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DOI: 10.1055/s-0038-1628760
Absetz- und Toleranzphänomene bei Antidepressiva
Discontinuation and tolerance phenomena with antidepressantsPublication History
Eingegangen am:
18 December 2009
angenommen am:
03 February 2010
Publication Date:
24 January 2018 (online)
Zusammenfassung
Antidepressiva gelten als Substanzen, die im Gegensatz zu Tranquilizern, opiathaltigen Schmerzmitteln und Barbituraten keine Abhängigkeit verursachen. Inzwischen ist bekannt, dass nach dem Absetzen von Antidepressiva Entzugssymptome auftreten können. Diese wurden schon früh in Fallberichten und seit den 1990er-Jahren in prospektiven Studien dokumentiert, im klinischen Alltag in ihrer Häufigkeit jedoch weiterhin unterschätzt. Absetzphänomene treten vor allem am Tag 1 bis 14 mit einem Maximum der Beschwerden an Tag 5 bis 7 nach abruptem Absetzen auf. Die am häufigsten beschriebenen Beschwerden sind Schwindel, Übelkeit/Erbrechen, Erschöpfbarkeit, Kopfschmerzen, Gangunsicherheit, Parästhesien und Sehstörungen. Besonders betroffen sind Antidepressiva mit kurzer Halbwertszeit. Diese Beobachtungen haben dazu geführt, dass ein schrittweises und langsames Absetzen empfohlen wird. Die Entwicklung von Toleranzphänomenen auf Antidepressiva ist umstritten. Toleranz tritt sicherlich nicht in vergleichbarem Maß wie z. B. bei Benzodiazepinen auf. Aufgrund der noch lückenhaften Datenlage kann diesbezüglich trotz der Hinweise auf solche Phänomene aktuell keine klare Handlungsanweisung gegeben werden.
Summary
Antidepressants are considered as substances that, in contrast to tranquilizers, opiates and barbiturates, do not cause dependency. In the meantime it is well known, that withdrawal reactions can occur after the discontinuation of antidepressants. Despite early case reports and prospective studies since the 1990s, the frequency of withdrawal symptoms following antidepressant pharmacotherapy is still underestimated in everyday clinical routine. Discontinuation symptoms occur between day 1 and 14 with a maximum of symptoms on days 5 through 7 after abrupt withdrawal of antidepressants. The complaints most commonly reported are dizziness, nausea/vomiting, exhaustion, unsteady gait, paresthesia and vision problems. These symptoms are especially prominent in antidepressants with a short half life. These observations have lead to recommendations of a gradual and slow phasing out of antidepressants. On the other side, the development of tolerance to antidepressants is a matter of contention. Tolerance phenomena certainly do not occur as frequently as with benzodiazepines. Due to limited data no definite recommendation for a course of action can currently be given despite some evidence for tolerance phenomena.
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