抗抑郁药物的停药一些问题

To reduce the risk of relapse, patients who have been treated successfully with antidepressant medications in the acute phase should continue treatment with these agents for 4?9 months . Selective serotonin reuptake inhibitors generally should not be abruptly discontinued after extended therapy and,whenever possible, should be tapered over several weeks to minimize discontinuation-emergent symptoms. Clinical experience and a few controlled studies suggest that among the SSRIs, discontinuation-emergent symptoms are more likely with paroxetine than sertraline, citalopram, or escitalopram and least likely to occur with fluoxetine (due to the long elimination half-life of its primary metabolite, norfluoxetine)Discontinuationemergent symptoms include both flu-like experiences such as nausea, headache, light-headedness, chills, and body aches, and neurological symptoms such as paresthesias, insomnia, and “electric shock-like” phenomena. These symptoms typically resolve without specific treatment over 1?2 weeks. However, some patients do experience more protracted discontinuation syndromes, particularly those treated with paroxetine, and may require a slower downward titration regimen. Another strategy is to change to a brief course of fluoxetine, e.g., 10 mg for 1?2 weeks, and then taper and discontinue the fluoxetine . 江西省精神病医院精神科朱健民

摘自:Practice Guideline for the Treatment of Patients With Major Depressive Disorder