Groot Peter C, van Os Jim
Department of Psychiatry, University Medical Centre Utrecht, Postbus 85500, Utrecht, 3508 GA, The Netherlands.
User Research Centre Netherlands, UMC Utrecht Brain Centre, University Medical Centre Utrecht, Utrecht, The Netherlands.
Ther Adv Psychopharmacol. 2020 Sep 2;10:2045125320954609. doi: 10.1177/2045125320954609. eCollection 2020.
Stopping antidepressants is often difficult due to withdrawal. Taperingstrips were developed to facilitate antidepressant discontinuation according to the recently described Horowitz-Taylor method, allowing for personalised titration of discontinuation to the intensity of withdrawal. A taperingstrip consists of antidepressant or other medication, packaged in a 28-day roll of small daily pouches, each with the same or slightly lower dose than the one before it. We previously reported that the short-term success rate of antidepressant taperingstrips was 71%. Here, we examine longer-term outcome after 1-5 years.
Patients whose doctor had ordered taperingstrips between January 2015 and December 2019 were sent a questionnaire for participation in anonymised research in January 2020. Of 1012, 483 participated, of whom 408 (85%) had attempted antidepressant tapering.
Of the 408 patients included, 192 (47%) had used strips for tapering venlafaxine, 142 (35%) for paroxetine and 74 (18%) for other antidepressants. Median length of antidepressant use was 4 years, and most (61%) had tried to come off without taperingstrips at least once. After 1-5 years, 270 patients (66%) remained off antidepressants after tapering their antidepressant, 6 (2%) had successfully reduced their medication, 87 (21%) had restarted due to (self-reported) relapse, 35 had restarted for another indication (9%), and 10 (3%) reported another outcome. People with more severe experience of withdrawal prior to tapering, and people who had been on antidepressants for a shorter period of time, were more likely to remain off medication after 1-5 years.
The previously reported 71% short-term success rate of taperingstrips in the most severely affected group, was matched by a 68% rate after 1-5 years. The evidence-based approach of personal tapering to counter withdrawal, as used for drugs causing withdrawal, for example, benzodiazepines, may represent a simple solution for an important antidepressant-related public health problem, without extra costs.
由于停药反应，停用抗抑郁药物往往很困难。减量条是根据最近描述的霍洛维茨 - 泰勒方法开发的，用于促进抗抑郁药物的停用，允许根据停药反应的强度进行个性化的减量滴定。减量条由抗抑郁药或其他药物组成，包装在一个28天的小药包卷中，每个药包的剂量与前一个相同或略低。我们之前报道抗抑郁药物减量条的短期成功率为71%。在此，我们研究1至5年后的长期结果。
2020年1月，向2015年1月至2019年12月期间医生开了减量条的患者发送问卷，邀请他们参与匿名研究。1012名患者中，483名参与，其中408名（85%）曾尝试使用减量条逐渐停用抗抑郁药物。
纳入的408名患者中，192名（47%）使用减量条逐渐停用文拉法辛，142名（35%）使用减量条逐渐停用帕罗西汀，74名（18%）使用减量条逐渐停用其他抗抑郁药物。抗抑郁药物使用的中位时长为4年，大多数（61%）患者至少有一次未使用减量条尝试停药。1至5年后，270名患者（66%）在逐渐停用抗抑郁药物后未再服用，6名（2%）成功减少了用药量，87名（21%）因（自我报告的）复发而重新开始用药，35名（9%）因其他指征重新开始用药，10名（3%）报告了其他结果。在逐渐减量前停药反应较严重的患者，以及服用抗抑郁药物时间较短的患者，在1至5年后更有可能不再用药。
之前报道的在受影响最严重的群体中减量条71%的短期成功率，在1至5年后为68%。像用于导致停药反应的药物（如苯二氮䓬类药物）那样，采用基于证据的个性化减量方法来应对停药反应，可以成为解决一个与抗抑郁药物相关的重要公共卫生问题的简单方案，且无需额外费用。
