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Nadeem H Bhanji
Guy Chouinard
Theodore Kolivakis
Howard C Margolese


Paroxetine, panic, tardive, rebound, discontinuation



To  describe  tardive  rebound  anxiety  phenomena  (panic,  anxiety  and  insomnia)  following  abrupt paroxetine discontinuation.


Case report, with comprehensive literature review on rebound and withdrawal phenomena associated with psychotropic medications.


Three different discontinuation syndromes with psychotropics are described: (1) new-onset CNS- depressant   type   withdrawal   symptoms   (minor   and   major);   (2)   rebound   syndromes;   and   (3) supersensitivity symptoms. Abrupt paroxetine discontinuation has been well described and fits the first category.  Tardive  rebound  panic  disorder-phenomena  with  paroxetine  has  some  features  of  the supersensitivity category.


Chronic paroxetine treatment may lead to 5-HT2-receptor down regulation, with desensitization of 5-HT1A and 5-HT2 receptors, which may contribute to tardive rebound symptoms upon abrupt withdrawal. Early reports  suggest  that  genetic  factors  may  also  contribute  to  withdrawal  symptoms  in  susceptible individuals. Cholinergic rebound may also occur and could explain tardive insomnia and anxiety in paroxetine withdrawal

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