Prevention of the serotonin reuptake inhibitor discontinuation syndrome

Prevention of the serotonin reuptake inhibitor discontinuation syndrome (SRIDS) is an important issue. The author suggests: (1) serotonin reuptake inhibitors (SRIs) should be used only when they are necessary. Sometimes tablets should be replaced with other treatment modalities; (2) patients should be given the lowest dosage of SRIs possible; (3) patients who have a history of medication noncompliance, who have experienced the discontinuation symptoms in the past, or who have treatment-emergent anxiety are at highest risk for experiencing the SRIDS and need closer monitoring; (4) SRIs should be tapered prior to stoppage; (5) generic drugs are allowed up to a 20% difference in bioequivalence from the brand original. Patients should receive continuity of supply from the dispenser, with no intermanufacturer switching; (6) patients and healthcare professionals should be educated to ensure that SRIs are not stopped abruptly; (7) neonatal SRIDS can follow maternal use of antidepressants during pregnancy and possibly breast feeding. The patient and physician should take this into consideration when making treatment decision.