PANES Persistent adverse neurological effects following SSRI discontinuation - Dr Ben Green, MRCPsych, ILTM available expert witness Seroxat litigation

PANES Persistent adverse neurological effects following SSRI discontinuation - case report: "Persistent adverse neurological effects following SSRI discontinuation (PANES)."


Dr Ben Green, MRCPsych, ILTM


Consultant Psychiatrist, Halton Hospital, UK and Hon. Senior Lecturer, University of Liverpool, UK These prolonged reactions were first described here in Spring 2000. No other reports are known of, although this condition may well be more widespread than is presently recognised. Selective serotonin reuptake inhibitor (SSRI) discontinuation syndrome has been described in the literature as a cluster of symptoms and signs that occur after SSRIs such as paroxetine, sertraline and fluoxetine have been discontinued Abrupt withdrawal of antidepressant therapy for 5-8 days is associated with symptoms such as dizziness, ataxia, paraesthesiae, gastrointestinal and flu-like symptoms, and other sensory and sleep disturbances. Psychiatric symptoms include anxiety, agitation, lability of mood, hypersexuality, crying spells, behaviour change and irritability. The SSRI discontinuation syndrome appears to be most marked with paroxetine and to a lesser degree sertraline, with few symptoms seen with fluoxetine (Rosenbaum et al, 1998). The frequency and severity of these symptoms appear to vary according to the half-life of the SSRI (Schatzberg et al, 1997). Schatzberg et al comment that most discontinuation symptoms rare 'short-lived', but that some effects may be longer lasting. Traditional explanations the pharmacology of SSRIs discuss the effects on the postsynaptic serotonin receptor, but the SSRIs work at a variety of locations and their effects reverberate through the nervous and endocrine systems, so that in animal models there may be altered neuroendocrine function for weeks after ceasing fluoxetine. Even 60 days after discontinuation of fluoxetine, the oxytocin response in animals was still significantly reduced by 26% compared with controls.


Transient dystonias and dyskinesias of the jaw have presviously been described with SSRIs (Fitzgerald & Healy, 1995). This report considers four patients on SSRIs who all suffered prolonged neurological symptoms for months after discontinuing their medication.