Corral M, Sivertz K, Jones B D
Department of Psychiatry, UBC Health Sciences Centre Hospital, Vancouver.
Can J Psychiatry. 1987 Dec;32(9):764-7. doi: 10.1177/070674378703200906.
The development of hypomania, mania and transient mood elevation within 2-3 days of antidepressant discontinuation, and lasting days to several weeks has been reported in unipolar depressed patients. Imipramine and desipramine are the antidepressants most frequently associated with the above phenomena. A reported case of transient mood elevation following abrupt reduction but not discontinuation of desipramine therapy in a woman with unipolar depression is described. The phenomenon was observed and documented on two separate occasions. Mood elevation occurred despite decreased plasma levels of the drug. Relapse followed despite maintenance of dose and similar drug plasma levels. Factors which could account for the transitory improvement of mood are examined. It is suggested that the patient's improvement in mood may have occurred due to a rebound paradoxical therapeutic effect. The features of the presented case history which appear to support this hypothesis are discussed. Also the clinical implications of this phenomenon are reviewed.
据报道，单相抑郁症患者在停用抗抑郁药后的2至3天内会出现轻躁狂、躁狂和短暂的情绪高涨，并持续数天至数周。丙咪嗪和地昔帕明是最常与上述现象相关的抗抑郁药。本文描述了一例单相抑郁症女性患者在突然减少而非停用去甲丙咪嗪治疗后出现短暂情绪高涨的病例。该现象在两个不同的场合被观察和记录。尽管药物血浆水平下降，但仍出现了情绪高涨。尽管维持了剂量且药物血浆水平相似，但仍出现了复发。研究了可能导致情绪短暂改善的因素。有人认为，患者情绪的改善可能是由于反跳性矛盾治疗效应。讨论了所呈现病例史中似乎支持这一假设的特征。此外，还回顾了这一现象的临床意义。
