Gahr Maximilian, Hiemke Christoph, Kölle Markus Alexander
Department of Psychiatry and Psychotherapy III, University of Ulm, Ulm, Germany.
Department of Psychiatry and Psychotherapy, University Medical Center of Mainz, Mainz, Germany.
Front Psychiatry. 2020 Feb 12;11:32. doi: 10.3389/fpsyt.2020.00032. eCollection 2020.
Withdrawal symptoms after discontinuation of antidepressants are common and have long been known. Typical symptoms after dose reduction or discontinuation of antidepressants are dizziness, drowsiness, headache, flu-like symptoms, hyperarousal, imbalance, insomnia, irritability, and nausea. Rebound, relapse, or recurrence associated with the underlying mental disorder may also occur. The occurrence of obsessive-compulsive symptoms (OCS) following abrupt discontinuation of antidepressants have not yet been reported. Here we report the development of OCS (obsessional suicidal thoughts) in a patient with major depressive disorder and absence of a previous obsessive-compulsive disorder following abrupt discontinuation of venlafaxine. Treatment with escitalopram facilitated remission of OCS. We discuss a possible causal link between abrupt discontinuation of venlafaxine and development of OCS under consideration of pathophysiologic aspects regarding obsessive compulsive disorders, the chronological sequence of symptoms in the present case, and pharmacodynamic and -kinetic aspects. Our case report suggests the possibility of the occurrence of obsessive-compulsive symptoms following abrupt discontinuation of venlafaxine.
停用抗抑郁药后的戒断症状很常见，且早已为人所知。减少剂量或停用抗抑郁药后的典型症状包括头晕、嗜睡、头痛、流感样症状、过度觉醒、失衡、失眠、易怒和恶心。还可能出现与潜在精神障碍相关的反跳、复发或再发。突然停用抗抑郁药后出现强迫症状（OCS）的情况尚未见报道。在此，我们报告1例重度抑郁症患者在突然停用文拉法辛后出现OCS（强迫性自杀念头），且既往无强迫症病史。艾司西酞普兰治疗使OCS缓解。我们结合强迫症的病理生理学方面、本例症状的时间顺序以及药效学和药动学方面，讨论了突然停用文拉法辛与OCS发生之间可能的因果关系。我们的病例报告提示突然停用文拉法辛后可能出现强迫症状。
