Complications
Abrupt discontinuation of serotonergic agents with a shorter half-life (e.g., paroxetine, venlafaxine) may cause acute withdrawal symptoms (e.g., dizziness, irritability, nausea, rebound anxiety).
Restarting the selective serotonin-reuptake inhibitor agent and scheduling a slow, gradual tapering schedule under close medical supervision is recommended.
Substance use disorders may develop as a means of regulating general anxiety and uncomfortable panic symptoms.
Various substances may also mimic panic-related sensations, especially during times of acute withdrawal, and thereby complicate treatment.
Nicotine use and dependence is disproportionately high among patients with panic disorder.[52]
Referral for substance use treatment programs may be indicated.
Discuss concerns and resistance, and use motivational techniques.
Provider may consult with local-area mental health professional for additional advice or referral options. Patient may benefit from web-based education materials available from the Anxiety and Depression Association of America. Anxiety and Depression Association of America Opens in new window
Sexual dysfunction may occur during treatment with selective serotonin-reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) and there is some evidence that it can persist after treatment discontinuation in some patients.[171] Symptoms include genital numbness, decreased sex drive, erectile dysfunction, vaginal dryness, failure to become aroused or orgasm, and premature ejaculation. Prevalence and incidence are both currently unclear, as are the cause and possible mechanisms of post-SSRI sexual dysfunction.[172]
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