SSRI Discontinuation Syndrome - Persistent Adverse Effects

Persistent Adverse Effects

In a very few cases, discontinuation of SSRIs may result in sexual dysfunction (decreased libido, impotence or reduced vaginal lubrication, difficulty initiating or maintaining an erection or becoming aroused, persistent sexual arousal syndrome despite absence of desire, muted, delayed or absent orgasm (anorgasmia), reduced or no experience of pleasure during orgasm (ejaculatory anhedonia), premature ejaculation, weakened penile, vaginal or clitoral sensitivity, genital anesthesia, loss or decreased response to sexual stimuli) that persists for years or forever after the fact.

Long term withdrawal syndromes outside of sexual dysfunction from SSRIs are not well documented. One Italian study found that in patients with panic disorder and agoraphobia, 45% exhibited a discontinuation syndrome that disappeared within a month in all but 11%. Symptoms of the discontinuation syndrome include agitation, anxiety, akathisia, panic attacks, irritability, hostility, aggressiveness, worsening of mood, dysphoria, crying spells or mood lability, overactivity or hyperactivity, depersonalization, decreased concentration, slowed thinking, confusion, and memory/concentration difficulties.

Most cases of discontinuation syndrome last between one and four weeks but a substantial minority, perhaps up to 15% of users, have persistent withdrawal symptoms evident one year post-withdrawal. Paroxetine and venlafaxine seem to be particular difficult to discontinue and prolonged withdrawal syndrome lasting over 18 months have been reported with paroxetine.