Download PDF
Nervenheilkunde 2010; 29(05): 282-288
DOI: 10.1055/s-0038-1628760
125. Wanderversammlung
Schattauer GmbH

Absetz- und Toleranzphänomene bei Antidepressiva

Discontinuation and tolerance phenomena with antidepressants
A. Milkereit
2   Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
,
U. Voderholzer
1   Medizinisch-Psychosomatische Klinik Roseneck, Prien am Chiemsee
2   Abteilung für Psychiatrie und Psychotherapie, Universitätsklinikum Freiburg
› Author Affiliations
Further Information

Publication History

Eingegangen am: 18 December 2009

angenommen am: 03 February 2010

Publication Date:
24 January 2018 (online)

Also available at
    Permissions and Reprints

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.

Schlüsselwörter

Antidepressiva - Absetzeffekte - Toleranzphänomene

Keywords

Antidepressant drug - discontinuation syndrome - tolerance
 

  • Literatur

  • 1 Baldessarini RJ, Ghaemi SN, Viguera AC. Tolerance in antidepressant treatment. Psychother Psychosom 2002; 71 (04) 177-9.
    CrossrefPubMedGoogle Scholar
  • 2 Baldessarini RJ. Chemotherapy in Psychiatry. Cambridge Massachusetts: Harvard University Press. 1977
    PubMedGoogle Scholar
  • 3 Baldwin DS. et al. Discontinuation symptoms in depression and anxiety disorders. Int J Neuropsychopharmacol 2007; 10 (01) 73-84.
    CrossrefPubMedGoogle Scholar
  • 4 Barr LC, Goodman WK, Price LH. Physical symptoms associated with paroxetine discontinuation. Am J Psychiatry 1994; 151 (02) 289.
    CrossrefPubMedGoogle Scholar
  • 5 Black DW, Wesner R, Gabel J. The abrupt discontinuation of fluvoxamine in patients with panic disorder. J Clin Psychiatry 1993; 54 (04) 146-9.
    PubMedGoogle Scholar
  • 6 Black K, Shea C, Dursun S, Kutcher S. Selective serotonin reuptake inhibitor discontinuation syndrome: proposed diagnostic criteria. J Psychiatry Neurosci 2000; 25 (03) 255-61.
    PubMedGoogle Scholar
  • 7 Blier P, Tremblay P. Physiologic mechanisms underlying the antidepressant discontinuation syndrome. J Clin Psychiatry 2006; 67 (Suppl. 04) 8-13.
    CrossrefPubMedGoogle Scholar
  • 8 Bridge JA. et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA 2007; 297 (15) 1683-96.
    CrossrefPubMedGoogle Scholar
  • 9 Byrne SE, Rothschild AJ. Loss of antidepressant efficacy during maintenance therapy: possible mechanisms and treatments. J Clin Psychiatry 1998; 59 (06) 279-88.
    CrossrefPubMedGoogle Scholar
  • 10 Delgado PL. Monoamine depletion studies: implications for antidepressant discontinuation syndrome. J Clin Psychiatry 2006; 67 (Suppl. 04) 22-6.
    PubMedGoogle Scholar
  • 11 DGPPN et al. (Hrsg.) für die Leitliniengruppe Unipolare Depression. S3-Leitlinie/Nationale Versorgungsleitlinie Unipolare Depression-Langfassung, 1. Auflage 2009. DGPPN, ÄZQ, AWMF – Berlin, Düsseldorf. 2009
    PubMedGoogle Scholar
  • 12 Fava GA. Holding on: depression, sensitization by antidepressant drugs, and the prodigal experts. Psychother Psychosom 1995; 64 (02) 57-61.
    CrossrefPubMedGoogle Scholar
  • 13 Fava GA. Can long-term treatment with antidepressant drugs worsen the course of depression?. J Clin Psychiatry 2003; 64 (02) 123-33.
    CrossrefPubMedGoogle Scholar
  • 14 Fava M. Prospective studies of adverse events related to antidepressant discontinuation. J Clin Psychiatry 2006; 67 (Suppl. 04) 14-21.
    PubMedGoogle Scholar
  • 15 Fergusson D. et al. Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials. BMJ 2005; 330 7488 396.
    CrossrefPubMedGoogle Scholar
  • 16 Fritze J. [Prescriptions for psychotropic drugs: results and comments on the 2007 prescription drug report]. Nervenarzt 2008; 79 (11) 1337-45.
    CrossrefPubMedGoogle Scholar
  • 17 Geddes JR. et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. Lancet 2003; 361 9358 653-61.
    CrossrefPubMedGoogle Scholar
