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BMJ:停用抗抑郁药是否增加患者焦虑症的复发风险?

2017-11-07 吴星 环球医学

2017年9月,发表在《BMJ》上的一项复发预防试验的系统回顾和Meta分析,研究了患者停用抗抑郁药对焦虑症复发率的影响。研究结果证实:在长达1年的随访期中,停用抗抑郁药与继续使用抗抑郁药相比,会造成患者更高的复发率。

2017年9月,发表在《BMJ》上的一项复发预防试验的系统回顾和Meta分析,研究了患者停用抗抑郁药对焦虑症复发率的影响。研究结果证实:在长达1年的随访期中,停用抗抑郁药与继续使用抗抑郁药相比,会造成患者更高的复发率。

目的:旨在检测抗抑郁药治疗有效的焦虑症患者中,停用抗抑郁药后焦虑症复发风险和复发时间,探讨复发风险是否与焦虑症类型、抗抑郁药类型、停药方式、治疗和随访时间、合并症、补充心理治疗相关。

设计:复发预防试验的系统回顾和Meta分析。

数据来源:Pubmed、Cochrane、Embase、临床试验注册(截至到2016年7月)。

研究选择:符合条件的研究中纳入了对抗抑郁药治疗有效的焦虑症患者。并将患者随机双盲分配到继续抗抑郁药或转换到安慰剂的组中,并比较了复发率或复发时间。

数据提取:两名评估者独立筛选文献并提取了数据。随机效应模型用于评估复发比值比、复发时间的风险比、每组的复发率。不同分类和连续变量的影响分别在亚组分析和Meta回归分析中进行探讨。使用Cochrane工具评估研究偏倚。

结果:Meta分析纳入了28项检测复发情况最长随访1年的的研究(5233人)。各研究中,偏倚风险为低。与继续抗抑郁药相比,停药会增加复发概率(摘要比值比,3.11;95% CI,2.48~3.89)。亚组分析和Meta回归分析未表现出统计学显着性。当停用抗抑郁药时,复发时间(3002人)缩短(3.63;2.58~5.10;11项研究)。安慰剂组和抗抑郁药组的总复发率分别为36.4%(30.8~42.1;28项研究)和16.4%(12.6~20.1;28项研究),但是各研究间的患病率具有较大差异,多数是由随访时间的差异造成的。安慰剂组的失访率较高(1.31;1.06~1.63;27项研究)。

结论:在长达1年的随访期中,停用抗抑郁药与继续使用抗抑郁药相比,会造成患者更高的复发率。由于缺乏1年后随访的证据因此不能给出1年后停用抗抑郁药的明确建议。鉴于焦虑症的长期性,建议治疗应长期考虑,包括复发率、副反应和患者偏好。

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    2018-06-07 wetgdt
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    2018-07-31 gaoxiaoe
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