Suicidality emerging from rapid Venlafaxine discontinuation

There is ongoing controversy about suicide risk associated with antidepressant use, but much less is known about suicide risk related to discontinuation of antidepressants. Antidepressant withdrawal syndrome (AWS) can be a burdensome syndrome, with well-known symptoms. One possible explanation for this condition is the oppositional model of tolerance. Some study results are suggestive that suicidality can be part of AWS, although the data are still inconclusive. We are aware of only 3 case reports of suicidal behavior with antidepressant discontinuation, which occurred after discontinuation of paroxetine, venlafaxine, and escitalopram. In this case report, we present a patient without a history of suicidal crisis who, in the span of 6 months, experienced 2 suicidal crises, each occurring directly following rapid discontinuation of venlafaxine. Both crises subsided with reintroduction of the drug.