Outcomes of hyperbolic tapering of antidepressants.

IF 3.4 3区 医学 Q2 PHARMACOLOGY & PHARMACY
Jim van Os, Peter C Groot
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引用次数: 2

Abstract

Background: In patients attempting to discontinue their antidepressant medication, there have been no prospective studies on patterns of withdrawal as a function of the rate of antidepressant reduction during the tapering trajectory, and moderators thereof.

Objective: To investigate withdrawal as a function of gradual dose reduction.

Design: Prospective cohort study.

Methods: The sampling frame consisted of 3956 individuals in the Netherlands who received an antidepressant tapering strip between 19 May 2019 and 22 March 2022 in routine clinical practice. Of these, 608 patients, majorly with previous unsuccessful attempts to stop, provided daily ratings of withdrawal in the context of reducing their antidepressant medications (mostly venlafaxine or paroxetine), using hyperbolic tapering strips offering daily tiny reductions in dose.

Results: Withdrawal in daily-step hyperbolic tapering trajectories was limited, and inverse to the rate of taper. Female sex, younger age, presence of one or more risk factors and faster rate of reduction over shorter tapering trajectories were associated with more withdrawal and differential course over time. Thus, sex and age differences were less marked early in the course of the trajectory, whereas differences associated with risk factors and shorter trajectories tended to peak early in the trajectory. There was evidence that tapering in weekly larger steps (mean per-week dose reduction: 33.4% of previous dose), in comparison with daily tiny steps (mean per-day dose reduction: 4.5% of previous dose or 25.3% per week), was associated with more withdrawal in trajectories of 1, 2 or 3 months, particularly for paroxetine and the group of other (non-paroxetine, non-venlafaxine) antidepressants.

Conclusion: Antidepressant hyperbolic tapering is associated with limited, rate-dependent withdrawal that is inverse to the rate of taper. The demonstration of multiple demographic, risk and complex temporal moderators in time series of withdrawal data indicates that antidepressant tapering in clinical practice requires a personalised process of shared decision making over the entire course of the tapering period.

Abstract Image

Abstract Image

Abstract Image

抗抑郁药双曲递减的结局。
背景:在试图停止抗抑郁药物治疗的患者中,目前还没有前瞻性研究表明,在逐渐减少的过程中,停药模式与抗抑郁药物减少率的关系及其调节因素。目的:探讨停药随剂量逐渐减少的变化规律。设计:前瞻性队列研究。方法:抽样框架包括荷兰的3956名个体,这些个体在2019年5月19日至2022年3月22日期间在常规临床实践中接受了抗抑郁药渐细条。其中,608名患者提供了在减少抗抑郁药物(主要是文拉法辛或帕罗西汀)的情况下每日停药的评分,使用双曲渐窄条提供每日剂量的微小减少。结果:每日双曲渐窄轨迹的停药是有限的,且与渐窄速度成反比。女性、年轻、存在一种或多种危险因素以及在较短的减量轨迹上更快的减量速度与更多的停药和随时间的不同病程相关。因此,性别和年龄差异在轨迹的早期不太明显,而与风险因素和较短轨迹相关的差异往往在轨迹的早期达到峰值。有证据表明,与每日小步骤(平均每日剂量减少:前剂量的4.5%或每周25.3%)相比,每周大步骤逐渐减少(每周平均剂量减少:前剂量的33.4%)与1、2或3个月的轨迹中更多的停药有关,特别是帕罗西汀和其他组(非帕罗西汀,非文拉法辛)抗抑郁药。结论:抗抑郁药的双曲逐渐减少与有限的、速率依赖的戒断有关,戒断与逐渐减少的速率相反。停药数据时间序列中的多重人口统计学、风险和复杂时间调节因子表明,临床实践中的抗抑郁药减量需要在整个减量过程中共同决策的个性化过程。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.90
自引率
2.40%
发文量
35
审稿时长
10 weeks
期刊介绍: Therapeutic Advances in Psychopharmacology delivers the highest quality peer-reviewed articles, reviews, and scholarly comment on pioneering efforts and innovative studies across all areas of psychopharmacology. The journal has a strong clinical and pharmacological focus and is aimed at clinicians and researchers in psychopharmacology, providing a forum in print and online for publishing the highest quality articles in this area.
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