PANES case 2 - withdrawal over 6 weeks - paraesthesiae, dizziness, mild ataxia, and slurred speech continue for 12 months

A 35-year-old man (Mr B) was prescribed paroxetine 30 mg daily for depression. The depression resolved and the paroxetine was continued at the same dose for two years. The medication was discontinued in a staged way, with reductions to 20, then 10 mg, managed over six weeks or so. Symptoms of withdrawal occurred throughout this period and comprised vivid nightmares, lability of mood, irritability, hypersexuality, episodic lightheadedness, episodic electric-shock like sensations, glove paraesthesiae, and ataxia. These symptoms ended two weeks after the withdrawal regime was finished. Nevertheless the patient continued to describe problems of an episodic nature well after the paroxetine had been discontinued. These episodes lasting hours to days at a time and comprised paraesthesiae, dizziness, mild ataxia, and slurred speech. These episodes have occurred intermittently throughout twelve months of follow-up during which time the patient has been drug-free. There are no focal neurological signs or any features suggestive of progressive neurological disease, nor was there a family history of neurological disease