Rennwald Andri, Hengartner Michael P
School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland.
Department of Applied Psychology, Kalaidos University of Applied Scieces, Zurich, Switzerland.
Epidemiol Psychiatr Sci. 2025 May 13;34:e29. doi: 10.1017/S204579602500023X.
The literature on persistent antidepressant withdrawal symptoms is sparse. This systematic review is the first to examine the prevalence, duration, severity, risk/protective factors and treatment strategies for post-acute withdrawal syndrome (PAWS) following the discontinuation of antidepressant medications.
We searched PubMed, Web of Science and PsycInfo, focusing on newer-generation antidepressants. The electronic database search was complemented with handsearching reference lists of pivotal studies. We included original studies in adults reporting on PAWS and providing data about epidemiology and clinical management of withdrawal symptoms persisting for at least 6 weeks.
The literature search yielded 1286 results, with 26 records assessed for eligibility, and seven studies fulfilled our selection criteria. Prevalence data were sparse, with one small cohort study reporting a 15% prevalence rate for PAWS in patients with panic disorder and agoraphobia. The duration of PAWS varied considerably across studies, ranging from 1.5 to 166 months. Long-term paroxetine use emerged as a potential risk factor for the development of PAWS. There was no reliable evidence to support the effectiveness of various treatment strategies, including the reinstatement of antidepressant medication, the use of benzodiazepines and the provision of cognitive-behavioral therapy.
The current evidence on PAWS is sparse and predominantly of low certainty. The presence of withdrawal symptoms, lasting several months and possibly even years in some patients, underscores the need for further research with rigorous methodology. Large prospective cohort studies are needed to assess the epidemiology of PAWS, while randomized controlled trials are quired to test the efficacy of clinical interventions to treat PAWS.
CRD42023461793.
关于持续性抗抑郁药戒断症状的文献稀少。本系统评价首次探讨了抗抑郁药物停用后急性戒断综合征（PAWS）的患病率、持续时间、严重程度、风险/保护因素及治疗策略。
我们检索了PubMed、科学网和PsycInfo，重点关注新一代抗抑郁药。电子数据库检索辅以关键研究参考文献列表的手工检索。我们纳入了关于PAWS的成人原始研究，并提供了持续至少6周的戒断症状的流行病学和临床管理数据。
文献检索产生了1286条结果，评估了26条记录的 eligibility，7项研究符合我们的选择标准。患病率数据稀少，一项小型队列研究报告惊恐障碍和广场恐惧症患者中PAWS的患病率为15%。PAWS的持续时间在不同研究中差异很大，从1.5个月到166个月不等。长期使用帕罗西汀成为PAWS发生的潜在风险因素。没有可靠证据支持包括恢复使用抗抑郁药物、使用苯二氮䓬类药物和提供认知行为疗法在内的各种治疗策略的有效性。
目前关于PAWS的证据稀少且主要确定性较低。戒断症状的存在，在一些患者中持续数月甚至数年，凸显了采用严格方法进行进一步研究的必要性。需要大型前瞻性队列研究来评估PAWS的流行病学，同时需要随机对照试验来测试治疗PAWS的临床干预措施的疗效。
PROSPERO注册：CRD42023461793。
