadine
• D Fluoxetine would have been the least likely drug to cause this picture ✓

Explanation

SSRI discontinuation syndrome features dizziness, sensory 'electric shock' phenomena, insomnia and irritability beginning 2 to 4 days after stopping short-half-life agents. Paroxetine, with the shortest half-life among SSRIs, carries the highest risk. Fluoxetine, whose active metabolite norfluoxetine has a half-life of about 1 to 2 weeks, provides self-tapering and is the least likely to cause the syndrome. The course is self-limiting over 1 to 2 weeks, distinguishing it from depressive relapse, which emerges later and lacks the sensory symptoms.

Reference: Kaplan and Sadock's Synopsis of Psychiatry, 12th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.