选择性5-羟色胺再摄取抑制剂撤药综合征的临床表现与管理策略:系统回顾与荟萃分析OA

The selective serotonin reuptake inhibitors(SSRIs)discontinuation syndrome is a common yet underrecognized clinical issue arising from the interruption or tapering of antidepressant treatment,with an estimated overall incidence of 20%to 50%.This syndrome is particularly frequent with short-half-life agents like paroxetine.There are multiple clinical challenges facing the treatment of this syn-drome,including under-recognition,a lack of uniform diagnostic criteria,and incompletely elucidated pathogenesis.Moreover,its symptoms are often misdiagnosed as recurrence of depression,leading to unnecessary re-medication or erroneous clinical decision-making,which seriously compromises the safety of treatment and prognosis of patients.Despite the focus of existing studies on such risk factors as half-life of drugs,treatment durations,and tapering rates,there remains a lack of summaries based on high-quality evidence and consensus on clinical management strategies.SSRIs discontinuation syndrome is characterized by a broad range of clinical features,including somatic symptoms such as autonomic instability,influenza-like illness,gastrointestinal disturbances,and neurological and sleep disorders,alongside psychiatric manifestations like anxiety,agitation,and depressed mood.The under-lying mechanisms are multifactorial and dynamic,involving acute central serotonergic dysregulation,imbalances in multiple neurotransmitter systems,alterations in neuroplasticity,peripheral gastrointestinal dysfunction,and individual variability in genetics and metabolism.As for interventions,a closed-loop management approach involving early prevention,early recognition,and early interventions is recom-mended.This strategy should be grounded on individualized gradual tapering,quick identification of symptoms and implementation of stratified,targeted interventions.Therefore,this study integrates evidence currently available through a systematic review and Meta-analysis in the hope of shedding light on the clinical manifestations and mechanisms of SSRIs discontinuation syndrome,assess its prevalence and risk factors,and summarize intervention strategies in order to provide an evidence-based framework to enhance clinical awareness and guide the development of standardized tapering protocols.