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Subtherapeutic doses of SSRI antidepressants demonstrate considerable serotonin transporter occupancy: implications for tapering SSRIs

  • Bryan B. Shapiro
Commentary
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Antidepressants are usually tapered to mitigate the risk of antidepressant discontinuation syndrome, a new entity in DSM-5 characterized by nonspecific sensory, somatic and cognitive-emotional symptoms emerging within 2–4 days of the dose reduction or abrupt discontinuation of antidepressants taken continuously for at least 1 month (American Psychiatric Association 2013). Selective serotonin reuptake inhibitors (SSRIs) are commonly implicated, and among these, discontinuation symptom risk is highest with paroxetine and lowest with fluoxetine (Rosenbaum et al. 1998).

Three patterns of symptomatology have been observed in patients discontinuing SSRI antidepressants: (1) New symptoms, which consist of “classic” withdrawal symptoms that are not part of the patient’s original psychiatric illness, (2) rebound symptoms, consisting of the patient’s initial psychiatric symptoms necessitating SSRI treatment but of greater intensity; and (3) persistent postwithdrawal disorders, which resemble...

Notes

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Conflict of interest

The author declares that he has no conflict of interest.

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© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Psychiatry and Human BehaviorUC Irvine Medical CenterOrangeUSA

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