Department of Health Sciences, University of Florence, Florence, Italy,
Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands,
Psychother Psychosom. 2020;89(5):283-306. doi: 10.1159/000506868. Epub 2020 Apr 7.
Studies on psychotropic medications decrease, discontinuation, or switch have uncovered withdrawal syndromes. The present overview aimed at analyzing the literature to illustrate withdrawal after decrease, discontinuation, or switch of psychotropic medications based on the drug class (i.e., benzodiazepines, nonbenzodiazepine benzodiazepine receptor agonists, antidepressants, ketamine, antipsychotics, lithium, mood stabilizers) according to the diagnostic criteria of Chouinard and Chouinard [Psychother Psychosom. 2015;84(2):63-71], which encompass new withdrawal symptoms, rebound symptoms, and persistent post-withdrawal disorders. All these drugs may induce withdrawal syndromes and rebound upon discontinuation, even with slow tapering. However, only selective serotonin reuptake inhibitors, serotonin noradrenaline reuptake inhibitors, and antipsychotics were consistently also associated with persistent post-withdrawal disorders and potential high severity of symptoms, including alterations of clinical course, whereas the distress associated with benzodiazepines discontinuation appears to be short-lived. As a result, the common belief that benzodiazepines should be substituted by medications that cause less dependence such as antidepressants and antipsychotics runs counter the available literature. Ketamine, and probably its derivatives, may be classified as at high risk for dependence and addiction. Because of the lag phase that has taken place between the introduction of a drug into the market and the description of withdrawal symptoms, caution is needed with the use of newer antidepressants and antipsychotics. Within medication classes, alprazolam, lorazepam, triazolam, paroxetine, venlafaxine, fluphenazine, perphenazine, clozapine, and quetiapine are more likely to induce withdrawal. The likelihood of withdrawal manifestations that may be severe and persistent should thus be taken into account in clinical practice and also in children and adolescents.
关于精神药物减量、停药或换药后出现戒断综合征的研究已经揭示了这一问题。本综述旨在分析文献，根据药物类别（即苯二氮䓬类、非苯二氮䓬类苯二氮䓬受体激动剂、抗抑郁药、氯胺酮、抗精神病药、锂、心境稳定剂），按照 Chouinard 和 Chouinard [Psychother Psychosom. 2015;84(2):63-71]的诊断标准，说明精神药物减量、停药或换药后出现戒断的情况，该标准涵盖了新的戒断症状、反弹症状和持续的戒断后障碍。所有这些药物在停药时可能会出现戒断综合征和反弹，即使缓慢减量也是如此。然而，只有选择性 5-羟色胺再摄取抑制剂、5-羟色胺去甲肾上腺素再摄取抑制剂和抗精神病药与持续的戒断后障碍和潜在的高症状严重程度一致，包括临床病程的改变，而与苯二氮䓬类药物停药相关的痛苦似乎是短暂的。因此，用抗抑郁药和抗精神病药等依赖性较小的药物替代苯二氮䓬类药物的普遍看法与现有文献相悖。氯胺酮，可能还有其衍生物，可能被归类为高度依赖和成瘾的风险药物。由于药物引入市场与戒断症状描述之间存在滞后阶段，因此在使用新型抗抑郁药和抗精神病药时需要谨慎。在药物类别内，阿普唑仑、劳拉西泮、三唑仑、帕罗西汀、文拉法辛、氟奋乃静、奋乃静、氯氮平、喹硫平更有可能引起戒断。因此，在临床实践中，也应该在儿童和青少年中，考虑到可能严重和持续的戒断表现的可能性。
