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Delayed Reaction to Long-Term Antidepressants


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Delayed Reaction to Long-Term Antidepressants

Fed Pract. 2014 July;31(7):43-44


Stress-induced cardiomyopathy (SIC) is usually triggered by intense emotional or physical stress, although it can also be due to invasive diagnostic procedures or surgery. Clinicians from the National Research Council Institute of Clinical Physiology and Scuola Superiore, Sant’Anna, both in Pisa; and Ospedale della Bassa val di Cecina in Cecina; all in Italy, suggest SIC could also be a delayed effect of withdrawal from long-term antidepressant use.


The authors reported on a 65-year-old woman who developed SIC 2 weeks after being weaned from a long-lasting antidepressant treatment. The SIC recurred a week later.


The patient had been admitted to an emergency department (ED) after repeated fainting episodes during and immediately after “light aerobic exercise” in a gym. In the ED, she reported weakness and mild dyspnea. She had a regular heartbeat, mild hypotension, and no sign of acute heart failure. An ECG showed normal sinus rhythm. She was postmenopausal, had never smoked, and had no history of arterial hypertension, hypercholesterolemia, diabetes, or cardiac or circulatory diseases. In fact, 3 months before the SIC episode, she was given a stress echocardiogram before starting a physical exercise program, which excluded ischemic heart disease.


She reported having severe depression for 25 years and had been treated for the past 8 years with a combination of antidepressants, both tricyclic and selective serotonin reuptake inhibitors (SSRIs), neuroleptics, anti-epileptics, and benzodiazepines. She was prescribed imipramine 25 mg bid, amitriptyline 10 mg uid, paroxuid, gabape tin 300 mg tid, trazo-done 12 mg uid, and delorazepam 0.25 mg uid.


This treatment had put her depression into remission for 2 years. Thus, her psychiatrist had admitted her to the hospital, planning to discontinue most of the drugs. The paroxetine was reduced gradually over 3 days, gabapentin was held at the same dose, and the other drugs were stopped. Diazepam and metadoxine were continuously infused intravenously during the first 3 days, then hydroxyzine 25 mg uid was started. The patient tolerated this procedure well and was discharged in good health. Two weeks later, she experienced her first SIC.


The case has several unusual features, the authors say: Both episodes were preceded by only a mild stressor; the SIC recurred, again without any apparent triggering event, in a different part of the heart; and the period between stopping the drug and the onset of the SIC was unusually long (symptoms of SSRI discontinuation usually appear within 7 days).


The authors note that acute withdrawal syndrome from alcohol or opiates has been known to trigger SIC and that rapid interruption of chronic SSRI treatment is known to induce a withdrawal syndrome, characterized by both psychological and somatic symptoms. They believe their case report provides some clues suggesting a link between SSRI withdrawal and SIC. In particular, they point to paroxetine. Due to its rapid clearance, paroxetine is the SSRI most frequently associated with withdrawal syndrome, they say. Moreover, their patient’s symptoms corresponded closely with the most frequent manifestations of SSRI withdrawal syndrome (dizziness and nausea) at the SIC onset. Her delayed reaction, though, may have been due, they say, to the extraordinarily long duration of continuous antidepressant treatment (8 years). Such long treatment may have considerable neuroplastic effects on the hippocampus—abruptly discontinuing the drugs could be a shock that induces “unpredictably delayed manifestations.”



Marabotti C, Venturini E, Marobotti A, Pingitore A. Heart Lung. 2014;43(3):225-230.
doi: 10.1016/j.hrtlng.2014.03.003.


Edited by ChessieCat
reduced font size and added paragraph spaces and link to article

Zoloft: 1995 - 2015

Prozac: 2015 - 2018 (tapered from 40mg x day on July 31 to 30mg on August 31 to 20mg on September 31 to 10mg October 31 to 0mg on  December 15, 2018

Gabapentin: 2016 to 2019  (tapered from 300mg x day to 150mg on August 31, 2019 to 75mg on September 15 to 50mg on September 31 to 25ishmg on October 15 to 0mg on December 1, 2019

Enalapril: 2010 - 2019

Lipitor: 2017 -2017

Metformin: 2000 - 2020

Liothyronine: 2007 - 2019

Levothyroxine: 2000 - 2022

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  • 2 years later...

It's an old topic, but I've got to say that these guys are really clueless, and they are supposed to be experts on the matter...


One look on this forum or even reddit and You know that delayed withdrawal is a common occurence, maybe even more common than immediate onset, as on reddit and everywhere else there is myriad of people reporting "relapse" few months after stopping.


I wonder how long will medical field take to even start making correct assumptions on this matter...


This is stupid that they are the ones getting paid stupid sums of money for their "expertise" while real experts, meaning moderators here and on other WD forums are volunteers.


