1Begin a different SSRI at a full therapeutic dose today because these symptoms confirm that depression has relapsed.
2Remain off paroxetine and wait several weeks because discontinuation symptoms show that the medication was toxic.
3Take twice the previous paroxetine dose tonight to replace the doses missed during the past 3 days.
4Contact the prescriber; abrupt paroxetine cessation can cause discontinuation syndrome and requires a supervised taper plan.✓ Correct answer
Explanation
Dizziness, nausea, insomnia, anxiety, and electric-shock sensations beginning within days of abrupt paroxetine cessation are consistent with antidepressant discontinuation syndrome. The nurse should assess safety and contact the prescriber. The prior dose can be resumed when symptoms are intolerable, followed by a slower individualized taper. The client should not double doses, start another antidepressant independently, or assume that the symptoms prove relapse or drug toxicity.
Clinical reasoning Paroxetine has a substantial discontinuation risk when stopped abruptly. The rapid onset and sensory symptoms support discontinuation syndrome, while depressive relapse tends to follow a different time course and symptom pattern.
Decision rule Assess suicidality and severe symptoms, involve the prescriber, and use a gradual dose reduction rather than abrupt cessation or unsupervised dose changes.
Scenario A client stopped paroxetine abruptly 3 days ago after taking it daily for 8 months. The client now reports dizziness, nausea, insomnia, anxiety, and brief electric-shock sensations but denies suicidal thoughts.
Antidepressant discontinuation syndrome — A cluster of neurologic, gastrointestinal, sleep, and mood symptoms after abrupt reduction or cessation of a serotonergic antidepressant.
Paroxetine taper — A prescriber-directed gradual dose reduction used to reduce discontinuation reactions.