Pecknold J C, Swinson R P, Kuch K, Lewis C P
McGill University, Montreal, Quebec, Canada.
Arch Gen Psychiatry. 1988 May;45(5):429-36. doi: 10.1001/archpsyc.1988.01800290043006.
Preliminary reports of discontinuation of alprazolam therapy in patients with panic disorder have revealed worsening of symptoms despite gradual withdrawal of medication. In this study, 126 patients with panic disorder and phobic avoidance received either alprazolam or placebo in doses of 2 to 10 mg daily for eight weeks. The medication was tapered over a period of four weeks, and patients were observed for another two weeks after all medication was discontinued. Sixty of the 63 alprazolam-treated patients and 49 of the 63 placebo-treated patients entered the taper and discontinuation study. After improvement in the active treatment period, the alprazolam-treated group had significant relapse between the first and last week of taper. However, during the second postdiscontinuation week, outcome scores were not significantly different from those of the placebo-treated group who did not deteriorate during taper. Twenty-seven percent of the alprazolam-treated group reported a rebound of panic attacks during taper and 13% reported a rebound of anxiety on the Hamilton Anxiety Scale. No serious or life-threatening withdrawal symptoms were reported, but distinct, transient, mild to moderate withdrawal syndrome occurred in 35% of the alprazolam-treated group and in none of the placebo-treated group. The coexistence of symptom rebound and a withdrawal syndrome occurred in 10% of the alprazolam-treated group, but both subsided by the end of the second week without alprazolam. We recommend that patients with panic disorder be treated for a longer period, at least six months, and that medication be tapered over a more prolonged period, at least eight weeks, especially where high doses are employed.
关于惊恐障碍患者停用阿普唑仑治疗的初步报告显示，尽管药物是逐渐减量停用的，但症状仍出现了恶化。在本研究中，126例伴有恐惧回避的惊恐障碍患者接受了阿普唑仑或安慰剂治疗，剂量为每日2至10毫克，为期8周。药物在4周内逐渐减量，在所有药物停用后，对患者又观察了2周。63例接受阿普唑仑治疗的患者中有60例以及63例接受安慰剂治疗的患者中有49例进入了减量和停药研究。在积极治疗期症状改善后，阿普唑仑治疗组在减量的第一周和最后一周之间出现了显著复发。然而，在停药后的第二周，结果评分与在减量期间未恶化的安慰剂治疗组没有显著差异。27%的阿普唑仑治疗组患者在减量期间报告惊恐发作反弹，13%的患者在汉密尔顿焦虑量表上报告焦虑反弹。未报告严重或危及生命的戒断症状，但35%的阿普唑仑治疗组出现了明显、短暂、轻度至中度的戒断综合征，而安慰剂治疗组未出现。10%的阿普唑仑治疗组同时出现了症状反弹和戒断综合征，但在第二周结束时，在未服用阿普唑仑的情况下，两者均消退。我们建议，惊恐障碍患者应接受更长时间的治疗，至少6个月，并且药物减量应在更长的时间内进行，至少8周，尤其是在使用高剂量药物的情况下。
