An adult patient who recently improved on a short-acting SSRI abruptly stops the medication. Which of the following is the most immediate concern?

• A. Increased risk of suicide
• B. Diminished sexual functioning
• C. Risk of drug withdrawal symptoms
• D. Worsened depressive symptoms

Answer: (C)

Abruptly stopping a short-acting SSRI triggers discontinuation symptoms because the drug leaves the body quickly and the brain experiences a sudden drop in serotonin activity to which it has adapted. The most immediate signs are physical and sensory and typically appear within days: flu-like malaise, dizziness or gait instability, insomnia or vivid dreams, headaches, nausea, fatigue, and paresthesias or “electric shock” sensations. Anxiety and irritability can accompany these symptoms, and they reflect the brain adjusting to the loss of the antidepressant effect. While worsened depressive symptoms or, in some cases, renewed suicidal thoughts can occur as part of a withdrawal or due to underlying illness, the prompt, concrete concern right after abrupt cessation is the discontinuation syndrome itself. Diminished sexual function is more related to ongoing medication effects rather than a direct result of stopping abruptly. To prevent these symptoms, taper the dose gradually rather than stopping suddenly, or switch to a longer-acting agent if discontinuation is necessary.