[2] Methods of prevention include gradually decreasing the dose among those who wish to stop, though it is possible for symptoms to occur with tapering.
These "brain zaps" have been described as an electric shock felt in the skull, potentially triggered by lateral eye movement, and at times accompanied by vertigo, pain, or dissociative symptoms.
[13] The SNRI venlafaxine has been reported to have a higher incidence in withdrawal symptoms after discontinuation when compared to other SNRIs.
[15] Venlafaxine has been implicated in causing the most severe withdrawal symptoms after cessation of use, possibly due to its short half-life.
[16] To simplify identifying the principal signs and symptoms, the mnemonic FINISH may be used: A 2009 Advisory Committee to the U.S. Food and Drug Administration found that online anecdotal reports of discontinuation syndrome related to duloxetine included severe symptoms and exceeded prevalence of both paroxetine and venlafaxine reports by over 250% (although acknowledged this may have been influenced by duloxetine being a much newer drug).
[21][22][23] The underlying reason for its occurrence is unclear,[2][12] though the syndrome appears similar to withdrawal from other psychotropic drugs such as benzodiazepines.
[24][27] Among antidepressants analyzed by Gastaldon et al. (2022), lofepramine, vortioxetine, mianserin, agomelatine, and esketamine are not associated with significantly disproportionate reporting of withdrawal syndrome.
The authors could not rule out the possibility of notoriety bias and/or low sample size in causing this result.
[2] Antidepressants, including SSRIs, can cross the placenta and have the potential to affect the fetus and newborn, including an increased chance of miscarriage, presenting a dilemma for pregnant women to decide whether to continue to take antidepressants at all, or if they do, considering if tapering and discontinuing during pregnancy could have a protective effect for the newborn.
[29] Neonatal withdrawal syndrome was first noticed in 1973 in newborns of mothers taking antidepressants; symptoms in the infant include irritability, rapid breathing, hypothermia, and blood sugar problems.
[31][32] Heightened media attention and continuing public concerns led to the formation of an expert group on the safety of SSRIs in England to evaluate all the research available prior to 2004.
[33]: iv The group determined that the incidence of discontinuation symptoms are between 5% and 49%, depending on the particular SSRI, the length of time on the medicine and abrupt versus gradual cessation.
[37][38] As such, some researchers advocate the term withdrawal over discontinuation, to communicate the similar physiological dependence and negative outcomes.
[2] In 2013, a proposed class action lawsuit, Jennifer L Saavedra v. Eli Lilly and Company,[39] was brought against Eli Lilly claiming that the Cymbalta label omitted important information about "brain zaps" and other symptoms upon cessation.