Deprescribing Antidepressants in Children and Adolescents: A Systematic Review of Discontinuation Approaches, Cross-Titration, and Withdrawal Symptoms.

IF 1.5 4区 医学 Q2 PEDIATRICS
Julia N Stimpfl, John T Walkup, Adelaide S Robb, Alexandra E Alford, Stephen M Stahl, James T McCracken, Stephani L Stancil, Laura B Ramsey, Graham J Emslie, Jeffrey R Strawn
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引用次数: 0

Abstract

Background: Antidepressant medications, including selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), are commonly used to treat depressive, anxiety, and obsessive-compulsive disorders in youth. Yet, data on discontinuing these medications, withdrawal symptoms, and strategies to switch between them are limited. Methods: We searched PubMed and ClinicalTrials.gov through June 1, 2024, to identify randomized controlled trials assessing antidepressant discontinuation in youth. We summarized pediatric pharmacokinetic data to inform tapering and cross-titration strategies for antidepressants and synthesized these data with reports of antidepressant withdrawal. Results: Our search identified 528 published articles, of which 28 were included. In addition, 19 records were obtained through other methods, with 14 included. The corpus of records included 13 randomized, double-blind, placebo-controlled trials (3026 patients), including SSRIs (K = 10), SNRIs (K = 4), and TCAs (K = 1), ranging from 4 to 35 weeks. Deprescribing antidepressants requires considering clinical status, treatment response, and, in cross-titration cases, the pharmacokinetics and pharmacodynamics of both medications. Antidepressant withdrawal symptoms are related to the pharmacokinetics of the medication, which vary across antidepressants and may include irritability, palpitations, anxiety, nausea, sweating, headaches, insomnia, paresthesia, and dizziness. These symptoms putatively involve changes in serotonin transporter expression and receptor sensitivity, impacting the serotonin, dopamine, and norepinephrine pathways. Conclusions: Although approaches to deprescribing antidepressants in pediatric patients are frequently empirically guided, accumulating data related to the course of relapse and withdrawal symptoms, as well as the pharmacokinetic and pharmacodynamic properties of medications, should inform these approaches. Recommendations within this review support data-informed discussions of deprescribing-including when and how-that are critically important in the clinician-family-patient relationship.

儿童和青少年抗抑郁药的停药:关于停药方法、交叉给药和戒断症状的系统性综述》(A Systematic Review of Discontinuation Approaches, Cross-Titration, and Withdrawal Symptoms.
背景:抗抑郁药物,包括选择性血清素再摄取抑制剂(SSRIs)和血清素-去甲肾上腺素再摄取抑制剂(SNRIs),常用于治疗青少年的抑郁、焦虑和强迫症。然而,有关停用这些药物、戒断症状以及药物转换策略的数据却很有限。研究方法我们检索了截至 2024 年 6 月 1 日的 PubMed 和 ClinicalTrials.gov,以确定评估青少年停用抗抑郁药的随机对照试验。我们总结了儿科药代动力学数据,为抗抑郁药的减量和交叉给药策略提供了参考,并将这些数据与抗抑郁药停药报告进行了综合。结果:我们在检索中发现了 528 篇已发表的文章,其中 28 篇被收录。此外,我们还通过其他方法获得了 19 条记录,其中 14 条被收录。这些记录包括 13 项随机、双盲、安慰剂对照试验(3026 名患者),包括 SSRIs(K = 10)、SNRIs(K = 4)和 TCAs(K = 1),疗程从 4 周到 35 周不等。停用抗抑郁药需要考虑临床状态、治疗反应,在交叉给药的情况下,还需要考虑两种药物的药代动力学和药效学。抗抑郁药的戒断症状与药物的药代动力学有关,不同抗抑郁药的戒断症状各不相同,可能包括烦躁、心悸、焦虑、恶心、出汗、头痛、失眠、麻痹和头晕。这些症状可能涉及血清素转运体表达和受体敏感性的变化,影响血清素、多巴胺和去甲肾上腺素通路。结论虽然儿科患者停用抗抑郁药的方法通常以经验为指导,但与复发和停药症状的过程以及药物的药代动力学和药效学特性有关的累积数据应为这些方法提供参考。本综述中的建议支持以数据为依据讨论停药问题,包括何时停药和如何停药,这在临床医生-家庭-患者关系中至关重要。
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来源期刊
CiteScore
3.60
自引率
5.30%
发文量
61
审稿时长
>12 weeks
期刊介绍: Journal of Child and Adolescent Psychopharmacology (JCAP) is the premier peer-reviewed journal covering the clinical aspects of treating this patient population with psychotropic medications including side effects and interactions, standard doses, and research on new and existing medications. The Journal includes information on related areas of medical sciences such as advances in developmental pharmacokinetics, developmental neuroscience, metabolism, nutrition, molecular genetics, and more. Journal of Child and Adolescent Psychopharmacology coverage includes: New drugs and treatment strategies including the use of psycho-stimulants, selective serotonin reuptake inhibitors, mood stabilizers, and atypical antipsychotics New developments in the diagnosis and treatment of ADHD, anxiety disorders, schizophrenia, autism spectrum disorders, bipolar disorder, eating disorders, along with other disorders Reports of common and rare Treatment Emergent Adverse Events (TEAEs) including: hyperprolactinemia, galactorrhea, weight gain/loss, metabolic syndrome, dyslipidemia, switching phenomena, sudden death, and the potential increase of suicide. Outcomes research.
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