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Clinical Symptoms in Tricyclic Antidepressant Discontinuation

Purpose: To evaluate a patient recently treated with a tricyclic antidepressant for symptoms of the discontinuation syndrome.

Description

Abrupt discontinuation of a tricyclic antidepressant can result in a variety of unpleasant symptoms for the patient. This was first described by Dilsaver et al.


 

Symptoms associated with tricyclic antidepressant discontinuation:

(1) anxiety, panic attacks or agitation

(2) anorexia, nausea, vomiting or other gastrointestinal distress

(3) general somatic distress including diaphoresis, chills, lethargy and/or headache

(4) sleep disturbances (excessive dreaming, insomnia)

(5) movement disorders (akathisia, parkinsonism)

(6) hypomania or behavioral activation (mania, delirium)

(7) cardiac arrhythmias

 

where:

• Akathisia involves motor restlessness that may include an inability to sit still.

 

The differential diagnosis would include continued activity of the underlying anxiety-depressive syndrome.

 


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Specialty

Objective

ICD-10