Paroxetine Discontinuation — MRCPsych Paper B MCQ

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EasyMood DisordersParoxetine DiscontinuationMRCPsych Paper B

A 50-year-old woman whose depression is in remission has taken paroxetine 40 mg daily for 6 months. She stops it abruptly. Four days later, she develops dizziness, electric shock-like sensations, nausea, irritability and vivid dreams. She is afebrile and has no clonus or hyperreflexia. Which syndrome best explains this presentation?

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Correct answer: C — Antidepressant withdrawal syndrome

This is antidepressant withdrawal syndrome. Abrupt cessation of paroxetine can produce symptoms within days, including dizziness, electric shock-like sensations, nausea, irritability and sleep disturbance with vivid dreams. Paroxetine should ordinarily be reduced gradually rather than stopped abruptly. SSRI activation syndrome occurs soon after starting treatment or increasing the dose and is characterised by agitation, anxiety or akathisia. Serotonin syndrome results from serotonergic excess and would suggest neuromuscular and autonomic features such as clonus, hyperreflexia, hyperthermia or diaphoresis. Depressive relapse does not usually occur immediately on stopping an antidepressant and would cause a return of depressive symptoms rather than prominent sensory symptoms. A hypersensitivity reaction would more typically cause rash, urticaria, angioedema or anaphylaxis.

Reference: Electronic Medicines Compendium. Paroxetine 40 mg Tablets – Summary of Product Characteristics, sections 4.4 and 4.8, 2026. https://www.medicines.org.uk/emc/product/9600/smpc