Goethe John W, Woolley Stephen B, Cardoni Alex A, Woznicki Brenda A, Piez Deborah A
Burlingame Center for Psychiatric Research and Education, The Institute of Living/Hartford Hospital, Hartford, CT 06106, USA.
J Clin Psychopharmacol. 2007 Oct;27(5):451-8. doi: 10.1097/jcp.0b013e31815152a5.
Patients with major depression discontinue taking their antidepressants for many reasons. Although side effects are often cited as the reason for discontinuation, few prospective studies have addressed this question, and none has specifically examined discontinuation in patients with severe depression.
Inpatients and outpatients treated with a selective serotonin reuptake inhibitor for major depressive disorder were identified after admission. Three months later, patients were contacted and interviewed to determine antidepressant usage and the side effects experienced, including when these were experienced and their severity.
Between October 2001 and April 2003, 406 English- or Spanish-speaking patients aged 18 to 75 years were followed up. One in 4 patients discontinued the index antidepressant. Among specific side effects noted, only "change in weight" and "anxiety" were significant predictors of discontinuation after controlling for confounders. Experiencing 1 or more "extremely" bothersome side effects was associated with more than a doubling of the risk of discontinuation, but the presence of side effects and side effects less severe than "extremely" bothersome were not significant predictors. There were no differences among selective serotonin reuptake inhibitor antidepressants in either the presence/absence of side effects or in the discontinuation rates.
The results suggest that the contribution of side effects to antidepressant discontinuation is more complex than previously suggested. Disparate findings from earlier studies may reflect aspects of study design, such as examining populations whose severity of depression varied widely or not controlling for important confounding factors. Future research should separately examine high-risk groups (or control for severity of depression) and carefully rule out other potential contributors to discontinuation.
重度抑郁症患者会因多种原因停用抗抑郁药。虽然副作用常被视为停药原因，但很少有前瞻性研究探讨过这个问题，且尚无研究专门考察重度抑郁症患者的停药情况。
在患者入院后确定接受选择性5-羟色胺再摄取抑制剂治疗重度抑郁症的住院患者和门诊患者。三个月后，联系并访谈患者以确定抗抑郁药使用情况及所经历的副作用，包括副作用出现的时间及其严重程度。
在2001年10月至2003年4月期间，对406名年龄在18至75岁、讲英语或西班牙语的患者进行了随访。四分之一的患者停用了索引抗抑郁药。在记录的特定副作用中，在控制混杂因素后，只有“体重变化”和“焦虑”是停药的显著预测因素。经历1种或更多“极其”烦扰的副作用会使停药风险增加一倍多，但出现副作用以及不如“极其”烦扰严重的副作用并非显著的预测因素。在副作用的有无或停药率方面，选择性5-羟色胺再摄取抑制剂类抗抑郁药之间没有差异。
结果表明，副作用对停用抗抑郁药的影响比之前认为的更为复杂。早期研究结果的差异可能反映了研究设计方面的问题，例如所研究人群的抑郁症严重程度差异很大，或者未控制重要的混杂因素。未来的研究应分别考察高危人群（或控制抑郁症严重程度），并仔细排除其他可能导致停药的因素。
