DATE      CITATION           DRUG                     REPORT                                      

1992 Szabadi Fluvoxamine Single case. 30-year old woman treated for OCD with FVX 100mg/day, unable to stop when she became pregnant: "whenever she had tried to do so, she was overwhelmed by strong feelings of aggression (she felt that she 'could murder someone')." Later, when attempting withdrawal from FVX 150mg/day, patient initially felt pleasantly elated but, from second day after discontinuation, she again experienced what she described as 'unbearably distressing' aggressive feelings and thoughts.
1993 Black et al Fluvoxamine In an open-label study, fourteen patients were abruptly withdrawn from FVX, after 7-8 months of treatment for panic disorder. Twelve patients (86%) developed new symptoms, characteristic of a withdrawal syndrome - mostly dizziness, incoordination, headaches, nausea and irritability. Symptoms peaked on day 5 after withdrawal. One subject had a recurrence of panic, and other developed anxiety and depression; both were re-medicated.
1993 Mallya et al Fluvoxamine Four out of 17 OCD patients (28%) treated with FVX for at least one year developed symptoms (including dizziness, nausea, headaches, confusion, memory problems, low energy, weakness) during or after gradual drug discontinuation.
1994 Ellison Fluoxetine Fluvoxamine Paroxetine Author reported "peculiar and distinctive withdrawal phenomena" in about 5% of patients treated with SSRIs - following either rapid or gradual withdrawal and persisting for several weeks. This "withdrawal buzz" is described as a distractingly intense sensation in the head, like a 'jolt', a 'rush', a 'shock' or brief moment of disorientation and dizziness". Author notes that "no specific SSRI has appeared to predominate in causing this phenomenon, although one might expect an SSRI with a longer elimination half-life to produce fewer and milder withdrawal symptoms".
1996 Coupland et al. Paroxetine Fluvoxamine Sertraline Fluoxetine This paper reports the results of a retrospective chart review of patients treated with SSRIs (also clomipramine) in an outpatient clinic. In the 158 patients who were supervised during gradual tapering and discontinuation of SSRIs, the most common symptoms were dizziness, lethargy, paresthesia, nausea, vivid dreams, irritability and lowered mood.  The most common symptom, "dizziness" was variously described as having a "swimming, spaced-out, drunken or buzzing quality and was markedly exacerbated by movement". The next most common symptom was "paresthesia" which was described as "burning, tingling or like electric shocks". Symptoms occurred much more frequently in patients treated with shorter half-life SSRIs (FVX, PRX) than in patients on SRN or FLX. Symptoms persisted for up to three weeks (mean 11.8 days).
1998 Benazzi Fluvoxamine Patient was a 33-year old woman being treated for recurrent major depression and panic disorder, with fluvoxamine 200mg/day and clonazepam 2mg/day. After six months, fluvoxamine was slowly withdrawn. At 50mg/day, she began to suffer typical SSRI symptoms, but these worsened and were accompanied by severe depression and new, severe symptoms of aggressiveness, irritability and fatigue alternating with intense agitation. Patient had previously experienced typical symptoms after paroxetine  withdrawal "which lasted many weeks but disappeared within a few days after fluvoxamine was introduced".
1998 Macdonald Paroxetine(17), sertraline (4), fluoxetine (3), fluvoxamine(2). This short report summarises the 26 reports of withdrawal reactions reported to the Canadian Adverse Drug Reaction Monitoring Programme, for the four available SSRIs.  In 15 cases, drug was restarted; in 10 cases symptoms abated. Of particular interest: three of the 26 cases (drug not specified) resulted in hospitalisation or prolonged hospitalisation;  and in one case, "electric shock-like" symptoms (paresthesia) persisted for four years after discontinuation of paroxetine.
1999 Mahendran & Chan Fluoxetine, fluvoxamine Interviews with nine Asian patients, treated in Singapore, who had spontaneously and abruptly discontinued treatment with an SSRI suggested that seven had experienced withdrawal symptoms - three of the four patients taking fluoxetine and all four patients on fluvoxamine
2001 Hirose Fluvoxamine Case report - believed to be the first published report of SSRI withdrawal in Japan - in which abrupt drug discontinuation produced marked symptoms of restlessness. Symptoms soon disappeared when patient was put back on drug.
2001 Silvestri et al Fluvoxamine


Investigation of sleep disruption induced by SSRI use in 14 healthy volunteers, in a 31-day protocol (7 days pre-drug, 19 days on drug and 5 days of acute withdrawal). Paroxetine disrupted sleep more than fluvoxamine and paroxetine-induced sleep disturbance persisted into the withdrawal phase
2002new.bmp (454 bytes) Diler & Avci Paroxetine, Fluvoxamine Sertraline Six case reports describing withdrawal symptoms (following abrupt and gradual discontinuation) in children (mean age 11.33 +/- 1.75 years) taking paroxetine (3 cases), fluvoxamine (2 cases) and sertraline. The withdrawal syndrome in children is described as similar to that experienced by adults; supportive strategies are discussed.

The following are the recommendations and warnings relating to withdrawal reactions for SSRI antidepressants in the Data Sheet Compendium 1998/99:

Fluvoxamine (Faverin/Luvox): "Symptoms, including headache, nausea, dizziness and anxiety, have rarely been reported after abrupt discontinuation of Faverin".

Contents page
  Pencil_and_PaperE190.gif (245 bytes) References
Table: all reports of SSRI withdrawal