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抗抑郁药停药导致潜在认知缺陷的对立耐受解释。

An Oppositional Tolerance Account for Potential Cognitive Deficits Caused by the Discontinuation of Antidepressant Drugs.

机构信息

Cognitive Neurophysiology, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.

Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr University Bochum, Bochum, Germany.

出版信息

Pharmacopsychiatry. 2021 Nov;54(6):252-260. doi: 10.1055/a-1520-4784. Epub 2021 Jul 22.


DOI:10.1055/a-1520-4784
PMID:34293810
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8575552/
Abstract

Depression is the leading cause of disability worldwide, making antidepressant drugs the most used psychiatric drugs in the USA. Withdrawal effects and rebound symptoms frequently occur after the reduction and/or discontinuation of these drugs. Although these phenomena have been investigated with respect to the clinical symptomatology, no studies have systematically investigated the effects of withdrawal/rebound on general cognition. We present a novel framework based on the idea of allostatic adaptation, which allows to predict how different antidepressants likely impair different cognitive processes as a result of withdrawal and rebound effects. This framework relies on the assumptions that the type of cognitive impairments evoked by an antidepressant is determined by the targeted neurotransmitter systems, while the severity of deficits depends on its half-life. Our model predicts that the severity of detrimental cognitive withdrawal and rebound effects increases with a shorter half-life of the discontinued antidepressant drug. It further proposes drug-specific effects: antidepressants mainly targeting serotonin should primarily impair aversive and emotional processing, those targeting norepinephrine should impair the processing of alerting signals, those targeting dopamine should impair motivational processes and reward processing, and those targeting acetylcholine should impair spatial learning and memory. We hope that this framework will motivate further research to better understand and explain cognitive changes as a consequence of antidepressant discontinuation.

摘要

抑郁症是全球范围内导致残疾的主要原因,这使得抗抑郁药成为美国使用最广泛的精神科药物。这些药物在减少和/或停药后,常常会出现戒断效应和反弹症状。尽管已经针对这些药物的临床症状进行了研究,但没有研究系统地调查戒断/反弹对一般认知的影响。我们提出了一个新的框架,基于适应的动态平衡的概念,该框架可以预测不同的抗抑郁药如何由于戒断和反弹效应而可能损害不同的认知过程。该框架基于以下假设:抗抑郁药引起的认知损伤类型取决于靶向的神经递质系统,而缺陷的严重程度取决于其半衰期。我们的模型预测,停止使用的抗抑郁药半衰期越短,有害的认知戒断和反弹效应的严重程度就越高。它进一步提出了药物特异性效应:主要靶向 5-羟色胺的抗抑郁药应主要损害厌恶和情绪处理,主要靶向去甲肾上腺素的抗抑郁药应损害警戒信号的处理,主要靶向多巴胺的抗抑郁药应损害动机过程和奖励处理,主要靶向乙酰胆碱的抗抑郁药应损害空间学习和记忆。我们希望这个框架将激发进一步的研究,以更好地理解和解释抗抑郁药停药后认知变化的原因。

相似文献

[1]
An Oppositional Tolerance Account for Potential Cognitive Deficits Caused by the Discontinuation of Antidepressant Drugs.

Pharmacopsychiatry. 2021-11

[2]
Understanding and Managing Withdrawal Syndromes After Discontinuation of Antidepressant Drugs.

J Clin Psychiatry. 2019-11-26

[3]
Antidepressant Withdrawal and Rebound Phenomena.

Dtsch Arztebl Int. 2019-5-17

[4]
[Antidepressant discontinuation syndrome in clinical and laboratory studies--implications for clinicians and patients].

Psychiatr Pol. 2009

[5]
Antidepressant withdrawal reactions.

Am Fam Physician. 1997-8

[6]
Physiologic mechanisms underlying the antidepressant discontinuation syndrome.

J Clin Psychiatry. 2006

[7]
Antidepressant discontinuation syndrome: A state-of-the-art clinical review.

Eur Neuropsychopharmacol. 2023-1

[8]
Possible biological mechanisms of the serotonin reuptake inhibitor discontinuation syndrome. Discontinuation Consensus Panel.

J Clin Psychiatry. 1997

[9]
[Discontinuation syndrome associated with antidepressants].

Rev Med Liege. 2007-10

[10]
Other Antidepressants.

Handb Exp Pharmacol. 2019

本文引用的文献

[1]
Depressive and Anxiety Symptoms Among People Under Quarantine During the COVID-19 Epidemic in China: A Cross-Sectional Study.

Front Psychiatry. 2021-2-15

[2]
A Survey of Psychological Distress Among the Community in the COVID-19 Epidemic: A Cross-Sectional Study.

Adv Exp Med Biol. 2021

[3]
Psychological Impact of Corona Lockdown in Germany: Changes in Need Satisfaction, Well-Being, Anxiety, and Depression.

Int J Environ Res Public Health. 2020-12-5

[4]
The 'patient voice': patients who experience antidepressant withdrawal symptoms are often dismissed, or misdiagnosed with relapse, or a new medical condition.

Ther Adv Psychopharmacol. 2020-11-9

[5]
Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany.

Psychiatry Res. 2020-9-18

[6]
Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020.

MMWR Morb Mortal Wkly Rep. 2020-8-14

[7]
Covid-19-Beyond virology: Potentials for maintaining mental health during lockdown.

PLoS One. 2020-8-4

[8]
Procognitive Effects of Antidepressants and Other Therapeutic Agents in Major Depressive Disorder: A Systematic Review.

J Clin Psychiatry. 2020-7-21

[9]
Adjunctive vortioxetine for SSRI-resistant major depressive disorder: a "real-world" chart review study.

Braz J Psychiatry. 2020-3-9

[10]
Computational Mechanisms of Effort and Reward Decisions in Patients With Depression and Their Association With Relapse After Antidepressant Discontinuation.

JAMA Psychiatry. 2020-5-1

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