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A 28-year-old male who has been taking paroxetine 40 mg daily for 2 years for major depressive disorder has been in sustained remission for over a year. After discussion with his PMHNP, both agree it is reasonable to attempt a supervised medication discontinuation. He reports that he previously tried to stop on his own by skipping doses for a week, which caused dizziness, electric shock-like sensations, irritability, nausea, and vivid dreams. Which of the following is the most appropriate approach to discontinuing paroxetine?
Explanation
Discontinuation management involves two key principles: identifying which SSRIs carry the highest risk (paroxetine and venlafaxine, both with short half-lives) and understanding the safest approach (gradual taper). FINISH symptoms indicate discontinuation syndrome, and the appropriate intervention is a slow taper.
Key Takeaway
Paroxetine carries the highest SSRI discontinuation risk due to one of the shortest half-lives among SSRIs, potent serotonin reuptake inhibition, and lack of active metabolites; always taper gradually (25% every 2-4 weeks) rather than stopping abruptly.