抗抑郁药在多个国家被广泛使用，美国、英国和澳大利亚分别有超过16%、近15%和14%的人口正在服用此类药物1。在美国，患者服用选择性5-羟色胺再摄取抑制剂（SSRIs）的中位时间已达5年，且有超过四分之一的患者服药时间长达10年或更久1。长期服药后停药可能引发严重的戒断反应，但2022年针对美、英、澳、加等国临床指南的审查显示，这些指南均缺乏具体的药物减量或戒断症状管理指导1。
英国国家医疗服务体系（NHS）研究员Mark Horowitz在服用SSRI类药物escitalopram十年后停药，经历了恐慌发作、眩晕和失眠等严重戒断症状1。Horowitz参与的一项针对300多名停药者的调查显示，近五分之四的人报告了某种戒断副作用，45%的人经历了中度或重度困难1。2024年一项涵盖16000多名停用抗抑郁药者的分析发现，约15%的人出现戒断症状，约1/35的人症状严重1。Horowitz同年对1148名尝试停药者的另一项研究指出，43%的人戒断症状持续至少一年，四分之一的人最终无法停药1。长期服用抗抑郁药还伴随其他健康风险，哥本哈根大学医院的研究发现服药至少6年者发生致命心脏事件的风险增加74%1。2023年的研究也表明，70至80岁服用SSRI者的认知衰退速度显著加快1。
医学界正推动新的减量方法和临床指南更新，促使医疗体系重新评估SSRIs的长期风险与治疗范式1。Horowitz创立了Outro Health诊所以帮助患者安全减量，并参与了英国皇家精神科医师学会官方指南的制定1。美国临床精神药理学学会发布了停药建议，要求至少每年重新评估精神科药物处方的价值1。英格兰和威尔士的新指南则将认知行为疗法、正念和冥想列为轻度抑郁的一线治疗1。
The medical community is undergoing a significant reassessment of antidepressant withdrawal, particularly concerning selective serotonin reuptake inhibitors (SSRIs), driven by growing research and patient experiences 1. Mark Horowitz, a researcher for the UK's National Health Service (NHS), personally experienced severe withdrawal symptoms, including panic attacks, dizziness, and insomnia, after stopping escitalopram, an SSRI, following a decade of use 1. This shift in perspective comes as antidepressant usage remains highly prevalent, with over 16% of the population in the US, nearly 15% in the UK, and 14% in Australia taking these medications 1. In the US alone, the median duration of SSRI use is five years, with more than a quarter of patients taking them for ten years or longer 1. Despite this widespread and prolonged use, a 2022 review of clinical guidelines across the US, UK, Australia, and Canada revealed that none of the guidelines provided specific instructions for tapering off or managing withdrawal symptoms 1.
Recent studies have highlighted the severe impact of discontinuing these medications and the potential long-term risks associated with their use 1. In a study involving over 300 individuals who stopped taking antidepressants, nearly four-fifths reported some form of withdrawal side effect, and 45% experienced moderate to severe difficulties 1. A broader 2024 analysis of more than 16,000 people who discontinued antidepressants found that approximately 15% experienced withdrawal symptoms, with about one in 35 suffering from severe symptoms 1. Furthermore, another 2024 study by Horowitz surveying 1,148 individuals attempting to stop the medication showed that 43% had withdrawal symptoms lasting at least a year, and one-quarter were unable to discontinue use entirely 1. Beyond withdrawal, long-term use carries other risks; a Copenhagen University Hospital study found a 74% increased risk of fatal cardiac events for those taking antidepressants for at least six years, while a 2023 study indicated significantly accelerated cognitive decline in SSRI users aged 70 to 80 1.
In response to these findings, new clinical approaches and guidelines are being implemented to better manage patient care 1. Horowitz has established the Outro Health clinic to assist patients in safely tapering their medications and has contributed to the development of official guidelines for the Royal College of Psychiatrists in the UK 1. Meanwhile, the American Clinical Psychopharmacology Society has issued new discontinuation recommendations, mandating that the value of psychiatric drug prescriptions be re-evaluated at least annually 1. Additionally, new guidelines in England and Wales now list cognitive behavioral therapy, mindfulness, and meditation as first-line treatments for mild depression 1.
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