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