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Subjects/Psychiatry/SSRIs
SSRIs
medium
brain Psychiatry

A 30-year-old female has been taking paroxetine 20 mg daily for 18 months for panic disorder with good symptom control. She now wishes to discontinue the medication. What is the most appropriate advice regarding discontinuation to minimize the risk of withdrawal symptoms?

A. A. Stop the medication abruptly as it is no longer needed.
B. B. Reduce the dose by 5 mg every 2-3 days until discontinued.
C. C. Taper the medication slowly over several weeks to months.
D. D. Switch to a different antidepressant and then taper that medication.

Explanation

Paroxetine has a relatively short half-life and is associated with a higher risk of discontinuation syndrome (also known as antidepressant withdrawal syndrome) upon abrupt cessation or rapid tapering. Symptoms can include dizziness, nausea, headache, paresthesias (electric shock sensations), anxiety, irritability, and flu-like symptoms. To minimize these symptoms, it is crucial to taper the medication slowly and gradually over several weeks to months, depending on the dose and duration of treatment. Abrupt cessation or rapid tapering (e.g., 5 mg every 2-3 days) is likely to induce significant withdrawal symptoms. Switching to another antidepressant is not indicated if the goal is complete discontinuation, and it would only delay the tapering process.

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