Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up
Impact of antidepressant discontinuation after acute bipolar depression remission on rates of depressive relapse at 1-year follow-up
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DOI：
10.1176/appi.ajp.160.7.1252
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发表时间：
2003-07-01
影响因子：
17.7
通讯作者：
Post, R
中科院分区：
文献类型：
--
作者：
Altshuler, L;Suppes, T;Post, R
目的：虽然治疗双相抑郁症患者的指南建议在缓解后6个月内停用抗抑郁药，但很少有研究评估这种策略对抑郁症复发风险的影响。本研究探讨了在双相情感障碍患者中，停用或继续使用抗抑郁药对急性抑郁发作成功治疗后抑郁复发风险的影响。84例双相情感障碍受试者在持续的情绪稳定剂治疗方案中加入抗抑郁药后抑郁发作缓解，前瞻性随访1年。43例缓解后6个月内停用抗抑郁药的受试者抑郁复发的风险（“停药组”）与41名继续服用抗抑郁药超过6个月的受试者的风险进行了比较（“延续组”）。结果：一项考克斯比例风险回归分析表明，成功治疗后较短的抗抑郁药暴露时间与抑郁复发此外，在缓解后的前6个月内停止抗抑郁药治疗的患者在1年随访期间抑郁复发前的心境正常期显著缩短。成功的抗抑郁药反应后一年，70%的抗抑郁药停药组经历了抑郁复发，而36%的继续治疗组。由1年的随访评估，15（18%）的84例受试者经历了躁狂复发，只有6个这些受试者正在服用抗抑郁药的时候躁狂revolution.Conclusions：抑郁症复发的风险与双相情感障碍患者缓解后不久停止抗抑郁药显着相关。躁狂复发的风险与持续使用抗抑郁药物无显著相关性，总体而言，显著低于抑郁复发的风险。在某些双相情感障碍患者中，维持抗抑郁治疗联合心境稳定剂可能是必要的。
Objective: While guidelines for treating patients with bipolar depression recommend discontinuing antidepressants within 6 months after remission, few studies have assessed the implications of this strategy on the risk for depressive relapse. This study examined the effect of antidepressant discontinuation or continuation on depressive relapse risk among bipolar subjects successfully treated for an acute depressive episode.Method. Eighty-four subjects with bipolar disorder who achieved remission from a depressive episode with the addition of an antidepressant to an ongoing mood stabilizer regimen were followed prospectively for 1 year. The risk of depressive relapse among 43 subjects who stopped antidepressant treatment within 6 months after remission ("discontinuation group") was compared with the risk among 41 subjects who continued taking antidepressants beyond 6 months ("continuation group").Results: A Cox proportional hazards regression analysis indicated that shorter antidepressant exposure time following successful treatment was associated with a significantly shorter time to depressive relapse. Furthermore, patients who discontinued antidepressant, treatment within the first 6 months after remission experienced a significantly shorter period of euthymia before depressive relapse over the length of 1-year follow-up. one year after successful antidepressant response, 70% of the antidepressant discontinuation group experienced a depressive relapse compared with 36% of the continuation group. By the 1-year follow-up evaluation, 15 (18%) of the 84 subjects had experienced a manic relapse; only six of these subjects were taking an antidepressant at the time of manic relapse.Conclusions: The risk of depressive relapse in patients with bipolar illness was significantly associated with discontinuing antidepressants soon after remission. The risk of manic relapse was not significantly associated with continuing use of antidepressant medication and, overall, was substantially less than the risk of depressive relapse. Maintenance of antidepressant treatment in combination with a mood stabilizer may be warranted in some patients with bipolar disorder.