Mandos L A, Rickels K, Cutler N, Roeschen J, Keppel Hesselink J M, Schweizer E
Philadelphia College of Pharmacy and Science, PA, USA.
Int Clin Psychopharmacol. 1995 Nov;10(4):251-6. doi: 10.1097/00004850-199511000-00007.
One hundred and sixty patients (mean age 39.8 years; 67% female) diagnosed with generalized anxiety disorder (GAD) who had completed a prospective, 8 week, double-blind comparison of lorazepam (mean daily dose 4.2 mg) and ipsapirone (mean daily dose 19.5 mg) were rapidly tapered by a substitution of half-strength medication for 3 days, then substitution of matched placebo for an additional 11 days. Patients treated with ipsapirone showed no rebound anxiety on discontinuation, nor any other significant increase in withdrawal symptomatology compared to patients who had been prospectively treated with placebo. In contrast, patients treated with lorazepam showed significant emergent anxiety and/or withdrawal-related symptomatology by almost all clinical measures employed. Overall, 25% of patients treated with lorazepam showed rebound anxiety, and 40% of them utilized reserve medication because they found drug discontinuation to be intolerable. The clinical implications for discontinuation of benzodiazepines after short-term therapy are discussed.
160例被诊断为广泛性焦虑症（GAD）的患者（平均年龄39.8岁；67%为女性）完成了一项前瞻性、为期8周的氯硝西泮（平均每日剂量4.2毫克）和伊沙匹隆（平均每日剂量19.5毫克）双盲对照试验，通过用半量药物替代3天，然后用匹配的安慰剂再替代11天来快速减药。与前瞻性接受安慰剂治疗的患者相比，接受伊沙匹隆治疗的患者停药时未出现反跳性焦虑，戒断症状也未出现任何其他显著增加。相比之下，几乎所有采用临床指标衡量，接受氯硝西泮治疗的患者都出现了显著的急性焦虑和/或与戒断相关的症状。总体而言，接受氯硝西泮治疗的患者中有25%出现反跳性焦虑，其中40%的患者使用了备用药物，因为他们发现停药无法耐受。文中讨论了短期治疗后停用苯二氮䓬类药物的临床意义。
