SSRI Discontinuation — MRCPsych Paper B MCQ

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EasyMood DisordersSSRI DiscontinuationMRCPsych Paper B

A 55-year-old man has taken citalopram 40 mg daily for 3 years. He stops it abruptly. Three days later, he develops dizziness, electric shock-like sensations, irritability, flu-like symptoms and vivid dreams. What is the most likely explanation?

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Correct answer: C — SSRI withdrawal (discontinuation) syndrome

The correct answer is **C, SSRI withdrawal (discontinuation) syndrome**. Withdrawal symptoms can begin within a few days of abruptly stopping an antidepressant. Dizziness, electric shock-like sensations, irritability and vivid dreams are particularly characteristic, and the risk is increased by sudden cessation after prolonged treatment. Depressive relapse generally develops less abruptly and would more typically involve recurrence of sustained low mood, anhedonia and other depressive symptoms. Serotonin syndrome results from excessive serotonergic activity rather than stopping an SSRI and usually features autonomic and neuromuscular abnormalities. A viral illness would not readily explain electric shock sensations, while hyponatraemia would require supporting features or biochemical confirmation. Mild withdrawal may be monitored with reassurance; if symptoms are more severe, NICE advises considering reinstatement of the previous dose followed by a slower, smaller-step taper.

Reference: National Institute for Health and Care Excellence. Depression in adults: treatment and management (NG222), recommendations 1.4.13–1.4.21, 2022. https://www.nice.org.uk/guidance/ng222/chapter/Recommendations