Schatzberg A F, Haddad P, Kaplan E M, Lejoyeux M, Rosenbaum J F, Young A H, Zajecka J
Department of Psychiatry, Stanford University School of Medicine, Calif 94305, USA.
J Clin Psychiatry. 1997;58 Suppl 7:5-10.
Adverse events following discontinuation from serotonin reuptake inhibitors (SRIs) are being reported in the literature with increasing frequency; the frequency and severity of these symptoms appear to vary according to the half-life of the SRI, e.g., the incidence appears higher with the shorter half-life agents than with fluoxetine, which has an extended half-life. Yet, there have been no systematic studies of the phenomenon to date. Therefore, a group of experts convened in Phoenix, Arizona, to develop a clear description or definition of the phenomenon based on these reports. The SRI discontinuation syndrome, referred to as "withdrawal symptoms" in many anecdotal case reports, is distinctly different from the classic withdrawal syndrome associated with alcohol and barbiturates. Anti-depressants are not associated with dependence or drug-seeking behavior. SRI discontinuation symptoms tend to be short-lived and self-limiting, but can be troublesome. They may emerge when an SRI is abruptly discontinued, when doses are missed, and less frequently, during dosage reduction. In addition, the symptoms are not attributable to any other cause and can be reversed when the original agent is reinstituted, or one that is pharmacologically similar is substituted. SRI discontinuation symptoms, in most cases, may be minimized by slowly tapering antidepressant therapy, but there have been several case reports where symptoms occurred consistently even through repeated attempts to taper therapy. Physical symptoms include problems with balance, gastrointestinal and flu-like symptoms, and sensory and sleep disturbances. Psychological symptoms include anxiety and/or agitation, crying spells, and irritability. Further analyses of data bases and clinical studies are needed to define this proposed syndrome more clearly.
关于停用5-羟色胺再摄取抑制剂（SRIs）后出现不良事件的报道在文献中越来越频繁；这些症状的频率和严重程度似乎因SRIs的半衰期而异，例如，半衰期较短的药物出现不良事件的发生率似乎高于半衰期较长的氟西汀。然而，迄今为止尚未对该现象进行系统研究。因此，一组专家在亚利桑那州凤凰城召开会议，根据这些报告对该现象进行清晰的描述或定义。在许多轶事病例报告中被称为“戒断症状”的SRIs停药综合征，与与酒精和巴比妥类药物相关的经典戒断综合征明显不同。抗抑郁药与依赖性或觅药行为无关。SRIs停药症状往往是短暂的且会自行缓解，但可能会造成困扰。当突然停用SRIs、漏服剂量以及较少见的在减量过程中，症状可能会出现。此外，这些症状不能归因于任何其他原因，并且当重新使用原药物或替换为药理作用相似的药物时症状可以逆转。在大多数情况下，通过缓慢减少抗抑郁治疗可以将SRIs停药症状降至最低，但有几例病例报告显示，即使反复尝试逐渐减少治疗，症状仍持续出现。身体症状包括平衡问题、胃肠道症状和类似流感的症状，以及感觉和睡眠障碍。心理症状包括焦虑和/或激动、哭泣发作和易怒。需要对数据库和临床研究进行进一步分析，以更清楚地定义这一拟议的综合征。
