Serotonin reuptake inhibitor withdrawal
Serotonin reuptake inhibitor withdrawal
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DOI：
10.1097/00004714-199610000-00003
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发表时间：
1996-10-01
影响因子：
2.9
通讯作者：
Potokar, JP
中科院分区：
文献类型：
--
作者：
Coupland, NJ;Bell, CJ;Potokar, JP
我们对 352 名在门诊接受非选择性血清素再摄取抑制剂氯米帕明或选择性血清素再摄取抑制剂 (SSRI) 之一、氟西汀、氟伏沙明、帕罗西汀或舍曲林治疗的患者进行回顾性图表审查，研究了报告的戒断症状。在服药逐渐减量和停药期间接受监督的 171 名患者中，最常见的症状是头晕、嗜睡、感觉异常、恶心、生动的梦、烦躁和情绪低落。当将至少一种新症状的患者定义为病例时，与服用半衰期较长的 SSRI 之一舍曲林或氟西汀 (1.5%) 的患者相比，接受过半衰期较短的 SSRI 之一氟伏沙明或帕罗西汀 (17.2%) 或氯米帕明 (30.8%) 治疗的患者出现这些症状的频率明显更高。不同的较短半衰期治疗之间的比率没有显着差异。使用氟伏沙明或帕罗西汀治疗的病例接受的治疗时间（中位 28 周）明显长于非病例（16 周），但与年龄或诊断分组没有显着相关性。有一种与男性相关的趋势。尽管缓慢减量停药，大多数病例还是发生，症状在发病后持续长达 21 天（平均 = 11.8 天）。重新开始用药后，这些症状在 24 小时内得到缓解，但苯二氮卓类药物或吗氯贝胺并未缓解。有人提出血清素在协调感觉和自主功能与运动活动方面的作用。我们认为这可能会导致关于血清素再摄取抑制剂戒断症状的病理生理学的有用假设。
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.