Paroxetine withdrawal

Paroxetine withdrawal Reactions 1680, p274 - 2 Dec 2017 REM sleep rebound: case report An adult man [exact age at reaction onset not stated] developed REM sleep rebound following the withdrawal of paroxetine [route and time to reaction onset not stated]. The 34-year-old man visited the sleep laboratory for heavy snoring, tendency to fall asleep in non-demanding situations and non-restorative sleep. Subsequently, he was diagnosed with moderate obstructive sleep apnoea. He was recommended for nasal surgery, diet and positional therapy. After 16 years, he came back. He had undergone nasal surgery 12 years ago. He was diagnosed as a hypertensive 10 years ago and currently treated with telmisartan, carvedilol and hydrochlorothiazide. Five months before, he was initiated on paroxetine 20 mg/day for the treatment of depressive symptoms. He reported severe worsening of daytime sleepiness and sleep quality, which introduced to a fragmented and restless sleep. Nocturnal polysomnography was performed and automated continuous positive airway pressure (CPAP) was applied during the polysomnography. He immediately fell asleep and showed a very short REM latency. Later, most of his sleep was described by 71.6% REM of total sleep time, while just few awakening and arousals occurred. The CPAP use satisfactorily corrected respiratory disorders during both REM and NREM sleep. Apnoea/hypopnea index was 1.9, and lowest SaO2 was 84%. However, mean SaO2 during effective CPAP was 94%. The next day, when asked, he mentioned that he had suddenly discontinued paroxetine three days before. A new polysomnography was planned to evaluate if the CPAP treatment and paroxetine withdrawal could revert sleep structure to normal. He came back four months later. He had no residual daytime sleepiness. He used CPAP regularly, but he had to initiate paroxetine again. Polysomnographic study with fixed CPAP at 12cm H2O demonstrated a decrease in REM duration to 57.5 minutes with a REM latency of 38.5 minutes. Apnoea/hypopnea index was 0.2, and lowest SaO2 was 89%. Author comment: "We enquired about possible additional factors contributing to that abnormal REM rebound and concluded that withdrawal of paroxetine could be involved." Lo Bue A, et al. Extreme REM rebound during continuous positive airway pressure titration for obstructive sleep apnea in a depressed patient. Case Reports in Medicine 2014: 292181, Jan 2014. Available from: URL: http:// doi.org/10.1155/2014/292181 - Italy 803285231 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Reactions Weekly Springer Journals

Paroxetine withdrawal

Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Publisher
Springer International Publishing
Copyright
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Subject
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
ISSN
0114-9954
eISSN
1179-2051
D.O.I.
10.1007/s40278-017-39205-7
Publisher site
See Article on Publisher Site

Abstract

Reactions 1680, p274 - 2 Dec 2017 REM sleep rebound: case report An adult man [exact age at reaction onset not stated] developed REM sleep rebound following the withdrawal of paroxetine [route and time to reaction onset not stated]. The 34-year-old man visited the sleep laboratory for heavy snoring, tendency to fall asleep in non-demanding situations and non-restorative sleep. Subsequently, he was diagnosed with moderate obstructive sleep apnoea. He was recommended for nasal surgery, diet and positional therapy. After 16 years, he came back. He had undergone nasal surgery 12 years ago. He was diagnosed as a hypertensive 10 years ago and currently treated with telmisartan, carvedilol and hydrochlorothiazide. Five months before, he was initiated on paroxetine 20 mg/day for the treatment of depressive symptoms. He reported severe worsening of daytime sleepiness and sleep quality, which introduced to a fragmented and restless sleep. Nocturnal polysomnography was performed and automated continuous positive airway pressure (CPAP) was applied during the polysomnography. He immediately fell asleep and showed a very short REM latency. Later, most of his sleep was described by 71.6% REM of total sleep time, while just few awakening and arousals occurred. The CPAP use satisfactorily corrected respiratory disorders during both REM and NREM sleep. Apnoea/hypopnea index was 1.9, and lowest SaO2 was 84%. However, mean SaO2 during effective CPAP was 94%. The next day, when asked, he mentioned that he had suddenly discontinued paroxetine three days before. A new polysomnography was planned to evaluate if the CPAP treatment and paroxetine withdrawal could revert sleep structure to normal. He came back four months later. He had no residual daytime sleepiness. He used CPAP regularly, but he had to initiate paroxetine again. Polysomnographic study with fixed CPAP at 12cm H2O demonstrated a decrease in REM duration to 57.5 minutes with a REM latency of 38.5 minutes. Apnoea/hypopnea index was 0.2, and lowest SaO2 was 89%. Author comment: "We enquired about possible additional factors contributing to that abnormal REM rebound and concluded that withdrawal of paroxetine could be involved." Lo Bue A, et al. Extreme REM rebound during continuous positive airway pressure titration for obstructive sleep apnea in a depressed patient. Case Reports in Medicine 2014: 292181, Jan 2014. Available from: URL: http:// doi.org/10.1155/2014/292181 - Italy 803285231 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680

Journal

Reactions WeeklySpringer Journals

Published: Dec 2, 2017

References

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