选择性5-羟色胺再摄取抑制剂撤药综合征42例的临床分析

目的:探讨选择性5-羟色胺再摄取抑制剂(SSRI)撤药综合征的临床特点、诱发因素及预防。方法:回顾性调查42例SSRI撤综合征的临床症状,诱发因素及处理。结果:42例撤药综合征以头晕、恶心、呕吐、头痛、感觉异常、心情低落、失眠、焦虑、激越等症状为主。撤药症状发生于停药后的1～5d,持续1～7d。42例中应用帕罗西汀27例,舍曲林6例,西酞普兰6例,氟西汀3例。诱发因素:自行突然停药30例,漏服6例,减药4例,换药2例。结论:骤停SSRI可引起撤药综合征,以帕罗西汀较易发生,应引起临床上重视。缓慢减量或使用半衰期较长的SSRI可预防撤药综合征的发生。

Clinical analysis of selective serotonin reuptake inhibitor discontinuation syndrome in 42 patients

Objective:To discuss the clinical features,predisposing factors,and prevention of SSRI discontinuation syndrome. Methods:The clinical features,the predisposing causes,and management in 42 patients with SSRI discontinuation syndrome were investigated retrospectively. Results:The main symptoms of SSRI discontinuation syndrome were dizziness,nausea,vomiting,headache,abnormal sensation,depressed mood,insomnia,anxiety,and agitation. The symptoms began within 1 to 5 days after discontinuation of SSRI and persisted 1 to 7 days. Of the 42 patients,27 had taking paroxetine,6 sertraline,6 citalopram,and 3 fluoxetine. The predisposing factors of SSRI discontinuation syndrome were sudden withdrawal by oneself (30 cases),missed doses (6 cases),dose reduction (4 cases),and drug switching (2 cases). Conclusion:There should be care of discontinuation syndrome after abrupt cessation of SSRI in clinical practice. The SSRI implicated most often is paroxetine. The gradual tapering or use of an agent with longer half-life is necessary in order to avoid the development of SSRIdiscontinuation syndrome.