Removing the Rose-Tinted Glasses: The effects of antidepressant drug withdrawal on mood and neurocognitive function

摘掉玫瑰色眼镜：抗抑郁药物戒断对情绪和神经认知功能的影响

• 批准号: 2381093
• 金额: --
• 依托单位: University of Bath
• 依托单位国家: 英国
• 项目类别: Studentship
• 财政年份: 2020
• 资助国家: 英国
• 起止时间: 2020 至 无数据
• 项目状态: 已结题
• 来源: https://gtr.ukri.org/projects?ref=studentship-2381093
• 关键词: Removing; Rose; Tinted; Glasses; effects

Depression is among the most common and costly mental health conditions in the UK with over 70 million prescriptions for antidepressants, such as SSRIs, in 2018 alone. Indeed, the number of prescriptions has doubled in the past decade. Many individuals are on antidepressants for a sustained period of time which is not ideal given their negative side effects, such as nausea, insomnia and sexual dysfunction. The cost to the NHS is also substantial. It is estimated that >50% of patients can safely withdraw from medication but it is currently difficult to predict which patients can stop taking SSRIs and which cannot (risk of relapse). Thus, finding ways of distinguishing between transient withdrawal effects and indicators of depressive relapse is vital in improving patient outcomes and potentially reducing the burden on the NHS.Biases in emotion processing and emotion dysregulation have consistently been observed in depression. Research has demonstrated a role of negatively-biased emotion processing in the development of depressive symptoms and has suggested that antidepressants work by targeting these negative biases. Such effects occur within hours or days after starting treatment, potentially leading to increases in positive mood over the course of weeks. However, whilst these changes are well-documented, little is known about the effects of antidepressant withdrawal on emotion processing and mood. Is there a re-establishment of low-level negative biases in emotion processing during withdrawal and does the re-emergence of emotional biases or dysregulation predict later mood disturbances or depressive relapse? This information might be key as early changes in emotion processing, after SSRI withdrawal, may serve as warning signs of relapse.The project's aims are twofold, firstly to characterise mood and emotion processing changes associated with withdrawal over time in order to better understand the effects of antidepressant withdrawal and their time course. Secondly, to enable the identification of early markers of symptom and mood changes that might aid in predicting depressive relapse. To address these aims, we will study primary care patients. The project will involve a novel combination of experience sampling, network analyses and neurocognitive testing (focusing on emotion processing).We will combine research methods to provide new insights and an in-depth understanding of antidepressant withdrawal effects. The project will be relevant to researchers, clinicians, patients taking SSRIs, NHS commissioners and policy makers. From a scientific perspective, emotion processing changes occurring after antidepressant withdrawal will be characterised, which could inform and potentially modify theories of antidepressant action. Whereas from a clinical perspective, characterising mood changes and other withdrawal symptoms and the associated network analysis will inform antidepressant withdrawal management. The project spans ESRC and MRC priorities and has the potential to lead to methodological innovations that will be relevant to a wide audience of social scientists. We hope the project will identify early markers of depressive relapse that can be targeted specifically to prevent relapse (while also helping those who can withdraw safely to do so). This research is urgently needed to help patients withdraw from antidepressants safely and effectively, and to reduce the personal, societal and economic costs of sustained antidepressant use.Specialist training in Aberdeen and Amsterdam may be sought.

抑郁症是英国最常见和最昂贵的心理健康疾病之一，仅在2018年就有超过7000万张抗抑郁药处方，如SSRIs。事实上，处方数量在过去十年中翻了一番。许多人持续服用抗抑郁药一段时间，考虑到它们的负面副作用，如恶心，失眠和性功能障碍，这并不理想。NHS的成本也很高。据估计，>50%的患者可以安全地停用药物，但目前很难预测哪些患者可以停止服用SSRIs，哪些不能（复发风险）。因此，寻找方法来区分短暂的戒断效应和抑郁症复发的指标是至关重要的，在改善患者的结果，并可能减少负担的NHS。偏见的情绪处理和情绪失调一直被观察到抑郁症。研究已经证明了消极偏见的情绪处理在抑郁症状的发展中的作用，并表明抗抑郁药通过针对这些消极偏见而起作用。这种效果在开始治疗后的几小时或几天内发生，可能会在几周内导致积极情绪的增加。然而，虽然这些变化是有据可查的，但人们对抗抑郁药戒断对情绪处理和情绪的影响知之甚少。在戒断过程中，在情绪处理中是否重新建立了低水平的负面偏见？情绪偏见或失调的重新出现是否预示着后来的情绪障碍或抑郁复发？这些信息可能是关键，因为在SSRI停药后，情绪处理的早期变化可能是复发的警告信号。该项目的目的是双重的，首先是观察随着时间的推移与停药相关的情绪和情绪处理变化，以便更好地了解抗抑郁药停药的影响及其时间过程。其次，能够识别可能有助于预测抑郁症复发的症状和情绪变化的早期标志物。为了实现这些目标，我们将研究初级保健患者。该项目将涉及经验采样，网络分析和神经认知测试（专注于情绪处理）的新颖组合。我们将联合收割机研究方法相结合，以提供新的见解和深入了解抗抑郁药戒断效应。该项目将与研究人员、临床医生、服用SSRIs的患者、NHS专员和政策制定者有关。从科学的角度来看，抗抑郁药停药后发生的情绪处理变化将被描述，这可能会告知并可能修改抗抑郁药作用的理论。而从临床角度来看，描述情绪变化和其他戒断症状以及相关的网络分析将为抗抑郁药戒断管理提供信息。该项目涵盖了ESRC和MRC的优先事项，并有可能导致与社会科学家广泛受众相关的方法创新。我们希望该项目将确定抑郁症复发的早期标志物，可以专门针对预防复发（同时也帮助那些可以安全退出的人这样做）。这项研究是迫切需要的，以帮助患者安全有效地退出抗抑郁药，并减少持续使用抗抑郁药的个人，社会和经济成本。