Antidepressant Discontinuation Syndrome in Children and Adolescents: A Systematic Review of Incidence and Symptoms

Abstract

Introduction: Antidepressant discontinuation syndrome (ADS) is well-described in adults, but pediatric data are scarce. As antidepressant prescribing to youth increases, understanding ADS incidence and symptom profile is critical for safe deprescribing.

Methods: We searched PubMed, Embase, and PsycINFO for prospective studies (RCTs, observational) of antidepressant tapering or abrupt discontinuation in youth (6–18 years) taking SSRIs or SNRIs for ≥8 weeks. Primary outcome: incidence of ADS (any new or worsening symptoms within 2 weeks of dose reduction/discontinuation, not attributable to relapse). Secondary: symptom types and severity. No meta-analysis due to heterogeneity.

Results: Nine studies (n=612 youth; 3 RCT discontinuation phases, 6 prospective cohort) met inclusion. Pooled incidence of any ADS symptom was 22% (range 12–38%). Highest incidence was for paroxetine (31%), then venlafaxine (27%), sertraline (19%), fluoxetine (6%). Most common symptoms: dizziness (58% of affected youth), gastrointestinal (nausea, vomiting; 45%), headache (38%), insomnia (35%), paresthesias ("electric shocks"; 19%). Severe symptoms (functional impairment) occurred in 5% of discontinuers. Symptoms began 1–5 days after dose reduction and lasted median 9 days. Abrupt discontinuation (vs. gradual taper >4 weeks) increased risk 3-fold.

Discussion: Antidepressant discontinuation syndrome occurs in approximately 1 in 5 youth, with paroxetine and venlafaxine highest risk. Fluoxetine's long half-life confers low risk. Symptom profile mirrors adult ADS, though "brain zaps" may be underreported in children. Limitations: small studies, absence of pediatric-specific severity scales.

Conclusions: Pediatric ADS is common but usually mild. Gradual tapering over ≥4 weeks, particularly for short-half-life antidepressants, reduces risk. Fluoxetine may be discontinued more rapidly. Clinicians should educate families before deprescribing.