Coupland N J, Bell C J, Potokar J P
Department of Psychiatry, University of Alberta, Edmonton, Canada.
J Clin Psychopharmacol. 1996 Oct;16(5):356-62. doi: 10.1097/00004714-199610000-00003.
We studied reported withdrawal symptoms in a retrospective chart review of 352 patients treated in an outpatient clinic with the nonselective serotonin reuptake inhibitor clomipramine or with one of the selective serotonin reuptake inhibitors (SSRIs), fluoxetine, fluvoxamine, paroxetine, or sertraline. In 171 patients who were supervised during medication tapering and discontinuation, the most common symptoms were dizziness, lethargy, paresthesia, nausea, vivid dreams, irritability, and lowered mood. When patients with at least one qualitatively new symptom were defined as cases, these symptoms occurred significantly more frequently in patients who had been treated either with one of the shorter half-life SSRIs, fluvoxamine or paroxetine (17.2%), or with clomipramine (30.8%), than in patients taking one of the SSRIs with longer half-life metabolites, sertraline or fluoxetine (1.5%). The rate was not significantly different between the different shorter half-life treatments. Cases treated with fluvoxamine or paroxetine had received a significantly longer period of treatment (median 28 weeks) than noncases (16 weeks), but there were no significant associations with age or with diagnostic grouping. There was a trend toward an association with male sex. The majority of cases occurred despite slowly tapered withdrawal. Symptoms persisted for up to 21 days (mean = 11.8 days) after onset. These symptoms were relieved within 24 hours by restarting the medication, but were not relieved by benzodiazepines or by moclobemide. A role has been suggested for serotonin in coordinating sensory and autonomic function with motor activity. We suggest that this may lead to useful hypotheses about the pathophysiology of withdrawal symptoms from serotonin reuptake inhibitors.
我们在一项回顾性病历审查中研究了报告的戒断症状，该审查涉及在门诊诊所接受非选择性5-羟色胺再摄取抑制剂氯米帕明或选择性5-羟色胺再摄取抑制剂（SSRI）之一（氟西汀、氟伏沙明、帕罗西汀或舍曲林）治疗的352例患者。在171例在药物逐渐减量和停药期间受到监测的患者中，最常见的症状是头晕、嗜睡、感觉异常、恶心、生动梦境、易怒和情绪低落。当将至少有一种定性新症状的患者定义为病例时，这些症状在接受半衰期较短的SSRI之一（氟伏沙明或帕罗西汀，17.2%）或氯米帕明（30.8%）治疗的患者中出现的频率明显高于服用半衰期代谢物较长的SSRI之一（舍曲林或氟西汀，1.5%）的患者。不同半衰期较短的治疗之间的发生率没有显著差异。接受氟伏沙明或帕罗西汀治疗的病例接受治疗的时间（中位数28周）明显长于非病例（16周），但与年龄或诊断分组没有显著关联。存在与男性相关的趋势。尽管逐渐缓慢停药，但大多数病例仍会出现。症状在发作后持续长达21天（平均=11.8天）。通过重新开始用药，这些症状在24小时内得到缓解，但苯二氮䓬类药物或吗氯贝胺无法缓解。有人提出5-羟色胺在协调感觉和自主功能与运动活动方面发挥作用。我们认为，这可能会产生关于5-羟色胺再摄取抑制剂戒断症状病理生理学的有用假设。
