tailieunhanh - HANDBOOK OF PSYCHIATRIC DRUGS - PART 4

Trước khi ngưng điều trị với thuốc chống trầm cảm, điều quan trọng là phải nhớ rằng trầm cảm thường là một bệnh suốt đời với một khóa học mãn tính. Một trong những nên luôn luôn cân nhắc những lợi ích của việc ngừng chống lại các nguy cơ trầm cảm tái phát. Bệnh nhân với một tập duy nhất trầm cảm cấp tính | ANTIDEPRESSANTS 69 though lower doses may increase compliance full doses should be used until new information indicates otherwise. DISCONTINUATION OF TREATMENT Before discontinuing treatment with an antidepressant it is important to remember that depression is often a lifelong disease with a chronic course. One should always weigh the benefits of discontinuation against the risks of recurrent depression. Patients with a single episode of acute depression and who have an onset before age 50 are the best candidates for discontinuation. For TCAs the usual strategy is to taper the dose at a rate of 25 to 50 mg day every 2 to 3 days. Too rapid a decrease in dose may produce symptoms of cholinergic rebound or supersensitivity nausea vomiting cramps other signs of autonomic hyperactivity diaphoresis anxiety agitation headache and insomnia as early as 48 hours or as late as 2 weeks after discontinuation. These early symptoms may be mistaken for relapse of depression. MAOIs may also have a withdrawal syndrome on abrupt cessation of treatment including symptoms of psychosis however this is rarer than that seen with the TCAs. Recommendations for discontinuing SSRIs depend on the particular drug. Fluoxetine has a long half-life and abrupt withdrawal should be permissible. Shorter half-life drugs such as sertraline citalopram escitalopram and paroxetine may require a 7-10-day taper. The withdrawal syndrome with shorter-acting agents includes symptoms of fatigue insomnia abdominal distress and influenza-like symptoms. The same may be true for venlafaxine and duloxetine. A first episode of depression has a high risk of recurrence and the risk is higher in patients who have only a partial response to treatment. After discontinuation the goal is to enable early intervention if symptoms recur. The patient should be educated to recognize the symptoms of depression and seek help at an early stage. SIDE EFFECTS Once the choice of an antidepressant has been made the main goal is to .