PEBC MCQ Neurology & Mental Health question: electric shock sensations

PEBC MCQNeurology & Mental Health

AL, 45, stopped paroxetine 30 mg abruptly 3 days ago because she felt better. She now has dizziness, 'electric shock' sensations, irritability and nausea. Which of the following is the most likely explanation?

a. An allergic reaction to paroxetine developing after stopping
b. A relapse of her depression
c. Serotonin syndrome
d. Antidepressant discontinuation syndrome

Show the answer and explanation

Answer: d. Antidepressant discontinuation syndrome

Abruptly stopping an SSRI with a short half-life, especially paroxetine or venlafaxine, commonly causes discontinuation symptoms within days: dizziness, paresthesias such as 'brain zaps', irritability, flu-like symptoms and nausea. Restarting and tapering slowly resolves them. Serotonin syndrome results from excess serotonin, not withdrawal, and relapse of depression typically develops more gradually over weeks. Source: Paroxetine (Paxil) product monograph, Warnings: discontinuation symptoms (DPD, checked 2026); CANMAT 2023 MDD update (Can J Psychiatry 2024;69:641).

Common mistake

Mistaking discontinuation symptoms for relapse or serotonin toxicity.

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