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首页> 外文期刊>The journal of clinical psychiatry >Discontinuation of maintenance selective serotonin reuptake inhibitor monotherapy after 5 years of stable response: a naturalistic study.
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Discontinuation of maintenance selective serotonin reuptake inhibitor monotherapy after 5 years of stable response: a naturalistic study.

机译：稳定反应5年后停止维持选择性5-羟色胺再摄取抑制剂的单一疗法：一项自然研究。

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OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are effective treatments of major depressive disorder (MDD), but data to guide the duration of maintenance therapy in community settings are limited. We assessed whether extending maintenance beyond 5 years provided additional benefit and identified other predictors of outcome. METHOD: All patients treated at an urban community outpatient clinic between June 1993 and September 2005 were considered for inclusion in this study. Based upon patient preference and clinician judgment, 60 patients with DSM-IV MDD elected to continue, and 27 patients to discontinue, SSRI treatment after 5 years of clinical stability on maintenance monotherapy in a community clinic. Differences in relapse risk were assessed using the Kaplan-Meier product limit method, and risk factors were evaluated in Cox proportional hazards regression, based on up to 8 years of illness course. RESULTS: Subjects who continued on SSRI treatment experienced a survival probability of maintaining remission during the first year, which was twice that of discontinued subjects (0.79 vs. 0.40), and survival differences persisted for over 30 months. Median survival time until relapse for patients who continued SSRIs was 38 months, exceeding the 10-month survival time of patients who discontinued. After controlling for significant covariates, the hazard ratio for SSRI discontinuation was 4.9. Residual depressive symptoms conferred increased relapse risk, while age, gender, SSRI type and dose, and prior depressive episodes did not predict relapse. CONCLUSION: After 5 years of maintenance monotherapy for MDD, SSRI discontinuation in a community setting is associated with a far poorer illness course than continued maintenance. Discontinuation of long-term maintenance is most likely to be successful in patients with minimal residual symptoms, and discontinued patients should be carefully monitored.
机译：目的：选择性5-羟色胺再摄取抑制剂（SSRIs）是治疗重度抑郁症（MDD）的有效方法，但指导社区维持治疗时间的数据有限。我们评估了将维护延长至5年以上是否可以提供额外的收益，并确定了其他预后指标。方法：将1993年6月至2005年9月在城市社区门诊就诊的所有患者纳入研究范围。根据患者的喜好和临床医生的判断，在社区诊所维持单一疗法5年的临床稳定性后，选择60例DSM-IV MDD患者继续治疗，并终止27例SSRI治疗。使用Kaplan-Meier产品极限法评估复发风险的差异，并基于长达8年的病程，通过Cox比例风险回归评估风险因素。结果：继续接受SSRI治疗的受试者在第一年内经历了维持缓解的生存概率，是停药受试者的两倍（0.79比0.40），并且生存差异持续了30个月以上。持续SSRI的患者直到复发的中位生存时间为38个月，超过了停药患者的10个月生存时间。在控制了显着的协变量后，SSRI停用的危险比为4.9。残留的抑郁症状会增加复发风险，而年龄，性别，SSRI类型和剂量以及先前的抑郁发作并不能预测复发。结论：对MDD进行单一维持治疗5年后，在社区环境中停用SSRI与持续维持相比，病程远差得多。中止症状消失的患者最有可能中止长期维持治疗，因此应仔细监测中止的患者。

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