Interventions to help patients withdraw from depression drugs: A systematic review.

IF 0.8 Q4 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE Pub Date : 2024-01-01 DOI:10.3233/JRS-230011

Peter C Gøtzsche, Maryanne Demasi

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Abstract

Background: Depression drugs can be difficult to come off due to withdrawal symptoms. Gradual tapering with tapering support is needed to help patients withdraw safely.

Objective: To review the withdrawal success rates, using any intervention, and the effects on relapse/recurrence rates, symptom severity, quality of life, and withdrawal symptoms.

Methods: Systematic review based on PubMed and Embase searches (last search 4 October 2022) of randomised trials with one or more treatment arms aimed at helping patients withdraw from a depression drug, regardless of indication for treatment. We calculated the mean and median success rates and the risk difference of depressive relapse when discontinuing or continuing depression drugs.

Results: We included 13 studies (2085 participants). Three compared two withdrawal interventions and ten compared drug discontinuation vs. continuation. The success rates varied hugely between the trials (9% to 80%), with a weighted mean of 47% (95% confidence interval 38% to 57%) and a median of 50% (interquartile range 29% to 65%). A meta-regression showed that the length of taper was highly predictive for the risk of relapse (P = 0.00001). All the studies we reviewed confounded withdrawal symptoms with relapse; did not use hyperbolic tapering; withdrew the depression drug too fast; and stopped it entirely when receptor occupancy was still high.

Conclusion: The true proportion of patients on depression drugs who can stop safely without relapse is likely considerably higher than the 50% we found.

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帮助患者戒除抑郁症药物的干预措施：系统综述。

背景：抑郁症药物会因戒断症状而难以停药。为了帮助患者安全停药，需要在减量支持下逐渐减量：回顾使用任何干预措施的戒断成功率，以及对复发率、症状严重程度、生活质量和戒断症状的影响：方法：基于PubMed和Embase检索（最后一次检索时间为2022年10月4日），对包含一个或多个治疗臂的随机试验进行系统性回顾，这些试验旨在帮助患者戒除抑郁症药物，与治疗指征无关。我们计算了停用或继续使用抑郁症药物的平均成功率和中位数以及抑郁症复发的风险差异：我们纳入了 13 项研究（2085 名参与者）。其中三项对两种停药干预措施进行了比较，十项对停药与继续用药进行了比较。不同试验的成功率差异很大（9% 到 80%），加权平均值为 47%（95% 置信区间为 38% 到 57%），中位数为 50%（四分位间范围为 29% 到 65%）。元回归结果显示，减药时间的长短对复发风险具有很高的预测性（P = 0.00001）。我们回顾的所有研究都将停药症状与复发混为一谈；没有使用双曲线减量法；抑郁症药物停药过快；以及在受体占用率仍然很高时完全停药：结论：能够安全停药而不复发的抑郁症患者的真实比例可能远远高于我们发现的 50%。

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

INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

2.20

自引率

17.60%

发文量

102

期刊介绍： The International Journal of Risk and Safety in Medicine is concerned with rendering the practice of medicine as safe as it can be; that involves promoting the highest possible quality of care, but also examining how those risks which are inevitable can be contained and managed. This is not exclusively a drugs journal. Recently it was decided to include in the subtitle of the journal three items to better indicate the scope of the journal, i.e. patient safety, pharmacovigilance and liability and the Editorial Board was adjusted accordingly. For each of these sections an Associate Editor was invited. We especially want to emphasize patient safety.