SSRI Discontinuation Syndrome - History

History

The first report of withdrawal symptoms occurring after SSRI discontinuation was for fluvoxamine (brand names Luvox (US), Faverin (UK)) in 1992. The Committee on Safety of Medicines in the United Kingdom reported withdrawal symptoms involving paroxetine (Paxil, Seroxat) in 1993, and the American Journal of Psychiatry revealed the same for sertraline (Zoloft, Lustral) the following year.

In 1996, Eli Lilly and Company sponsored a symposium to address the increasing number of reports of patients who had difficult symptoms after going off their antidepressants:

By then it had become clear that drug-company estimates that at most a few percent of those who took antidepressants would have a hard time getting off were far too low. Jerrold Rosenbaum and Maurizio Fava, researchers at Massachusetts General Hospital, found that among people getting off antidepressants, anywhere from 20 percent to 80 percent (depending on the drug) suffered what was being called antidepressant withdrawal (but which, after the symposium, was renamed “discontinuation syndrome”).

The World Health Organization (WHO) continues to track withdrawal syndrome, and notes:

SSRIs are an example of how a conceptual confusion over terminology can affect proper reporting, interpretation and communication of adverse drug reactions related to dependence. To avoid the association with dependence, an increasing number of researchers have used a different term, discontinuation syndrome, instead of withdrawal syndrome. The number of hits for discontinuation syndrome in searches of the international medical literature began to increase, relative to the occurrence of withdrawal syndrome, in 1997 after symposium on antidepressant discontinuation syndrome held in 1996. In fact, dependence syndrome has been reported to the Uppsala Monitoring Centre for all SSRIs through the same postmarketing surveillance systems, although there are significantly fewer reports of dependence syndrome than of withdrawal syndrome.

The same WHO note ranks antidepressants according to withdrawal, with paroxetine having the highest number of withdrawal syndrome reports and fluoxetine the highest number of drug dependence reports; the note concludes, "Three SSRIs are among the 30 highest-ranking drugs in the list of drugs for which drug dependence has ever been reported to the Uppsala Monitoring Centre database; a total of 269 reports had been received as of June 2002 (109 reports for fluoxetine, 91 for paroxetine and 69 for sertraline)."