Nefazodone Withdrawal Syndrome Responds to the Administration of Trazodone

Most antidepressants can induce a withdrawal syndrome when the treatment is abruptly interrupted, after a significant period of drug administration. However, such a withdrawal syndrome has been rarely reported under nefazodone or trazodone. Here, we report a case of nefazodone withdrawal syndrome, which was adequately treated by the administration of trazodone. A seventy-year old man had taken nefazodone 400mg/d during several years, without complications. Nefazodone has been withdrawn from the market in Switzerland. His treatment was then abruptly interrupted and the patient was switched within one day to a treatment of venlafaxine, 75mg/d. Within two days, the patient experienced dizziness, facial pain of the type of trigeminal neuralgia as well as cacosmia. These symptoms started two days after nefazodone withdrawal and the beginning of venlafaxine. After two days of venlafaxine, the patient decided to interrupt this treatment. However, the symptoms persisted and he consulted an internist ten days after having stopped nefazodone. During this visit, blood pressure was measured at 170/110mmHg. The patient still complained of cacosmia and severe facial pain. On the same day, trazodone was administrated in the evening. All symptoms rapidly disappeared.

In this case, the substitution of nefazodone by venlafaxine was not pharmacologically adequate, since these two antidepressants have different modes of action. The short duration of administration of venlafaxine as well as the persistence of symptoms after interruption of venlafaxine indicate that this medication was not responsible for the symptoms. Moreover, the symptoms persisted until trazodone was prescribed, ten days after the interruption of nefazodone. Overall, less than 20 case reports of nefazodone or trazodone withdrawal have been published. To our knowledge, this is the first description of trazodone usefulness in this situation.