Management of Paresthesias on Latuda, Trazodone, and Citalopram

Primary Differential: SSRI Discontinuation Syndrome

The American Academy of Child and Adolescent Psychiatry recommends verifying medication adherence to prevent SSRI discontinuation syndrome, which can occur with missed doses or abrupt discontinuation of shorter-acting SSRIs 1, 2, 3
Paresthesias typically arise within 24-48 hours of missed doses or dose changes, and are associated with symptoms such as dizziness, vertigo, sensory disturbances, anxiety, irritability, headaches, nausea, or imbalance 1, 2, 3

The American Academy of Child and Adolescent Psychiatry advises to rule out serotonin syndrome in patients taking multiple serotonergic agents, such as citalopram, trazodone, and lurasidone, and to immediately discontinue all serotonergic agents and provide supportive care with continuous cardiac monitoring if serotonin syndrome is present 2, 3
Mental status changes, such as confusion, agitation, and anxiety, are key clinical features to assess for serotonin syndrome, along with neuromuscular hyperactivity and autonomic hyperactivity 2, 3

The American Academy of Child and Adolescent Psychiatry recommends restarting or continuing citalopram at the previous effective dose if discontinuation syndrome is confirmed, and tapering slowly over 1-2 week intervals using the smallest available increments if dose reduction is necessary 1, 2, 3
The combination of citalopram, trazodone, and lurasidone requires caution, and patients should be monitored for QT prolongation, especially if the citalopram dose exceeds 40 mg/day 1, 2, 3

The American Academy of Child and Adolescent Psychiatry recommends monitoring patients for resolution of paresthesias within 24-48 hours, and ongoing monitoring of vital signs, mental status, and neuromuscular examination for signs of serotonin syndrome 2, 3
ECG monitoring is recommended if the citalopram dose is >40 mg/day or if the patient has cardiac risk factors 1, 2, 3