Relapse of vasomotor symptoms after discontinuation of the selective serotonin reuptake inhibitor escitalopram: results from the menopause strategies: finding lasting answers for symptoms and health research network.
Relapse of vasomotor symptoms after discontinuation of the selective serotonin reuptake inhibitor escitalopram: results from the menopause strategies: finding lasting answers for symptoms and health research network.
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停用选择性血清素再摄取抑制剂艾司西酞普兰后血管舒缩症状复发：更年期策略的结果：寻找症状和健康研究网络的持久答案。
DOI：
10.1097/gme.0b013e31826d3108
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Freeman,EllenW
中科院分区：
文献类型：
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作者：
Joffe,Hadine;Guthrie,KatherineA;Larson,Joseph;Cohen,LeeS;Carpenter,JanetS;Lacroix,AndreaZ;Freeman,EllenW
目的探讨血管舒缩症状（VMS）在停止激素治疗后复发的原因。选择性5 -羟色胺再摄取抑制剂（SSRIs）越来越多地用于治疗VMS，但停止SSRI后VMS是否复发尚不清楚。我们假设停用SSRI后VMS复发至基线水平是常见的，并可通过绝经期和心理特征预测。方法：在一项为期8周的随机、安慰剂对照试验中，研究人员对伴有潮热和盗汗的围绝经期/绝经后妇女停用艾司西酞普兰3周后，用每日日记记录VMS的复发情况（频率、严重程度和困扰）。工作人员和参与者的盲视一直保持着。复发定义为平均每日VMS频率、严重程度或麻烦比预处理水平低20%或更低。结果在76、57和51名女性中，分别有34.2%、38.6%和37.3%的女性VMS复发频率、严重程度和麻烦。在调整后的模型中，较高水平的预处理失眠症状（P= 0.02）和较弱的艾司西酞普兰反应（P= 0.03）可预测VMS频率复发。结论：在使用艾司西酞普兰后VMS得到改善的女性中，大约三分之一在停药后迅速复发。那些有预处理失眠症和对艾司西酞普兰反应较弱的患者在停药后VMS复发的风险最大。女性在接受短期治疗后停止服用ssri类药物，应被告知VMS症状复发的可能性。
ObjectiveVasomotor symptoms (VMS) recur after discontinuation of hormonal therapy. Selective serotonin reuptake inhibitors (SSRIs) are used increasingly to treat VMS, but whether VMS recur after cessation of SSRI is unknown. We hypothesized that relapse of VMS to baseline levels after SSRI cessation would be common and predicted by menopausal and psychological characteristics.MethodsRecurrence of VMS (frequency, severity, and bother) was measured with daily diaries for 3 weeks after cessation of escitalopram, which was administered to perimenopausal/postmenopausal women with hot flashes and night sweats in an 8-week randomized, placebo-controlled trial. Blinding of staff and participants was maintained throughout. Relapse was defined as mean daily VMS frequency, severity, or bother 20% or less lower than pretreatment levels.ResultsOf 76, 57, and 51 women included in the analysis for VMS frequency, severity, and bother, 34.2%, 38.6%, and 37.3%, respectively, had relapse of VMS frequency, severity, and bother. In adjusted models, VMS frequency relapse was predicted by higher levels of pretreatment insomnia symptoms (P= 0.02) and a weaker response to escitalopram (P= 0.03).ConclusionsAmong women whose VMS improved with escitalopram, approximately one third relapsed swiftly after discontinuation of the medication. Those with pretreatment insomnia and those with a weaker response to escitalopram may be at greatest risk for VMS relapse after treatment discontinuation. Women should be educated about the likelihood of VMS symptom relapse when they discontinue SSRIs after receiving benefits from short-term treatment.