Long‑term SRI use can trap patients in a hidden withdrawal syndrome—learn why stopping after a year matters.

Dr. Nassir Ghaemi explains serotonin withdrawal syndrome, a topic gaining media attention after recent NPR coverage. Because randomized trials of SRIs rarely exceed eight weeks, long‑term effects are known mainly from clinician and patient observations.

His clinical impression is that withdrawal symptoms typically appear after a year or more of continuous SRI therapy. Reported signs include flu‑like illness, headaches, “brain zaps” or lightning‑bolt sensations, tremor, panic‑like anxiety, and an immediate depressive episode that can last days to months. While exact prevalence is unknown, he estimates roughly one‑third to one‑half of patients on SRIs for longer than a year experience some form of withdrawal.

Prevention is key: avoid maintaining SRIs beyond six to twelve months unless there is a clear indication such as severe OCD. If a patient has been on an SRI for years, the recommended approach is to cross‑taper to fluoxetine (Prozac) because of its long half‑life, then taper fluoxetine slowly over several months. This strategy can mitigate withdrawal from drugs with short half‑lives like venlafaxine or duloxetine.

Maintenance studies show no benefit of SRIs after six months; efficacy beyond that point is equivalent to placebo. See the FDA analysis https://pubmed.ncbi.nlm.nih.gov/24717376/ and a recent meta‑analysis https://pubmed.ncbi.nlm.nih.gov/36253442/ for details.

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