Withdrawal from fluoxetine

Severe stimulation reactions were reported in four of six fluoxetine-treated patients with posttraumatic stress disorder, requiring three of them to withdraw from the study Two experienced agitation and worsening of hyperarousal symptoms one patient s panic symptoms markedly... 

The long half-lives of fluoxetine and Its active metabolites mean that dose changes will not be fully reflected In plasma for several weeks, lengthening titration to final dose and extending withdrawal from treatment... 

Residential treatment appeared the most likely way of making an impact on Carl s crack cocaine use, and plans were made for an admission. This could not happen immediately, and in the meantime Carl was prescribed fluoxetine 20mg per day, and diazepam 20-30mg per day. He was keen to try to withdraw himself from crack without going into hospital, and he and his mother were instructed about his use of the two medications. They were advised that diazepam would reduce anxiety and agitation, and might help relieve craving for crack. 

Of 93 cases of neonatal symptoms associated with the use of SSRIs in mothers around the time of delivery 64 were associated with paroxetine but reactions were also reported in infants whose mothers had taken citalopram, fluoxetine, and sertraline (87). It is unclear from these data whether paroxetine is actually most likely to provoke the neonatal syndrome, but in adults its use is associated with more severe withdrawal reactions than other SSRIs. It should also be noted that it is not clear whether the syndrome described in neonates is due to SSRI withdrawal or a form of serotonin toxicity. 

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