  • 18 Geyskes GG, Dorhout EJMees, Boer P. Clonidine withdrawal mechanism and frequency of rebound hypertension. A reply to the letters of Dr. McMahon (1979) and Drs Whitsett & Chrysant (1979) Br J Clin Pharmacol 1979; 08 (04) 379-80.
    Google Scholar
  • 19 Goodwin FK. The biology of recurrence: new directions for the pharmacologic bridge. J Clin Psychiatry 1989; 50 Suppl: 40-4.
    PubMedGoogle Scholar
  • 20 Haddad PM. Antidepressant discontinuation syndromes. Drug Saf 2001; 04 (03) 193-97.
    Google Scholar
  • 21 Haddad P. The SSRI discontinuation syndrome. J Psychopharmacol 1998; 12 (03) 305-13.
    CrossrefPubMedGoogle Scholar
  • 22 Hirschfeld RM. Clinical importance of long-term antidepressant treatment. Br J Psychiatry Suppl 2001; 42: S4-8.
    Google Scholar
  • 23 Kirsch I. et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration. PLoS Med 2008; 05 (02) e45.
    CrossrefPubMedGoogle Scholar
  • 24 Kramer JC, Klein DF, Fink M. Withdrawal symptoms following dicontinuation of imipramine therapy. Am J Psychiatry 1961; 118: 549-50.
    CrossrefPubMedGoogle Scholar
  • 25 Lépine JP. et al. A randomized, placebo-controlled trial of sertraline for prophylactic treatment of highly recurrent major depressive disorder. Am J Psychiatry 2004; 161 (05) 836-42 Erratum in: Am J Psychiatry 2004; 161(7): 1320.
    CrossrefPubMedGoogle Scholar
  • 26 Lieb J. Antidepressant tachyphylaxis. J Clin Psychiatry 1990; 51 (01) 36.
    PubMedGoogle Scholar
  • 27 Lund N, Pedersen LH, Henriksen TB. Selective serotonin reuptake inhibitor exposure in utero and pregnancy outcomes. Arch Pediatr Adolesc Med 2009; 163 (10) 949-54.
    CrossrefPubMedGoogle Scholar
  • 28 Mucci M. Reboxetine: a review of antidepressant tolerability. J Psychopharmacol 1997; 11 (Suppl. 04) S33-7.
    PubMedGoogle Scholar
  • 29 Reid JL, Campbell BC, Hamilton CA. Withdrawal reactions following cessation of central alpha-adrenergic receptor agonists. Hypertension 1984; 06 (5 Pt 2): II71-5.
    Google Scholar
  • 30 Rosenbaum JF. et al. Selective serotonin reuptake inhibitor discontinuation syndrome: a randomized clinical trial. Biol Psychiatry 1998; 44 (02) 77-87.
    CrossrefPubMedGoogle Scholar
  • 31 Rosenstock HA. Sertraline withdrawal in two brothers: a case report. Int Clin Psychopharmacol 1996; 11 (01) 58-9.
    CrossrefPubMedGoogle Scholar
  • 32 Schatzberg AF. et al. Serotonin reuptake inhibitor discontinuation syndrome: a hypothetical definition. Discontinuation Consensus panel. J Clin Psychiatry 1997; 58 (Suppl. 07) 5-10.
    PubMedGoogle Scholar
  • 33 Schmidt ME. et al. Treatment approaches to major depressive disorder relapse. Part 1: dose increase. Psychother Psychosom 2002; 71 (04) 190-4.
    CrossrefPubMedGoogle Scholar
  • 34 Shelton RC. The nature of the discontinuation syndrome associated with antidepressant drugs. J Clin Psychiatry 2006; 67 (Suppl. 04) 3-7.
    CrossrefPubMedGoogle Scholar
  • 35 Tanum L. Reboxetine: tolerability and safety profile in patients with major depression. Acta Psychiatr Scand Suppl 2000; 402: 37-40.
    Google Scholar
  • 36 Turner EH. et al. Selective publication of antidepressant trials and its influence on apparent efficacy. N Engl J Med 2008; 358 (03) 252-60.
    CrossrefPubMedGoogle Scholar
  • 37 Valuck RJ, Orton HD, Libby AM. Antidepressant discontinuation and risk of suicide attempt: a retrospective, nested case-control study. J Clin Psychiatry 2009; 70 (08) 1069-77.
    CrossrefPubMedGoogle Scholar
  • 38 Viguera AC, Baldessarini RJ, Friedberg J. Discontinuing antidepressant treatment in major depression. Harv Rev Psychiatry 1998; 05 (06) 293-306.
    CrossrefPubMedGoogle Scholar
  • 39 Zajecka J, Tracy KA, Mitchell S. Discontinuation symptoms after treatment with serotonin reuptake inhibitors: a literature review. J Clin Psychiatry 1997; 58 (07) 291-7.
    CrossrefPubMedGoogle Scholar