Withdrawal from sertraline

By the mid-1990s, there were also reports of severe withdrawal from Paxil and Zoloft. Debattista and Schatzberg (1995) reported on physical symptoms associated with a case of paroxetine withdrawal with vomiting, headache, and tremulousness, which they compared to a similar report concerning sertraline withdrawal (Louie et al., 1994). 

In a 34-year-old man with bipolar depression treated with valproate, the addition of sertraline (100 mg/day) was associated with signs of valproate intoxication and an increase in serum valproic acid concentration from 378 to 1127 gmol/l (141). The serum valproic acid concentration returned to baseline after sertraline withdrawal. 

Extensive databases [see Table 24-1) have now shown that paroxetine and sertraline can reduce panic attacks to zero and prevent relapse. Paroxetine studies constitute the largest data set more than 700 patients have been treated for periods ranging from 10 to 36 weeks. In the placebo-controlled comparisons with clomipramine, paroxetine had an earlier onset of action and was better tolerated than clomipramine. Paroxetine was significantly better than placebo from week 4 onward, whereas no separation was seen between clomipramine and placebo until the end of the study. Fewer withdrawals occurred as a result of adverse events with paroxetine (7.3%) than with either clomipramine (14.9%) or placebo (11.4%). The minimum dose shown to be superior to placebo was 40 mg/day. 

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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