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抗抑郁药停药后的疾病复发

Relapse after Discontinuing Antidepressants

2021年9月30日

朗读者：Dr. Stephen Morrissey, NEJM常务执行主编

近几十年来，高收入国家初级医疗机构开出的抗抑郁药处方数量有所增加，主要原因是治疗持续时间延长。有报道指出患者停药后复发频率增加，但这些研究有许多局限性。短视频中总结了新的研究发现。

初级医疗机构患者维持和停用抗抑郁药的比较

Maintenance or Discontinuation of Antidepressants in Primary Care

摘 要

背景

在初级医疗机构接受治疗的抑郁症患者可能会长期接受抗抑郁药治疗。关于初级医疗机构患者维持或停用抗抑郁药的效应，目前数据有限。

Background

Patients with depression who are treated in primary care practices may receive antidepressants for prolonged periods. Data are limited on the effects of maintaining or discontinuing antidepressant therapy in this setting.

方法

我们在英国150家全科诊所正在治疗的成人患者中开展了一项随机双盲试验。所有患者均有至少2次抑郁症发作史或已服用抗抑郁药至少2年，并且自我感觉良好，考虑停用抗抑郁药。我们以1:1的比例将接受西酞普兰、氟西汀、舍曲林或米氮平治疗的患者随机分组，一组维持当前的抗抑郁药治疗（维持组），另一组使用匹配安慰剂逐渐减量并停用上述药物（停药组）。主要结局是52周试验期间抑郁症首次复发（在至事件发生的时间分析中评估）。次要结局包括抑郁和焦虑症状、躯体和停药症状、生活质量、至停用抗抑郁药或安慰剂的时间和总体情绪评定。

Methods

We conducted a randomized, double-blind trial involving adults who were being treated in 150 general practices in the United Kingdom. All the patients had a history of at least two depressive episodes or had been taking antidepressants for 2 years or longer and felt well enough to consider stopping antidepressants. Patients who had received citalopram, fluoxetine, sertraline, or mirtazapine were randomly assigned in a 1:1 ratio to maintain their current antidepressant therapy (maintenance group) or to taper and discontinue such therapy with the use of matching placebo (discontinuation group). The primary outcome was the first relapse of depression during the 52-week trial period, as evaluated in a time-to-event analysis. Secondary outcomes were depressive and anxiety symptoms, physical and withdrawal symptoms, quality of life, time to stopping an antidepressant or placebo, and global mood ratings.

结果

共计1466例患者接受了筛选。其中478例被纳入本试验（维持组238例，停药组240例）。患者平均年龄为54岁；73%为女性。维持组和停药组患者对试验分组的依从率分别为70%和52%。截至52周时，维持组238例患者中的92例（39%）和停药组240例患者中的135例（56%）出现复发（风险比，2.06；95%置信区间，1.56~2.70；P<0.001）。次要结局通常与主要结局的方向相同。停药组患者的抑郁、焦虑和停药症状比维持组患者多。

Result

A total of 1466 patients underwent screening. Of these patients, 478 were enrolled in the trial (238 in the maintenance group and 240 in the discontinuation group). The average age of the patients was 54 years; 73% were women. Adherence to the trial assignment was 70% in the maintenance group and 52% in the discontinuation group. By 52 weeks, relapse occurred in 92 of 238 patients (39%) in the maintenance group and in 135 of 240 (56%) in the discontinuation group (hazard ratio, 2.06; 95% confidence interval, 1.56 to 2.70; P<0.001). Secondary outcomes were generally in the same direction as the primary outcome. Patients in the discontinuation group had more symptoms of depression, anxiety, and withdrawal than those in the maintenance group.

结论

在自我感觉良好，考虑停用抗抑郁药的初级医疗机构患者中，截至52周时，停药组患者的抑郁症复发风险高于维持组患者（由英国国家卫生研究院[National Institute for Health Research]资助；ANTLER在ISRCTN注册号为ISRCTN15969819。）

Conclusions

Among patients in primary care practices who felt well enough to discontinue antidepressant therapy, those who were assigned to stop their medication had a higher risk of relapse of depression by 52 weeks than those who were assigned to maintain their current therapy. (Funded by the National Institute for Health Research; ANTLER ISRCTN number, ISRCTN15969819.)

Gemma Lewis, Louise Marston, Larisa Duffy, et al. Maintenance or Discontinuation of Antidepressants in Primary Care. DOI: 10.1056/NEJMoa2106356

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版权信息

本文由嘉会医学研究和教育集团（J-Med）与《新英格兰医学杂志》（NEJM）联手打造的《NEJM医学前沿》翻译、编写或约稿。中译全文及所含图表等由NEJM集团独家授权。如需转载，请留言或联系[e-mail]。未经授权的翻译是侵权行为，版权方保留追究法律责任的权利。

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