Similar discontinuation symptoms for withdrawal from medium-dose paroxetine and venlafaxine after nine years in the same patient

A woman who had developed a discontinuation syndrome nine years ago with paroxetine tapered from 10 to 5 mg/day represented the same syndrome recently when she occasionally missed her 75 mg q 12 h venlafaxine doses. The symptoms, comprising agitation, numbness, pricking sensations, sweating, difficulty concentrating, weakness, derealisation and perceived xerophthalmia, immediately subside upon drug dose reinstitution. The patient had used cannabis irregularly before the onset of pauci-symptomatic panic attacks, but none of her panic symptoms were present in her withdrawal symptomatology. Some symptoms waxed and waned during the withdrawal period. The syndrome is compatible with both hyper- and hypoactivity of the central serotonergic system.