反弹效应

反弹效应(英语:rebound effect,也称为反弹现像(rebound phenomenon)),是指患者的医学征象因受药物治疗而消失,或是受到控制,但在停药或减少剂量时,症状会出现,或是重新出现。重新出现时,症状的程度通常比治疗前更为严重。[1][2]

例子

镇静安眠药

反弹性失眠指的是在停止服用缓解原发性失眠的镇静剂后,而发生的失眠。使用这些物质通常会导致用者产生身体依赖,必须继续服用才能入睡。因此,当患者停止服药并且受到“反弹”的影响而失眠,这是药物戒断的症状。有时这种失眠的程度会比治疗之前的更严重。[3]会导致此种问题的常见药物,已知的有艾司佐匹克隆唑吡坦抗焦虑药(例如苯二氮䓬类药物)。这些药物供难以入睡或是难以安稳睡眠的人使用。

以前没罹患抑郁症状的人可能会出现此类症状。[4]

反弹现像不一定只在停药后才会出现。例如,典型的苯二氮䓬类戒断症状如焦虑症、金属味觉、知觉障碍等白天反弹效应,可能会在短效苯二氮䓬类催眠药消退后的第二天出现。例如,当短效的催眠药力消退后,可能会出现清晨反弹性失眠,而导致反弹性觉醒,迫使人们能在完成整夜睡眠之前变得完全清醒。因为三唑仑的强力效果和超短半衰期, 常与这种现象发生关连,但类似影响也会由其他短效催眠药造成。[5][6][7]由于夸西泮英语Quazepam对1型苯二氮䓬类受体具有选择性,半衰期长,在治疗过程中不会引起白天焦虑反弹效应,说明半衰期对于夜间催眠药是否会引起次日反弹戒断效应,有重要影响。[8]白天反弹效应不一定属于轻微,但有时会产生相当明显的精神和心理障碍。[9]

兴奋剂

哌醋甲酯右旋安非他命兴奋剂所产生的反弹效应有兴奋剂精神病英语stimulant psychosis、抑郁症、和注意力不足过动症(ADHD)复发,症状会以短暂而夸张的形式出现。[10][11][12]当服用哌醋甲酯时,多达3分之1曾罹患ADHD的儿童会出现反弹效应。[13]

抗抑郁药

许多抗抑郁药,包括选择性5-羟色胺再摄取抑制剂(SSRIs), 停药时会导致反弹性抑郁、惊恐发作、焦虑、和失眠。[14]

抗精神病药

服用抗精神病药物,当换药英语Antipsychotic switching或是停药过速时,可能会出现突然以及严重的精神病发作,[15]或是复发[16]

肾上腺素能alpha2-受体激动剂

可乐定[17]胍法辛[18]停药后会出现反弹性高血压,会高过治疗前的水准。

持续使用局部去充血剂英语Topical decongestant鼻腔喷雾剂英语nasal spray)会导致持续的鼻塞,称为药物性鼻炎英语rhinitis medicamentosa

其他药物

另个例子是当止痛药剂量降低、药效退散、或是突然停药时,所引起的药品过度使用头痛英语Medication overuse headache[19]

于2022年,有关于Covid-19患者,在接受Paxlovid治疗后,会出现病毒RNA及症状反弹的报告。同年5月,美国疾病管制与预防中心(CDC)甚至发布健康警讯,告知医生有关“Paxlovid反弹”情事,这在拜登总统出现反弹时受到关注。但反弹原因尚不清楚,因为治疗与否,约3分之1的患者均会出现症状反弹。

一个例子是使用强效皮质类固醇(例如丙酸氯倍他索),以治疗牛皮癣。突然停药会导致更严重的牛皮癣发生。因此应逐步停药,也许用乳液稀释药物,直到实际药物降到极少的程度。[20]

参见

参考文献

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