Possible Nefazodone Withdrawal Syndrome

Mr. A was a 28-year-old white man who enrolled as a healthy volunteer in a study protocol conducted at our institution. Written informed consent was obtained from Mr. A after the study procedures were explained. The protocol required that subjects receive 9 days of nefazodone therapy. The dose was titrated over the course of 4 days to 200 mg twice daily. It was maintained for 5 days and then abruptly discontinued.

Mr. A complained of dizziness and “electrical sensations down [his] legs” beginning approximately 36 hours after his final nefazodone dose. The electrical sensations lasted throughout the night and were described as “tickling electrical sensation[s]” severe enough to interfere with sleep. The discomfort would subside upon movement but return after approximately 30 seconds of immobility. By the following morning (48 hours after nefazodone discontinuation), the leg symptoms had subsided. Dizziness, however, persisted throughout the day and at times led to nausea. Seventy-two hours after discontinuation, his dizziness had begun to subside and was completely gone shortly thereafter.

Although single doses of dextromethorphan and methylprednisolone were administered as study medications, they were unlikely to cause these symptoms. Mr. A reported that he had never experienced similar symptoms.