J Psychiatr Pract. 2021 Sep 16;27(5):361-371. doi: 10.1097/PRA.0000000000000578.
Selective serotonin reuptake inhibitors (SSRIs) are among the most commonly prescribed medications. They are among the first-line medications for several chronic or relapsing-remitting psychiatric conditions, including major depressive disorder and anxiety disorders. The advantages of SSRI use include ease of titration and their tolerability and safety profile. Guidelines for the short-term use of SSRIs are widely available, but there is no well-organized guidance on how and whether to maintain a patient on SSRIs for the long-term. In this article, we discuss the benefits and possible adverse consequences of long-term SSRI use, as well as clinical practice considerations when using SSRIs chronically. The major benefit of long-term SSRI use is relapse prevention. The current literature suggests that the general health risks of long-term SSRI use are low; however, further research, particularly in special populations including youth and the elderly, is needed. Long-term SSRI use increases the risk of tachyphylaxis and discontinuation syndrome. Recognizing that many patients may remain on SSRIs for many years, there are several factors that prescribers should consider if they choose to use an SSRI when initiating treatment and during long-term monitoring. The decision to continue or to discontinue an SSRI should be an active one, involving both the patient and prescriber, and should be revisited periodically. Patients who remain on SSRIs for the long-term should also have periodic monitoring to reassess the risk-benefit ratio of remaining on the SSRI, as well as to assess the safety, tolerability, and efficacy of the medication.
选择性 5-羟色胺再摄取抑制剂（SSRIs）是最常用的药物之一。它们是几种慢性或复发性精神疾病的一线药物，包括重度抑郁症和焦虑症。SSRIs 的使用优势包括易于滴定以及其耐受性和安全性。短期使用 SSRIs 的指南广泛可用，但对于如何以及是否长期维持患者使用 SSRIs 缺乏良好组织的指导。在本文中，我们讨论了长期使用 SSRIs 的益处和可能的不良后果，以及慢性使用 SSRIs 时的临床实践注意事项。长期使用 SSRIs 的主要益处是预防复发。目前的文献表明，长期使用 SSRIs 的一般健康风险较低；然而，需要进一步的研究，特别是在包括青少年和老年人在内的特殊人群中。长期使用 SSRIs 会增加产生快速耐受和停药综合征的风险。认识到许多患者可能会长期使用 SSRIs，因此，如果在开始治疗和长期监测期间选择使用 SSRIs，医生应该考虑一些因素。继续或停止使用 SSRIs 的决定应该是积极的，涉及患者和医生，并应定期重新评估。长期使用 SSRIs 的患者还应定期进行监测，以重新评估继续使用 SSRIs 的风险-效益比，以及评估药物的安全性、耐受性和疗效。
