Antidepressant Discontinuation Syndrome

Q: Which of the following is usually not present in the antidepressant discontinuation syndrome? - select one

A) Chills without fever

B) Rhinorrhea

C) Electric shock-like sensations

D) Vivid dreams

E) Pupillary dilation

Answer: E

The antidepressant discontinuation syndrome may cause new-onset somatic and neuropsychiatric symptoms. Importantly, discontinuation symptoms differ from any adverse effects that occurred during active treatment with the antidepressant. These symptoms include:

• Dizziness
• Headache
• Insomnia
• Irritability
• Nausea/vomiting
• Agitation
• Anxiety
• Chills without fever (choice A)
• Diaphoresis
• Dysphoria
• Fatigue
• Lethargy
• Myalgias
• Rhinorrhea (choice B)
• Paresthesias
• Electric shock-like sensations (choice C)
• Tremor
• Vivid dreams (choice D)
• Anorexia 
• Loss of balance 
• Cognitive impairment
• Crying spells
• Dry mouth 
• Hypertension 
• Hypomania and mania
• Psychosis (with auditory and/or visual hallucinations
• Sexual dysfunction 
• Suicidal ideation
• Tinnitus 

Pupillary dilation occurs in opioid withdrawal but not in antidepressant discontinuation syndrome.

#psychiatry

#pharmacology

References:

1. Fornaro M, Cattaneo CI, De Berardis D, Ressico FV, Martinotti G, Vieta E. Antidepressant discontinuation syndrome: A state-of-the-art clinical review. Eur Neuropsychopharmacol. 2023 Jan;66:1-10. doi: 10.1016/j.euroneuro.2022.10.005. Epub 2022 Nov 4. PMID: 36345093.

2. Gabriel M, Sharma V. Antidepressant discontinuation syndrome. CMAJ. 2017 May 29;189(21):E747. doi: 10.1503/cmaj.160991. PMID: 28554948; PMCID: PMC5449237.

3. Kalfas M, Tsapekos D, Butler M, McCutcheon RA, Pillinger T, Strawbridge R, Bhat BB, Haddad PM, Cowen PJ, Howes OD, Joyce DW, Nutt DJ, Baldwin DS, Pariante CM, Lewis G, Young AH, Lewis G, Hayes JF, Jauhar S. Incidence and Nature of Antidepressant Discontinuation Symptoms: A Systematic Review and Meta-Analysis. JAMA Psychiatry. 2025 Sep 1;82(9):896-904. doi: 10.1001/jamapsychiatry.2025.1362. Erratum in: JAMA Psychiatry. 2025 Nov 1;82(11):1153. doi: 10.1001/jamapsychiatry.2025.2398. PMID: 40632531; PMCID: PMC12242823.