Misdiagnosis of antidepressant discontinuation symptoms

OBJECTIVE: To demonstrate that when antidepressants are switched, discontinuation symptoms from the first antidepressant may be misdiagnosed as adverse effects of the second antidepressant. METHOD: Single case report. RESULTS: A female patient was switched from paroxetine to dothiepin due to lack of efficacy. Over the next week she developed physical symptoms which she and her doctor regarded as side effects of dothiepin. It was decided to change the dothiepin and a second opinion was obtained regarding a suitable alternative. At that point it was realized that her symptoms represented a paroxetine discontinuation syndrome. The patient was reassured and continued dothiepin. The discontinuation symptoms resolved over the next 3 weeks and her depression subsequently remitted. CONCLUSION: Increased professional awareness of discontinuation symptoms is necessary to prevent misdiagnosis and inappropriate treatment.