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Withdrawal reaction associated with venlafaxine

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7161.787a (Published 19 September 1998) Cite this as: BMJ 1998;317:787

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Withdrawal reactions to SSRI's

I recently reviewed you article by Johnson, Bouman, and Lawton with
regard to withdrawal reaction to venlaxafine. I have seen similar
reactions in a single patient on withdrawal of sertraline, fluoxetine, and
nefazadone. All of these including the venlaxafine have some
SSRI(selective serotonin reuptake inhibitor) activity. It is further of
interest that these symptoms resolved in a much shorter timeframe than the
three weeks as described in the aforementioned article when she was
withdrawn from one SSRI and started on another. Most recently however,
she was weaned from venlaxafine to bupropion, the symptoms were much more
persistent. Bupropion is not an SSRI.
This suggests a common withdrawal syndrome to SSRI medication and not just
venlaxafine. Clearly larger scale and preferably randomized studies need
to be done to obtain a clearer answer.
My patient is a 38 year old woman who was initially started on fluoxetine
in May 1995 for an episode of major depression. As no clinical response
was obtained at a dose of 40 mg for four weeks(July 1995), she was then
gradually withdrawn and started on sertraline. The positional vertigo
resolved in two or three days of starting the new medication. In July of
1996 she was withdrawn from the sertraline and started on nefazadone over
a period of two weeks. Again two or three days only of positional vertigo
occurred. Because of recent clinical ineffectiveness at 600 mg per day of
nefazadone she was again gradually withdrawn and restarted on venlaxafine
again over a two week period. The venlaxafine was effective, but again
because of side effect issues, she was started on bupropion. As the
bupropion approached therapeutic doses the effexor was gradually tapered
over two weeks, the last four days having a single daily dose of 37.5 mg.
The positional vertigo recurred but was more persistent. The symptoms
rapidly disappeared with a single dose of 37.5 mg of venlaxafine.
This is an issue of concern given the liberty with which SSRI medications
are prescribed.

Competing interests: No competing interests

28 September 1998
Margaret R Lightheart
Part-time associate clinical professor Department of Obstetrics and Gynecology
McMaster University, Hamilton, Ontario Canada