A patient has taken sertraline 100 mg daily for two years and remains well. After reducing directly to 50 mg, he developed dizziness, vivid dreams

Question

A patient has taken sertraline 100 mg daily for two years and remains well. After reducing directly to 50 mg, he developed dizziness, vivid dreams and electric-shock sensations within three days, which resolved on returning to 100 mg. He still wishes to stop. Which plan best accords with NICE guidance?

Accepted Answer

Use smaller proportional dose reductions, allowing withdrawal symptoms to settle before each step

Answer

Continue 100 mg indefinitely because previous withdrawal proves continuing clinical need

Answer

Take 100 mg on alternate days so that the weekly dose falls without changing tablet strength

Answer

Stop abruptly and use a benzodiazepine if withdrawal symptoms recur

Answer

Change directly to paroxetine because its shorter half-life makes withdrawal less likely

SSRI continuation counselling — GPhC CRA MCQ