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A 36-year-old woman with MDD in sustained remission for 18 months on paroxetine 40 mg daily wishes to discontinue her antidepressant after a thorough risk-benefit discussion with her PMHNP. Five days after reducing from 40 mg to 20 mg, she reports dizziness, electric shock-like sensations in her head, irritability, nausea, and vivid dreams. She denies any return of depressed mood or anhedonia. What is the most appropriate next step?
Explanation
SSRI discontinuation syndrome presents with dizziness, electric shock sensations, irritability, nausea, and sleep disturbances within days of dose reduction. Paroxetine carries the highest risk among SSRIs due to its short half-life. The correct management is to resume the prior tolerated dose and restart with a slower, more gradual taper. This must be distinguished from depressive relapse, which develops over weeks with mood-specific symptoms.
Key Takeaway
SSRI discontinuation syndrome, especially with paroxetine, requires resuming the prior tolerated dose and implementing a slower taper with smaller decrements, and must not be confused with depressive relapse.