Rosenbaum J F, Fava M, Hoog S L, Ascroft R C, Krebs W B
Clinical Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
Biol Psychiatry. 1998 Jul 15;44(2):77-87. doi: 10.1016/s0006-3223(98)00126-7.
Recent reports describe discontinuation-emergent adverse events upon cessation of selective serotonin reuptake inhibitors including dizziness, insomnia, nervousness, nausea, and agitation. We hypothesized that interruption of fluoxetine treatment would be associated with fewer discontinuation-emergent adverse events than interruption of sertraline or paroxetine treatment, based on fluoxetine's longer half-life.
In this 4-week study, 242 patients with remitted depression receiving maintenance therapy with open-label fluoxetine, sertraline, or paroxetine for 4-24 months had their maintenance therapy interrupted with double-blind placebo substitution for 5-8 days. The Symptom Questionnaire (SQ), the Discontinuation-Emergent Signs and Symptoms checklist, the 28-item Hamilton Depression Rating Scale, and the Montgomery-Asberg Depression Rating Scale were used to assess somatic distress and stability of antidepressant response.
Two hundred twenty patients (91%) completed the study. Following interruption of therapy, fluoxetine-treated patients experienced fewer discontinuation-emergent events than either sertraline-treated or paroxetine-treated patients (p < .001). The mean SQ somatic symptom scale score in fluoxetine-treated patients was significantly lower than that in sertraline-treated and paroxetine-treated patients (p < .001). Fluoxetine-treated patients also experienced less reemergence of depressive symptoms than sertraline-treated or paroxetine-treated patients (p < .001).
Abrupt interruption of antidepressant therapy for 5-8 days was associated with the emergence of new somatic and psychological symptoms in patients treated with paroxetine and to a lesser degree sertraline, with few symptoms seen with fluoxetine.
近期报告描述了在停用选择性5-羟色胺再摄取抑制剂后出现的停药后突发不良事件，包括头晕、失眠、紧张、恶心和激动。基于氟西汀较长的半衰期，我们推测与舍曲林或帕罗西汀治疗中断相比，氟西汀治疗中断与较少的停药后突发不良事件相关。
在这项为期4周的研究中，242例接受开放标签氟西汀、舍曲林或帕罗西汀维持治疗4至24个月且抑郁症已缓解的患者，其维持治疗被双盲安慰剂替代中断5至8天。使用症状问卷（SQ）、停药后突发体征和症状清单、28项汉密尔顿抑郁量表和蒙哥马利-阿斯伯格抑郁量表来评估躯体不适和抗抑郁反应的稳定性。
220例患者（91%）完成了研究。治疗中断后，接受氟西汀治疗的患者比接受舍曲林或帕罗西汀治疗的患者经历的停药后突发事件更少（p < 0.001）。接受氟西汀治疗的患者的平均SQ躯体症状量表评分显著低于接受舍曲林和帕罗西汀治疗的患者（p < 0.001）。与接受舍曲林或帕罗西汀治疗的患者相比，接受氟西汀治疗的患者抑郁症状的复发也更少（p < 0.001）。
抗抑郁治疗突然中断5至8天与帕罗西汀治疗的患者出现新的躯体和心理症状相关，舍曲林治疗的患者相关程度较低，而氟西汀治疗的患者出现的症状较少。
