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Incidence and risk factors of antidepressant withdrawal symptoms: a meta-analysis and systematic review

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机构: [1]Peking Univ, Natl Inst Drug Dependence, Beijing, Peoples R China [2]Peking Univ, Beijing Key Lab Drug Dependence Res, Beijing, Peoples R China [3]Air Force Med Univ, Xijing Hosp, Dept Psychiat, Xian, Peoples R China [4]Peking Univ, Hlth Sci Ctr, Dept Neurobiol, Beijing, Peoples R China [5]Peking Univ, Peking Univ Sixth Hosp, Natl Clin Res Ctr Mental Disorders, NHC Key Lab Mental Hlth, Beijing, Peoples R China [6]Peking Univ, Peking Tsinghua Ctr Life Sci, Beijing, Peoples R China [7]Peking Univ, PKU IDG McGovern Inst Brain Res, Beijing, Peoples R China [8]Peking Univ First Hosp, Dept Infect Control, Beijing, Peoples R China [9]Beijing Normal Univ, Sch Govt, Beijing, Peoples R China [10]North East London NHS Fdn Trust NELFT, Res & Dev Dept, Ilford, England [11]Peking Univ, Hlth Sci Ctr, Dept Pharmacol, Beijing, Peoples R China [12]Chinese Acad Med Sci & Peking Union Med Coll, Peking Union Med Coll Hosp, Translat Med Ctr, Dept Endocrinol,Key Lab Endocrinol,Natl Hlth Commi, Beijing, Peoples R China [13]Capital Med Univ, Xuanwu Hosp, Beijing Inst Geriatr, Dept Endocrinol, Beijing, Peoples R China [14]Chongqing Med Univ, Affiliated Hosp 1, Dept Psychiat, Chongqing, Peoples R China [15]Chongqing Med Univ, Key Lab Major Brain Dis & Aging Res, Minist Educ, Chongqing, Peoples R China [16]Chongqing Med Univ, Affiliated Hosp 1, Dept Neurol, Chongqing, Peoples R China [17]Chongqing Med Univ, Affiliated Hosp 1, NHC Key Lab Diag & Treatment Brain Funct Dis, Chongqing, Peoples R China [18]North China Univ Sci & Technol, Coll Publ Hlth, Sch Psychol, Tangshan, Hebei, Peoples R China [19]Shandong First Med Univ, Shandong Prov Hosp, Dept Psychol, Jinan, Shandong, Peoples R China [20]Shandong First Med Univ & Shandong Acad Med Sci, Inst Brain Sci & Brain Inspired Res, Jinan, Shandong, Peoples R China
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Antidepressants are among the most extensively prescribed psychotropic drugs worldwide. Discontinuation induced withdrawal symptoms have been reported for almost all antidepressants. The incidence of antidepressant withdrawal syndrome (AWS) and other characteristics remain unknown. We searched the PubMed, Embase, PsycINFO, MEDLINE, CINAHL, and Cochrane Central Register of Controlled Trials databases from inception to December 31, 2023. Randomized double-blinded trials, longitudinal or cross-sectional studies that reported the incidence and other characteristics of antidepressant withdrawal symptoms were included. The pooled incidence of AWS was calculated by a random effects model. We included 35 studies, of which 2 studies just provided incidence of specific withdrawal symptoms, and 4 studies only described other characteristics. The pooled incidence of AWS from all available studies was 42.9%, from 11 RCTs was 44.4%, in studies in which the treatment duration was mostly 8-12 weeks, which usually appear within 2 weeks, and were generally measured for <4 weeks. The incidence in selective serotonin-norepinephrine reuptake inhibitors was the lowest (29.7%), followed by selective serotonin reuptake inhibitors (45.6%) and tricyclic antidepressants (59.7%), without significant differences (p = 0.221). Treatment duration showed a dose-response to the incidence of AWS (6-12 W: 35.1%, 12-24 W: 42.7%, >24 W: 51.4%). The half-life did not show such a simple dose-dependent relationship. The pooled estimate was robust regardless whether withdrawal symptoms were measured in RCTs or observational studies (including face-to-face and online survey studies). Tapering the dose reduced the incidence of AWS compared with abrupt stoppage (34.5% vs 42.5%), without a significant difference (p = 0.484). Risk factors for withdrawal symptoms included being female, younger, experiencing adverse effects early in treatment, taking higher doses or longer duration of medication, abrupt cessation of drugs, and those with a lower clearance of drugs or with serotonin 1A receptor gene variation. The findings suggest the incidence of AWS are common and some clinical characteristics and risk factors which can help clinicians identify who is at greater risk of experiencing AWS. Discontinuation studies on long-term antidepressant users with long follow-up periods are required in the future.

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出版当年[2023]版:
大类 | 1 区 医学
小类 | 1 区 生化与分子生物学 1 区 神经科学 1 区 精神病学
最新[2023]版:
大类 | 1 区 医学
小类 | 1 区 生化与分子生物学 1 区 神经科学 1 区 精神病学
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出版当年[2022]版:
Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY Q1 NEUROSCIENCES Q1 PSYCHIATRY
最新[2023]版:
Q1 NEUROSCIENCES Q1 PSYCHIATRY Q1 BIOCHEMISTRY & MOLECULAR BIOLOGY

影响因子: 最新[2023版] 最新五年平均 出版当年[2022版] 出版当年五年平均 出版前一年[2021版] 出版后一年[2023版]

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第一作者机构: [1]Peking Univ, Natl Inst Drug Dependence, Beijing, Peoples R China [2]Peking Univ, Beijing Key Lab Drug Dependence Res, Beijing, Peoples R China [3]Air Force Med Univ, Xijing Hosp, Dept Psychiat, Xian, Peoples R China
通讯作者:
通讯机构: [1]Peking Univ, Natl Inst Drug Dependence, Beijing, Peoples R China [2]Peking Univ, Beijing Key Lab Drug Dependence Res, Beijing, Peoples R China [5]Peking Univ, Peking Univ Sixth Hosp, Natl Clin Res Ctr Mental Disorders, NHC Key Lab Mental Hlth, Beijing, Peoples R China [6]Peking Univ, Peking Tsinghua Ctr Life Sci, Beijing, Peoples R China [7]Peking Univ, PKU IDG McGovern Inst Brain Res, Beijing, Peoples R China [20]Shandong First Med Univ & Shandong Acad Med Sci, Inst Brain Sci & Brain Inspired Res, Jinan, Shandong, Peoples R China
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