SSRI Discontinuation and Buspirone
Ms. A, a 62-year-old woman, initially came to our clinic with a 3-year history of depression and associated features of anxiety. She had previously been treated with amitriptyline and had experienced only partial response; she had also taken buspirone for anxiety. She began taking sertraline, 50 mg/day, and subsequently increased the dose to 100 mg/day. At 6 weeks, she had a partial response to sertraline and mild side effects of dizziness and nausea. One month later, she reported additional improvement, most notably in decreased sadness and pessimism. Her side effects had disappeared. At the 5-month follow-up, her depression was in full remission, and she was experiencing no side effects.Six weeks later, she came to the clinic on an emergency basis with intense nausea, anxiety, dizziness, and vertigo. Four days before, she had abruptly stopped taking sertraline because of problems with refilling her prescription. On the third day of symptoms, she had decided to treat the anxiety and dizziness with buspirone, 15 mg/day. She experienced an exacerbation of symptoms shortly after this, which led to her coming to the clinic. She was again given sertraline, 100 mg/day; her symptoms disappeared within 24 hours.
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