• When stopping or reducing the dose of an antidepressant, some people experience such symptoms as dizziness, nausea, paraesthesiae, anxiety, diarrhoea, flu-like symptoms, and headaches. These symptoms occur with all classes of antidepressants, and are often referred to as discontinuation (or withdrawal) symptoms:
• Discontinuation symptoms are more common with longer treatment courses and rarely occur with treatments lasting less than 6 weeks.
• Onset is usually within 5 days of stopping treatment. Occasionally, symptoms occur during tapering or after missed doses.
• Symptoms are usually mild and self limiting, rarely lasting for more than 1–2 weeks. However, they can be severe, particularly if the drug is stopped abruptly.
• Discontinuation symptoms are more likely with: antidepressants with a short half-life, such as paroxetine; in people who developed anxiety symptoms at the start of treatment; and in people taking other centrally-acting drugs.
• Reduce the dose or frequency of antidepressant gradually over 4 weeks:
• More rapid discontinuation may be necessary in people with severe adverse reactions to treatment.
• In people who have been receiving longer-term treatment, taper the dose over 6 months.
• Fluoxetine can be stopped abruptly if the dose is 20 mg daily, as it has a long half-life and active metabolites.
• When stopping an antidepressant, ask the person to seek advice if they experience significant discontinuation symptoms.
• If discontinuation symptoms are mild, reassure the person that the symptoms usually pass in a few days.
• If discontinuation symptoms are severe, consider reintroducing the original antidepressant and then tapering more slowly while monitoring symptoms.

[Anderson et al, 2000; Haddad, 2001; Taylor et al, 2003; NICE, 2004]