What is the recommended practice when stopping an SSRI?

• A. Stop abruptly to avoid withdrawal.
• B. Taper gradually rather than abrupt cessation.
• C. Switch to another SSRI at once.
• D. Increase dose before stopping.

Answer: (B)

Stopping an SSRI should be done by tapering gradually rather than stopping all at once. This helps prevent discontinuation syndrome, a cluster of symptoms that fans of the medication can experience when the brain readjusts to functioning without the drug. Common withdrawal-like symptoms include dizziness, flu-like feeling, sleep problems, anxiety, irritability, mood changes, and sometimes sensations described as electric shocks. The brain has adapted to the drug’s presence, so a slow, planned reduction gives neurotransmitter systems time to re-equilibrate and reduces the intensity of these symptoms.

How to taper is individualized. Some SSRIs, like paroxetine, have a higher withdrawal risk due to a shorter half-life, while longer-acting options like fluoxetine tend to have smoother discontinuation profiles. A typical approach is to reduce the dose by small amounts every 1–2 weeks and adjust the pace if withdrawal symptoms appear. Practical steps include consulting a clinician, using a precisely adjustable form (such as a liquid preparation) when possible, and monitoring symptoms closely. If significant withdrawal symptoms occur, slowing the taper or pausing may be necessary, and in some cases a clinician might suggest a brief switch to a long-acting antidepressant to ease the transition, always under medical supervision.

Abrupt stopping, increasing the dose before stopping, or switching to another SSRI right away without addressing withdrawal risk are less favorable options because they don't adequately reduce the risk or duration of discontinuation symptoms.