Himei Akio, Okamura Takehiko
Department of Neuropsychiatry, Osaka Medical College, Osaka, JapanOsaka Institute of Psychiatry, Osaka, Japan.
CNS Drugs. 2006;20(8):665-72. doi: 10.2165/00023210-200620080-00005.
To examine the factors that contribute to the occurrence of the discontinuation syndrome in patients who have received paroxetine to treat depression.
The clinical records of individuals from the outpatient units of two centres in the western area of Japan who had had a single episode of major depressive disorder (MDD) and had completed monotherapy with paroxetine in the previous 5 years were retrospectively reviewed. All patients had been diagnosed with MDD according to the DSM-IV criteria. The patients were divided into two groups, according to whether or not they had experienced the discontinuation syndrome when paroxetine was stopped. The syndrome was diagnosed according to standard criteria for the SSRI discontinuation syndrome. The two groups were compared for sex, age, maintenance dosage of paroxetine, duration of treatment with paroxetine, presence of adverse reactions in the early phase of treatment with paroxetine, and method of paroxetine withdrawal (abrupt or tapered).
Of the 385 patients included in the review, 41 patients experienced the discontinuation syndrome. The occurrence of the discontinuation syndrome did not correlate with sex, maintenance dosage of paroxetine or duration of treatment with the drug. However, there was a relationship between the method of drug withdrawal and the occurrence of the discontinuation syndrome, with the syndrome occurring significantly more frequently in those patients in whom paroxetine was abruptly discontinued. There was an association between the occurrence of the discontinuation syndrome and age, but this association seemed to have been caused by the fact that younger patients were more inclined to abruptly stop taking the medication. It was also found that the discontinuation syndrome occurred at a significantly higher rate in patients who had experienced adverse reactions to paroxetine in the early phase of treatment.
The discontinuation syndrome in patients taking paroxetine was more likely to occur in those patients who stopped taking the drug abruptly. The occurrence of the discontinuation syndrome was also correlated with younger age, but this association seemed to be secondary to the fact that younger patients tended to be more likely to abruptly stop taking the medication. It appears that the discontinuation syndrome can be prevented by carefully tapering the dosage of paroxetine when treatment is withdrawn. Interestingly, the discontinuation syndrome was more likely to occur in those patients who experienced adverse reactions in the early phase of treatment with paroxetine. When the drug is discontinued, additional attention should be paid to patients who have presented with adverse reactions in the early phase of paroxetine therapy.
探讨接受帕罗西汀治疗抑郁症的患者出现撤药综合征的相关因素。
回顾性分析日本西部地区两个中心门诊的个体临床记录，这些个体曾有单次重度抑郁症（MDD）发作，且在过去5年中完成了帕罗西汀单一疗法治疗。所有患者均根据DSM-IV标准诊断为MDD。根据停用帕罗西汀时是否经历撤药综合征，将患者分为两组。撤药综合征根据SSRI撤药综合征的标准进行诊断。比较两组患者的性别、年龄、帕罗西汀维持剂量、帕罗西汀治疗时长、帕罗西汀治疗早期不良反应的发生情况以及帕罗西汀撤药方法（突然停药或逐渐减量）。
纳入回顾的385例患者中，41例经历了撤药综合征。撤药综合征的发生与性别、帕罗西汀维持剂量或用药时长无关。然而，撤药方法与撤药综合征的发生之间存在关联，帕罗西汀突然停药的患者中该综合征发生频率显著更高。撤药综合征的发生与年龄有关，但这种关联似乎是由于年轻患者更倾向于突然停药所致。还发现，在治疗早期对帕罗西汀有不良反应的患者中，撤药综合征的发生率显著更高。
服用帕罗西汀的患者中，突然停药的患者更易出现撤药综合征。撤药综合征的发生也与年轻有关，但这种关联似乎是继发于年轻患者更倾向于突然停药这一事实。似乎通过在撤药时谨慎逐渐减少帕罗西汀剂量可预防撤药综合征。有趣的是，在帕罗西汀治疗早期出现不良反应的患者中更易发生撤药综合征。停药时，应格外关注在帕罗西汀治疗早期出现不良反应的患者。
