Wilson Emma, Lader Malcolm
King's College London, Institute of Psychiatry, London SE5 8AF, UK.
King's College London, London, UK.
Ther Adv Psychopharmacol. 2015 Dec;5(6):357-68. doi: 10.1177/2045125315612334.
Strong evidence supports the existence of a discontinuation syndrome following the withdrawal of antidepressant medication, particularly second-generation antidepressants. The syndrome is a common phenomenon and guidance as to best avoid the symptoms is essential for both practitioners and patients. The current study reviewed the available literature on the best methods of discontinuation for antidepressants in order to avoid or prevent the occurrence of any unpleasant side effects associated with antidepressant withdrawal. Accordingly, an electronic search of the PubMed/MedLine database and Google Scholar was conducted to find relevant literature published within the last 10 years. From this, 18 related articles were identified; five clinical studies, one case series, one consensus panel's recommendations and 11 literature reviews. Of the articles reviewed there is a general consensus as to tapering the drug slowly over a period of weeks or months. Also, in those patients who experience severe symptoms the drug should be reinstated and discontinued more gradually. The discontinuation syndrome does not occur as frequently or severely with longer-acting agents such as fluoxetine and therefore it is recommended that switching to this drug prior to withdrawal may be advisable. The articles reviewed also emphasize the need for patient education and reassurance throughout the discontinuation process. One in particular adds that cognitive behavioural therapy may be a useful tool in easing the patients' distress. However, this review highlights the lack of controlled data to support the available guidelines. Furthermore, the guidance which is available is somewhat conflicting. Research approaches should address this issue as well as develop appropriate methods of withdrawal for specific drugs.
有力证据支持在停用抗抑郁药物后，尤其是第二代抗抑郁药物后，会出现停药综合征。该综合征是一种常见现象，对于从业者和患者而言，了解如何最好地避免这些症状至关重要。本研究回顾了关于抗抑郁药物最佳停药方法的现有文献，以避免或预防与抗抑郁药物撤药相关的任何不良副作用的发生。因此，对PubMed/MedLine数据库和谷歌学术进行了电子检索，以查找过去10年内发表的相关文献。从中确定了18篇相关文章；5项临床研究、1个病例系列、1个共识小组的建议和11篇文献综述。在所审查的文章中，对于在数周或数月的时间内缓慢减药存在普遍共识。此外，对于那些出现严重症状的患者，应恢复用药并更缓慢地停药。与氟西汀等长效药物相比，停药综合征的发生频率和严重程度较低，因此建议在撤药前换用这种药物可能是明智的。所审查的文章还强调在整个停药过程中需要对患者进行教育和安抚。特别是有一篇文章补充说，认知行为疗法可能是缓解患者痛苦的有用工具。然而，本综述强调缺乏支持现有指南的对照数据。此外，现有的指南也存在一定冲突。研究方法应解决这一问题，并为特定药物制定合适的撤药方法。
