Department of Psychiatry & Behavioral Neuroscience, University of Chicago, Chicago, Illinois 60637, USA.
Int Clin Psychopharmacol. 2013 Jul;28(4):200-5. doi: 10.1097/YIC.0b013e3283613e4d.
Although data fully support the use of serotonin reuptake inhibitors (SRIs) in the treatment of obsessive-compulsive disorder (OCD), investigations on pharmacotherapy discontinuation during the course of OCD are lacking. This 5-year prospective study sought to better understand the long-term course of SRI utilization among individuals with OCD.
A total of 252 adult outpatients with Diagnostic and Statistical Manual of Mental Disorders, 4th ed. OCD, treated with medication in the community, were examined for discontinuation and resumption of SRIs. Data on weekly OCD symptoms, medications, and dosage changes were obtained annually using the Longitudinal Interval Follow-up Evaluation.
During the 5-year follow-up period, 151 patients had at least one trial of an SRI for 12 weeks or more. A total of 110 patients (43.7%) discontinued their medication (i.e. ceased taking medication for ≥4 weeks) at least once during the follow-up period. In patients symptomatic at the time of discontinuation, the cumulative incidence of worsening of OCD after SRI discontinuation was 9.8%, whereas in patients in partial or full remission at the time of discontinuation, the corresponding cumulative incidence was 33.3%. Among patients with worsening of OCD upon SRI discontinuation, the median time to worsening was 39 weeks.
This first longitudinal study on the use of SRIs in OCD found that patients who had achieved partial or full remission on SRIs were less likely to discontinue medication, and the cumulative incidence of worsening of OCD after discontinuation was negatively associated with OCD severity at the time of SRI discontinuation.
尽管数据充分支持使用选择性 5-羟色胺再摄取抑制剂（SSRIs）治疗强迫症（OCD），但缺乏关于 OCD 治疗过程中药物治疗中断的研究。这项为期 5 年的前瞻性研究旨在更好地了解 OCD 患者长期使用 SSRIs 的情况。
共有 252 名成年门诊患者符合《精神障碍诊断与统计手册》第 4 版 OCD 诊断标准，在社区接受药物治疗，对他们 SSRIs 的停药和重新使用情况进行了检查。使用纵向间隔随访评估，每年获得 OCD 症状、药物和剂量变化的每周数据。
在 5 年的随访期间，151 名患者至少有一次尝试使用 SSRIs 治疗 12 周或更长时间。共有 110 名患者（43.7%）在随访期间至少有一次停药（即停止服用药物≥4 周）。在停药时仍有症状的患者中，SSRIs 停药后 OCD 恶化的累积发生率为 9.8%，而在停药时处于部分或完全缓解的患者中，相应的累积发生率为 33.3%。在 SSRIs 停药后 OCD 恶化的患者中，恶化的中位数时间为 39 周。
这是第一项关于 OCD 中 SSRIs 使用的纵向研究发现，在 SSRIs 治疗中达到部分或完全缓解的患者更不可能停药，SSRIs 停药后 OCD 恶化的累积发生率与停药时 OCD 严重程度呈负相关。
