University Psychiatric Clinic, Clinical Hospital Centre Rijeka, Krešimirova 42, 51000 Rijeka, Croatia.
Psychiatr Danub. 2011 Mar;23(1):117-9.
Dual-action antidepressants serotonin-norepinephrine reuptake inhibitors (SRNIs) are widely used to treat depression. Owing to its efficiency and safety, venlafaxine holds a prominent place in this group of depressants. Abrupt venlafaxine discontinuation involves a high risk of withdrawal syndrome. Mechanism of its development is similar to that of selective serotonin reuptake inhibitors (SSRIs), but of higher intensity. Venlafaxine withdrawal symptoms may include several somatic symptoms as well as several psychiatric symptoms. In some cases, symptoms may look like a stroke. A treatment option is re-inclusion of venlafaxine or a SSRI antidepressant. The paper presents the case of a 70-year-old patient who discontinued of her own accord to take venlafaxine, which she had been taking regularly at a daily dose of 225 mg for more than a year. A few hours after taking the last dose, withdrawal syndrome occurred with severe symptoms resembling a stroke. The patient was examined by a neurologist and the CT and laboratory parameters showed no irregularities. Diagnosis was made after psychiatric observation. Venlafaxine, 150 mg per day, was prescribed, the symptoms disappeared relatively quickly, and the patient fully recovered. Withdrawal syndrome is a real risk for each venlafaxine treated patient. The possibility of its occurrence should be always kept in mind and patients should be timely informed about it. In this way, the risk of venlafaxine withdraw syndrome could be reduced, unnecessary stress to patients prevented and the costs of medical treatment lowered.
双重作用抗抑郁药 5-羟色胺-去甲肾上腺素再摄取抑制剂(SNRIs)被广泛用于治疗抑郁症。由于其疗效和安全性,文拉法辛在这组抗抑郁药中占有突出地位。突然停止文拉法辛会有很高的戒断综合征风险。其发展机制与选择性 5-羟色胺再摄取抑制剂(SSRIs)相似,但强度更高。文拉法辛戒断症状可能包括几种躯体症状和几种精神症状。在某些情况下,症状可能看起来像中风。一种治疗选择是重新开始使用文拉法辛或 SSRI 抗抑郁药。本文介绍了一位 70 岁女性患者自行停药的案例,她一直每天服用文拉法辛 225 毫克,已经持续了一年多。在最后一次服药后几个小时,出现了戒断综合征,症状严重,类似于中风。患者接受了神经科医生的检查,CT 和实验室参数没有异常。经过精神科观察后做出诊断。每天开 150 毫克文拉法辛,症状很快消失,患者完全康复。戒断综合征是每个接受文拉法辛治疗的患者都面临的真正风险。应始终牢记其发生的可能性,并及时告知患者。这样可以降低文拉法辛戒断综合征的风险,避免给患者带来不必要的压力,并降低医疗费用。