Antidepressant discontinuation effects

抗抑郁药停药的影响

• 批准号: 7032066
• 负责人: ROSS J BALDESSARINI
• 金额: $ 8.05万
• 依托单位: MCLEAN HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-01-01 至 2007-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7032066
• 关键词: MAO inhibitors; antidepressants; bipolar depression; clinical research; disease /disorder proneness /risk; disease /therapy duration; drug adverse effect; drug withdrawal; human data; human subject; international cooperation; lithium; longitudinal human study; major depression; mental disorder chemotherapy; patient /disease registry; patient oriented research; relapse /recurrence; serotonin inhibitor; tricyclic antidepressant

DESCRIPTION (provided by applicant): Our earlier studies first demonstrated that rapid discontinuation of lithium is followed by major increases in early risks of recurrences of mania, depression and suicide in bipolar disorder patients that are much less following gradual discontinuation. We also found evidence of similar effects of rapid vs. gradual discontinuation of antipsychotic agents in schizophrenia patients. Risk of relapse or recurrence in major depression is much higher after discontinuing vs. during antidepressant treatment, and abrupt discontinuation of some antidepressants can induce physiological withdrawal reactions. However, possible later impact of rapidly discontinuing antidepressants on risk or time to recurrence of new major depressive episodes has not been adequately studied. We hypothesize that risk and latency to recurrences of depression are greater/shorter after abrupt or rapid than gradual discontinuation of antidepressants, following recovery from an index episode of major depression. This hypothesis will be tested with a large computerized database of nearly 500 major affective disorder patients (that will be increased to approximately 1000 subjects) evaluated and followed for an average of 5 years in a collaborating mood disorder research clinic. Using survival-analysis with covariates, we will compare latency from antidepressant discontinuation to the onset of a first new episode of major depression. We will also compare episode counts, rates, durations, and wellness-intervals in subjects prior to psychiatric treatment and outcome measures following antidepressant discontinuation. Secondary analyses will compare selected demographic, clinical, and treatment factors among patients discontinuing antidepressants rapidly vs. gradually vs. those continuing antidepressant treatment, and will consider unipolar depressive vs. bipolar depressive subjects separately. The findings expected should contribute to improved safety of antidepressant treatment and reduced morbid and mortal risks following its discontinuation.

描述（由申请人提供）：我们早期的研究首先表明，快速停药后，双相情感障碍患者躁狂、抑郁和自杀的早期复发风险大幅增加，而逐渐停药后，这种风险要小得多。我们还发现了精神分裂症患者快速停用抗精神病药物与逐渐停用抗精神病药物产生类似效果的证据。与抗抑郁治疗期间相比，停药后重度抑郁症复发的风险要高得多，并且突然停药某些抗抑郁药可能会引起生理戒断反应。然而，快速停用抗抑郁药对新的重度抑郁发作风险或复发时间可能产生的影响尚未得到充分研究。我们假设，在从重度抑郁症发作恢复后，突然或快速停用抗抑郁药比逐渐停用抗抑郁药后，抑郁症复发的风险和潜伏期更大/更短。这一假设将通过一个大型计算机数据库进行测试，该数据库包含近 500 名主要情感障碍患者（将增加到大约 1000 名受试者），并在合作的情绪障碍研究诊所进行平均 5 年的评估和跟踪。使用协变量的生存分析，我们将比较从抗抑郁药停用到重性抑郁首次新发作的潜伏期。我们还将比较受试者在接受精神科治疗之前的发作次数、发生率、持续时间和健康间隔以及停用抗抑郁药物后的结果测量。二次分析将比较快速停用抗抑郁药、逐渐停用抗抑郁药的患者与继续抗抑郁药治疗的患者中选定的人口统计学、临床和治疗因素，并将分别考虑单相抑郁受试者与双相抑郁受试者。预期的结果应有助于提高抗抑郁治疗的安全性，并降低停药后的发病和死亡风险。