Sorry, had to vent, wishing all of us a lifelong window.


Duloxetine 2016/17 - 30/60mg/30mg, c/t, light WD.

Sertraline June 2019 50mg ADR

Clorazepate June 2019 20-15-10mg for 3 weeks then sparsely until 2022, 2 times per month max and very low dose (5mg)

Clorazepate Jan2022 10mg 5 days 2,5mg 2 days then off

Venlafaxine June 2019 75mg ADR, 17,5mg, titrated to 37,5mg

Venlafaxine Jan 2022 Covid, hard ADR on 37,5mg, reduced to 20mg ADR, tried ct, crash,

Venlafaxine 22Jan22 reinstated 9,4mg, too low/ 01Feb22- 12mg/ 12Feb- 11,25mg/ 16Feb- 11mg/ 20Feb- 10,8mg/ 24Feb22-10,575mg/ 16Mar22- 10,46mg/ 26Mar22- 10,35mg/ 26Apr22- 10mg/ 01Oct- 9,9mg/ 13Nov- 9,7mg

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On 12/13/2022 at 6:35 PM, Vasherr said:

This is stupid that they are the ones getting paid stupid sums of money for their "expertise" while real experts, meaning moderators here and on other WD forums are volunteers.


Sorry, had to vent, wishing all of us a lifelong window.


Welcome to neoliberalism in action - it wasn't in the financial interests (their only real interest) of the pharma companies to do trials on the longterm effects of anti depressants and  the psychiatric profession with a few exceptions are mainly concerned about how much money  they're going to make and how much status they're going to get so are willfully blind to the damage suffered by their patients. 


Just look at Thomas Incels' the ex head of NIMH's most recent book 'Healing'.  He admits that the current medical model has failed and then advocates more of the same.  Huge, huge bad joke...thousands of lives wasted that shouldn't have been also because pharmaceutical companies wanted to make lots of money and psychiatrists wanted to regain the status and money they lost in the 1970's.  Big, massive crime that will never be punished in our lifetime or as long as neo liberalism remains the dominant model in the West.... I need to vent also.  It makes me feel something like awe that the mods here who work so hard are doing it for free to help others - the very opposite of neoliberalism - just high mindedness and decency, qualities that got chucked in the bin around 40 years ago.

Currently tapering Mirtazapine; previously tapered Cymbalta 30mg to zero from June 2018-Feb 2019 and Seroquel 150mg to zero from Oct-December 2020

Supplements for Hashimoto's disease and histamine issues relating to Mirtazapine:   Vitamin D3 1,000mcg, bio-identical HRT, Selenium, Quercetin, Lutein, Zinc, Vitamin C, Omega 3.

Mirtazapine Taper: 2021 16th Aug -  transitioned to liquid from tablet by dissolving two 15mg tablets into a solution of 15 ml water and 15 ml maple syrup on a starting dose of what I thought was 7.5ml; 17 Sept  - 7.31; 24 Sept  - 7.13; 15 Oct  - 6.95; 6 Nov  - 6.78; 21 Nov  - 6.61; 5 Dec  - 6.51;

2022 - 1 Jan 6.41; 1 Feb  - 6.1; 9 Mar -  5.8; 13 Mar - 5.9; 7 Apr - 5.8; 21 Apr - 5.7; 7 May - 5.63; 23 May - 5.55; 8 June 5.50;  (got COVID on 12th June so held); 1 July 5.4; 15 July 5.32; 8 Aug 5.2; 15 Aug 5.1; 22 Aug 5; 19 Sept 4.9; 2 Oct 4.81; 13 Oct 4.71; (COVID Booster 17/10/22 so longer hold ); 1 Nov 4.65; 3 Nov 4.60; 10 Nov 4.55; 13 Nov 4.50; 17 Nov 4.45; 20 Nov 4.40;  2 Dec 4.30mg; 9 Dec 4.20mg; I discovered that the volumetric container measured 33ml rather than 30ml some time in Dec 2022 (held for 3 months after this). Following helpful advice from moderator OMW (see specifically reply of the 5th March) discovered taper with current dilution is 3.8mg (calculated by dividing 30/33 so that every 1ml of solution has  0.90ml of Mirtazapine.  7.50 - 0.90= 6.6ml which was the starting dose on 16th Aug 2021 not 7.5ml).  I decided to keep using the solution I had started with rather than change the volumetric container to one that gave a more accurate reading as I am used to it and don't want more change to deal with than I have to.. 

2023 17 Mar 4.1(3.7); 26 Mar 4.0(3.6); 14 Apr 3.9(3.5); 28 Apr 3.8(3.4); 


This is not 'medical advice' - my 'non medical advice' is don't get any more 'medical advice' or you may end up getting more 'medical treatment' i.e more drugs, DSM labels and/or ECT.   Please do not PM me thanks.

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