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）：我们的较早研究首先表明，锂的快速停用之后，躁狂症患者的躁狂症，抑郁症和自杀的早期风险大大增加，而逐渐停药后少得多。我们还发现了精神分裂症患者中抗精神病药的快速与逐步中断的相似作用的证据。在抗抑郁药治疗期间，在重大抑郁症中复发或复发的风险要高得多，而某些抗抑郁药的突然中断会诱导生理戒断反应。但是，尚未对新的重大抑郁发作的风险或时间复发的迅速中断的后来影响，尚未得到充分研究。我们假设在突然或迅速中断抗抑郁药的抑郁症复发的风险和潜伏期更大/较短，这是从重大抑郁症的指数发作中恢复后的。该假设将通过近500名主要情感障碍患者（将增加到大约1000名受试者）的大型计算机数据库进行测试，并在合作情绪障碍研究诊所中平均进行5年的评估。使用与协变量的生存分析，我们将比较从抗抑郁药的延迟到重大抑郁症的第一集新事件的潜伏期。我们还将比较抗抑郁药中停用后的精神治疗和结果指标之前的发作计数，率，持续时间和健康间隔。次要分析将比较迅速与持续抗抑郁药治疗的患者中迅速相对于抗抑郁药的患者中选定的人口统计，临床和治疗因素，并将分别考虑单极抑郁症与双极性抑郁受试者。预期的发现应有助于改善抗抑郁药治疗的安全性，并在中断后降低病态和致命风险。