Bockting Claudi L H, ten Doesschate Mascha C, Spijker Jan, Spinhoven Philip, Koeter Maarten W J, Schene Aart H
Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Psychother Psychosom. 2008;77(1):17-26. doi: 10.1159/000110056. Epub 2007 Dec 14.
Maintenance antidepressant (AD) medication is the most commonly used preventive strategy in a highly recurrent disease, i.e. depression. Little is known about the discontinuation of maintenance AD use and the association with recurrence in daily clinical practice. The purpose was to examine the discontinuation rate of maintenance AD in daily clinical practice in recurrently depressed patients and the associated risk of recurrence.
Prospectively AD maintenance medication and recurrence were examined in 172 euthymic patients with recurrent depression. AD user profiles before recurrence (nonusers, intermittent users, continuous users) were examined and related to recurrence over a 2-year follow-up period.
Less than half of the patients (42%) used AD continuously. Taking into account the minimal required adequate used dosage (> or = 20 mg fluoxetine equivalent), only 26% of the patients used AD as recommended by international guidelines. Despite continuous use of AD, 60.4% relapsed in 2 years. This relapse rate was comparable to the rate of the intermittent users (63.6%). In patients who stopped taking AD after remission and who received additional preventive CT, the recurrence rates were significantly lower than in non-AD-using patients treated with usual care (8 vs. 46%).
The majority of recurrently depressed patients treated with AD discontinue maintenance AD therapy in daily primary and secondary clinical practice. AD seems to offer poor protection against relapse in this patient group. Patients who stopped using AD experienced less relapse, especially if they were treated with preventive CT. Alternative maintenance treatments (including preventive cognitive therapy after discontinuation of AD) should be studied in recurrently depressed patients with intermittent good remission, not only in secondary but also in primary care.
维持性抗抑郁药物（AD）治疗是抑郁症这种高复发性疾病最常用的预防策略。在日常临床实践中，对于维持性AD治疗的停药情况以及与复发的关联知之甚少。目的是研究复发性抑郁症患者在日常临床实践中维持性AD治疗的停药率以及相关的复发风险。
前瞻性地研究了172例处于缓解期的复发性抑郁症患者的AD维持治疗及复发情况。对复发前的AD使用情况（非使用者、间歇使用者、持续使用者）进行了检查，并与2年随访期内的复发情况相关联。
不到一半的患者（42%）持续使用AD。考虑到最低所需的充足使用剂量（≥20毫克氟西汀等效剂量），只有26%的患者按照国际指南推荐使用AD。尽管持续使用AD，但60.4%的患者在2年内复发。该复发率与间歇使用者的复发率（63.6%）相当。在缓解后停止服用AD并接受额外预防性CT治疗的患者中，复发率显著低于接受常规治疗的非AD使用者（8%对46%）。
在日常的初级和二级临床实践中，大多数接受AD治疗的复发性抑郁症患者停止了维持性AD治疗。AD似乎对该患者群体的复发预防效果不佳。停止使用AD的患者复发较少，尤其是在接受预防性CT治疗时。对于间歇性缓解良好的复发性抑郁症患者，不仅在二级护理中，而且在初级护理中，都应研究替代维持治疗方法（包括AD停药后的预防性认知治疗）。
