Discontinuation Symptoms: Never Say Never

In " Tips to manage and prevent discontinuation syndromes " ( Current Psychiatry , September 2005), Dr. Sriram Ramaswamy et al state, "no discontinuation symptoms have been reported with mirtazapine, bupropion, or duloxetine."

Discontinuation symptoms with mirtazapine and bupropion—though quite rare—have been described in case reports. 1 - 4 Also, a discontinuation syndrome was observed after duloxetine was abruptly stopped in placebo-controlled clinical trials; this is noted in the package insert.

James W. Jefferson, MDMadison Institute of Medicine, Inc.Clinical professor of psychiatryUniversity of Wisconsin Medical School, Madison