抗抑郁药戒断症状的发生率和危险因素:元分析和系统审查

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Mi-Mi Zhang^1,2, Xuan Tan^1,3, Yong-Bo Zheng^4,5

¹National Institute on Drug Dependence and Beijing Key Laboratory of Drug Dependence Research, Peking University, Beijing, China.

Molecular psychiatry

|October 11, 2024

概括

抗抑郁药物戒断症状很常见,影响超过40%的使用者. 较长的治疗时间和突然停止等因素增加了风险,强调了需要谨慎管理的必要性.

科学领域:

精神病学和药理学精神病学和药理学
临床神经科学临床神经科学
证据综合证据综合

背景情况:

抗抑郁药在全球范围内被广泛使用.
抗抑郁药戒断综合征 (AWS) 经常被报告,但其发生率和特征尚未确立.
了解AWS对于患者护理和药物管理至关重要.

研究的目的:

为了确定抗抑郁药戒断综合征 (AWS) 的综合发病率.
调查与AWS相关的临床特征和风险因素.
综合当前关于抗抑郁药停用症状的证据.

主要方法:

在多个数据库 (PubMed,Embase,PsycINFO等) 的系统文献搜索. 最长时间为2023年12月31日.
包括随机对照试验 (RCT) 和报告AWS发生率和特征的观察性研究.
使用随机效应模型进行元分析,以计算聚合发病率并分析风险因素.

主要成果:

在35项研究中,AWS的综合发病率为42.9%,在11个RCT中为44.4%.
根据抗抑郁药类的发病率有所不同:SSRI (45.6%),SNRIs (29.7%) 和TCA (59.7%).
较长的治疗持续时间 (24周以上) 增加了AWS发病率 (51.4%),剂量逐渐下降显示出较低发病率的趋势 (34.5%对42.5%).
确定的危险因素包括女性性别,年龄较小,早期不良反应,剂量较高,持续时间较长,突然停止,药物清除率较低和特定基因变异.

结论:

抗抑郁药物戒断症状是一种常见的临床问题.
特定的患者人口统计学,药物特征和戒药方法都会影响AWS的风险.
对于长期接受抗抑郁药物治疗的患者,需要进行进一步的长期停药研究.

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