Bogetto Filippo, Bellino Silvio, Revello Raffaele Bonatto, Patria Luca
Unit of Psychiatry, Department of Neuroscience, University of Turin, Turin, Italy.
CNS Drugs. 2002;16(4):273-83. doi: 10.2165/00023210-200216040-00006.
Many authors have reported discontinuation symptoms associated with selective serotonin reuptake inhibitors (SSRIs). The aim of this study was to investigate the incidence and characteristics of the discontinuation syndrome in patients who stopped treatment with the SSRIs paroxetine and fluoxetine under the usual conditions of clinical practice, and to identify clinical predictors of the syndrome.
Ninety-seven outpatients who received an initial diagnosis of dysthymic disorder, who responded to >or=8 weeks treatment with paroxetine (n = 52) or fluoxetine (n = 45), and who discontinued the SSRI according to their psychiatrist's instructions were included. They were assessed at the time of discontinuation using a semi-structured interview for clinical and treatment characteristics, the Hamilton Depression Rating Scale (HAM-D) and the Montgomery-Asberg Depression Rating Scale (MADRS). Patients were then assessed 4 weeks later using a checklist for discontinuation symptoms, a semi-structured interview for discontinuation symptom characteristics, and the HAM-D and the MADRS.
A discontinuation syndrome was found in 26 patients (26.8% of our sample); of this group, 22 patients (84.6%) had received paroxetine, and 4 patients (15.4%) had received fluoxetine. The mean time at onset of symptoms was 2 days after drug discontinuation and the mean duration was 5 days. The statistical comparison between the groups with and without a discontinuation syndrome found two significant differences - a discontinuation syndrome was more common in patients treated with paroxetine and in patients with an earlier onset of dysthymic disorder. Multiple regression analysis confirmed that these two factors were related to the duration of discontinuation symptoms, while the number of symptoms was associated with three factors, including use of paroxetine, age at onset of dysthmia and female gender.
A discontinuation syndrome is common after treatment with SSRIs is stopped in patients with dysthymia, and it appears to be more common in patients receiving paroxetine than in those receiving fluoxetine. The syndrome is related both to drug and clinical characteristics. The features of the syndrome in patients with different Axis I diagnoses should be compared in further investigations.
许多作者报道了与选择性5-羟色胺再摄取抑制剂（SSRI）相关的停药症状。本研究旨在调查在临床实践的常规条件下停用SSRI帕罗西汀和氟西汀治疗的患者中停药综合征的发生率和特征，并确定该综合征的临床预测因素。
纳入97例门诊患者，这些患者最初被诊断为心境恶劣障碍，对帕罗西汀（n = 52）或氟西汀（n = 45）进行了≥8周的治疗，并根据精神科医生的指示停用了SSRI。在停药时，使用半结构化访谈评估其临床和治疗特征、汉密尔顿抑郁量表（HAM-D）和蒙哥马利-阿斯伯格抑郁量表（MADRS）。然后在4周后，使用停药症状清单、停药症状特征半结构化访谈以及HAM-D和MADRS对患者进行评估。
26例患者（占样本的26.8%）出现了停药综合征；在该组中，22例患者（84.6%）接受过帕罗西汀治疗，4例患者（15.4%）接受过氟西汀治疗。症状出现的平均时间为停药后2天，平均持续时间为5天。有停药综合征和无停药综合征组之间的统计学比较发现了两个显著差异——停药综合征在接受帕罗西汀治疗的患者以及心境恶劣障碍发病较早的患者中更常见。多元回归分析证实，这两个因素与停药症状的持续时间有关，而症状数量与三个因素有关，包括使用帕罗西汀、心境恶劣发病年龄和女性性别。
心境恶劣障碍患者停用SSRI治疗后，停药综合征很常见，而且接受帕罗西汀治疗的患者似乎比接受氟西汀治疗的患者更常见。该综合征与药物及临床特征均有关。在进一步研究中应比较不同轴I诊断患者的综合征特征。
