Baldwin David S, Montgomery Stuart A, Nil Rico, Lader Malcolm
Clinical Neurosciences Division, School of Medicine, University of Southampton, UK.
Int J Neuropsychopharmacol. 2007 Feb;10(1):73-84. doi: 10.1017/S1461145705006358. Epub 2005 Dec 19.
The present overview investigates whether different antidepressants have differing discontinuation symptoms upon treatment cessation, if these symptoms vary between depression and anxiety disorders, and with length of treatment. Data came from two comparative studies of escitalopram in major depressive disorder (MDD) (one vs. venlafaxine XR and one vs. paroxetine), two studies in social anxiety disorder (SAD) (one of which used paroxetine as the active reference), and one study in generalized anxiety disorder (GAD), using paroxetine as an active reference [total number of patients: escitalopram (n=1051); paroxetine (n=336); venlafaxine XR (n=124); placebo (n=239)]. All studies included a defined discontinuation period and used the Discontinuation Emergent Signs and Symptoms (DESS) checklist to record the number of discontinuation symptoms. All three antidepressants showed more discontinuation symptoms compared with placebo (p<0.001). Patients reported significantly fewer discontinuation symptoms with escitalopram than with paroxetine and venlafaxine XR in MDD (p<0.05). Escitalopram showed significantly fewer discontinuation symptoms than paroxetine in SAD (p<0.05) and GAD (p<0.001). For each antidepressant, no differences in discontinuation symptoms were observed between the three indications and there was no evidence for increased symptom incidence with increased length of treatment. Thus, discontinuation profiles differ between antidepressants of the same class and are broadly similar in different disorders. No evidence was seen for a higher discontinuation burden with longer treatment.
本综述调查了不同的抗抑郁药在停药时是否有不同的停药症状，这些症状在抑郁症和焦虑症之间是否存在差异，以及与治疗时长的关系。数据来自两项艾司西酞普兰治疗重度抑郁症（MDD）的对照研究（一项与文拉法辛缓释剂对比，一项与帕罗西汀对比）、两项社交焦虑症（SAD）研究（其中一项将帕罗西汀作为活性对照）以及一项广泛性焦虑症（GAD）研究（将帕罗西汀作为活性对照）[患者总数：艾司西酞普兰（n = 1051）；帕罗西汀（n = 336）；文拉法辛缓释剂（n = 124）；安慰剂（n = 239）]。所有研究都设定了明确的停药期，并使用停药后出现的体征和症状（DESS）清单来记录停药症状的数量。与安慰剂相比，所有三种抗抑郁药都表现出更多的停药症状（p<0.001）。在MDD中，患者报告的艾司西酞普兰停药症状明显少于帕罗西汀和文拉法辛缓释剂（p<0.05）。在SAD（p<0.05）和GAD（p<0.001）中，艾司西酞普兰的停药症状明显少于帕罗西汀。对于每种抗抑郁药，在三种适应症之间未观察到停药症状的差异，也没有证据表明症状发生率会随着治疗时长的增加而升高。因此，同一类抗抑郁药的停药特征不同，但在不同疾病中大致相似。没有证据表明治疗时间越长停药负担越高。
