Medication-Induced Movement Disorders 713
quently reported sensory and somatic symptoms  include flashes of lights, “electric shock”
sensations, nausea, and hyperre sponsivity to nois es or lights. Nons pecific anxiety and
feelings of dread may also be reported. Symptoms are alleviated by restarting the same
medication or starting a different medication that has a similar mechanism of action—
for example, discontinuation symptoms afte r withdrawal from a serotonin-norepineph-
rine reuptake inhibitor may be alleviated by starting a tricyclic antidepressant. To qualify
as antidepressant discontinuation syndrome, the symptoms should not have been present
before the antidepressant dosa ge was reduced and are not be tter explained by another
mental disorder (e.g., manic or hypomanic episode, substance intoxication, substance
withdrawal, somatic symptom disorder).
Diagnostic Features
Discontinuation symptoms may occur following treatment with tricyclic antidepressants
(e.g., imipramine, amitriptyline, desipramine) , serotonin reuptake in hibitors (e.g., fluox-
etine, paroxetine, sertraline), and monoamine oxidase inhibitors (e.g., phenelzine, selegi-
line, pargyline). The incidence of this syndrome  depends on the dosage and half-life of the
medication being taken, as well as the rate at  which the medication is tapered. Short-acting
medications that are stopped ab ruptly rather than tapered gradually may pose the great-
est risk. The short-acting selective serotonin reuptake inhibitor (SSRI) paroxetine is the
agent most commonly associated with disconti nuation symptoms, but such symptoms oc-
cur for all types of antidepressants.