Managing Discontinuation Symptoms of Lamotrigine, Quetiapine, and Citalopram

Discontinuation Syndromes and Their Symptoms

The American Academy of Child and Adolescent Psychiatry recommends that abrupt discontinuation of citalopram can cause a discontinuation syndrome characterized by dizziness, fatigue, lethargy, general malaise, myalgias, chills, headaches, nausea, vomiting, diarrhea, insomnia, imbalance, vertigo, sensory disturbances, paresthesias, anxiety, irritability, and agitation 1, 2
Quetiapine discontinuation can lead to rebound effects including weight changes and fluid retention, according to Diabetes Care 3
Antipsychotics like quetiapine are associated with significant weight gain during treatment, and discontinuation can lead to metabolic changes, as reported by the American Academy of Child and Adolescent Psychiatry 4, 3
Sudden discontinuation of quetiapine may cause withdrawal symptoms including anxiety, agitation, and physical discomfort, according to the American Academy of Child and Adolescent Psychiatry 4
Lamotrigine is considered weight-neutral during treatment, but discontinuation effects on weight are less documented, as noted by Gastroenterology 5, 6

The American Academy of Child and Adolescent Psychiatry suggests that a typical taper for SSRIs should occur over 10-14 days at minimum 7
For edema and fluid retention, American Family Physician recommends mild sodium restriction and elevation of affected extremities 8
For pain in extremities, American Family Physician suggests non-pharmacological approaches including gentle exercise and physical therapy 8
Avoid NSAIDs if restarting SSRIs due to increased bleeding risk, as warned by the American Academy of Child and Adolescent Psychiatry 1
Diabetes Care recommends implementing dietary changes and increased physical activity for weight management 3
Be aware that sudden discontinuation of weight management pharmacotherapy often results in weight gain and worsening of cardiometabolic risk factors, according to Diabetes Care 3
Regular follow-up to assess resolution of symptoms is necessary, as stated by American Family Physician 8
If restarting treatment is necessary, consider alternatives with better side effect profiles, as suggested by Gastroenterology 5, 6
Watch for serotonin syndrome if restarting medications, especially if multiple serotonergic agents are used, as cautioned by the American Academy of Child and Adolescent Psychiatry 1
Monitor for abnormal bleeding, especially with concomitant NSAIDs or aspirin, as warned by the American Academy of Child and Adolescent Psychiatry 1