Lejoyeux Michel, Matharan Sophie, de Bodinat Christian
1Hôpital Bichat,Claude Bernard 46,Paris,France.
2Institut de Recherches Internationales Servier (IRIS),Suresnes,France.
CNS Spectr. 2015 Feb;20(1):29-38. doi: 10.1017/S1092852913000813. Epub 2013 Dec 13.
OBJECTIVE/INTRODUCTION: The present trial informs clinicians about switching conditions with the antidepressant agomelatine after the failure of a treatment with either paroxetine or venlafaxine.
The total number of discontinuation-emergent symptoms, according to the Discontinuation-Emergent Signs and Symptoms checklist, was compared in double-blind conditions after 3 switching options: immediate substitution or initiation of agomelatine (25 mg/day p.o.) with either a short- or long-tapering of the previous drug. Secondary objectives included tolerability and safety assessments and the early clinical benefit after the switch.
For all switching options, a withdrawal syndrome was observed 1 week after cessation of the selective serotonin reuptake inhibitor (SSRI)/serotonin-norepinephrine reuptake inhibitor (SNRI) treatment. Psychic symptoms were the most frequently reported, and somatic symptoms were comparatively few. Early discontinuation symptoms after cessation of SSRI/SNRI treatment did not prejudice the antidepressant benefits of agomelatine over 8 weeks.
Both abrupt and start-taper switching with agomelatine are options in everyday practice for those patients who have not responded to either paroxetine or venlafaxine. However, regardless of the switching strategy, the present double-blind study shows that early discontinuation symptoms that arise upon cessation of SSRI/SNRI can alter the patients' perception of the clinical benefit of the new antidepressant. Both practitioners and patients must be warned about these early discontinuation symptoms to prevent the symptoms from being confounded with a lack of therapeutic benefit of the new treatment.
目的/引言：本试验为临床医生提供了关于在使用帕罗西汀或文拉法辛治疗失败后换用抗抑郁药阿戈美拉汀的情况。
根据停药后出现的体征和症状清单，在3种换药方案后的双盲条件下，比较停药后出现的症状总数：立即替换或开始使用阿戈美拉汀（口服25mg/天），同时对前一种药物进行短期或长期递减。次要目标包括耐受性和安全性评估以及换药后的早期临床获益。
对于所有换药方案，在选择性5-羟色胺再摄取抑制剂（SSRI）/5-羟色胺-去甲肾上腺素再摄取抑制剂（SNRI）治疗停止1周后观察到戒断综合征。精神症状是最常报告的，躯体症状相对较少。SSRI/SNRI治疗停止后的早期停药症状在8周内并未影响阿戈美拉汀的抗抑郁疗效。
对于对帕罗西汀或文拉法辛均无反应的患者，在日常实践中，阿戈美拉汀的突然换药和开始递减换药都是可行的选择。然而，无论换药策略如何，本双盲研究表明，SSRI/SNRI停药后出现的早期停药症状可能会改变患者对新抗抑郁药临床获益的认知。必须向医生和患者双方警告这些早期停药症状，以防止这些症状与新治疗缺乏治疗益处相混淆。
