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(1)±âºÐÀå¾Ö(Mood d-isorder)
±âºÐÀå¾Ö´Â °¨Á¤Àå¾Ö ¶Ç´Â Á¤µ¿Àå¾Ö¶ó°í ÇÏ¸ç ¿ì¿ïÁõ ¿¡ÇǼҵ常 ³ªÅ¸³ª´Â ÁÖ¿ä ¿ì¿ïÁõ(major depressive dis-order)°ú ¿ì¿ïÁõ°ú Á¶Áõ ¿¡ÇǼҵ尡 °°ÀÌ ³ªÅ¸³ª´Â Á¶¿ïÁõ(manic-depressive disorder)À¸·Î ³ª´©¸ç ´ÜÁö Á¶Áõ(manic disorder)¸¸ ³ªÅ¸³ª´Â °æ¿ì´Â ¸Å¿ì µå¹É´Ù.
±âºÐÀå¾Ö´Â À¯ÀüÀûÀÎ ¿äÀÎ, ½Å°æÈÇй°Áú ¿äÀÎ ¹× Á¤½ÅÀûÀÎ ¿äÀο¡ ÀÇÇØ ¹ß»ýÇÑ´Ù.
±×Áß ½Å°æÈÇй°Áú¿äÀÎÀ¸·Î´Â ·Î´Â ÁÖ¿ä¿ì¿ïÁõÀÎ °æ¿ì serotonin °áÇÌ, ¿ì¿ïÁõÀÎ °æ¿ì¿¡´Â norepinephrine ¶Ç´Â serotonin °áÇÌ°ú Á¶ÁõÀÎ °æ¿ì norepinephrine °ú´Ù°¡ ¿øÀÎÀÌ µÈ´Ù.
´ÙÀ½ 8°¡Áö Áõ»óÁß 4°¡Áö ÀÌ»ó Áõ»óÀÌ 2ÁÖ°£ Áö¼ÓµÉ ¶§ ¿ì¿ïÁõÀ̶ó Áø´ÜÇÑ´Ù.
-½Ä¿åÀÇ Áõ°¡ ¶Ç´Â °¨¼Ò
-ºÒ¸é ¶Ç´Â °ú¸é
-Á¤½Å¿îµ¿ Áö¿¬ ¶Ç´Â µ¿¿ä
-°¡Á·, ¼º»ýÈ°, ÀÏ, Ãë¹Ì ¹× »çȸȰµ¿¿¡ ´ëÇÑ °ü½É ÀúÇÏ ¶Ç´Â Áõ°¡
-¹«°¡Ä¡ ¶Ç´Â ÁËÃ¥°¨ »ý°¢
-¿¡³ÊÁö ÀúÇÏ ¹× ¸¸¼ºÇÇ·Î
-ÁýÁß·Â ÀúÇÏ ¶Ç´Â ±â¾ï·Â °¨Åð
-Àڻ쿡 »ý°¢, ½Ãµµ ¹× Á×À½¿¡ ´ëÇÑ ÁýÂø
¿ì¿ïÁõÄ¡·áÁ¦·Î´Â »ïȯ°èÇ׿ì¿ïÁ¦(TCA, tricyclic antidepressants), ¼¼·ÎÅä´Ñ ÀçÈí¼öÂ÷´ÜÁ¦(SSRI, selective serotonin reuptake inhibitors), °¡¿ªÀû ´Ü±â¾Æ¹ÎÈ¿¼ÒÀúÇØÁ¦(RIMA, reversible inhibitors of monoamine oxidase) ¹× ¼¼·ÎÅä´Ñ ¹× ³ë¸£¿¡Çdz×ÇÁ¸° ÀçÈí¼öÂ÷´ÜÁ¦(SNRI, serotonin and norepinephrine reupatke inhibitors)°¡ ÀÖ´Ù.
TCA(¿¹, amitriptyline)´Â norepineph-rine, serotoninÀ» Áõ°¡½ÃÅ°°í histamine, a-cethylcholine, ¾ËÆÄ ¼ö¿ëü¸¦ Â÷´ÜÇÑ´Ù.
SSRI(¿¹, fluoxetine)´Â ÁÖ·Î serotonin¸¸À» Áõ°¡½ÃŲ´Ù.
RIMA(¿¹, moclobemide)´Â ÁÖ·Î nor-epinephrine¸¸À» Áõ°¡½ÃŲ´Ù.
SNRI(¿¹, venlafaxine)´Â serotonin°ú norepinephrine ¸ðµÎ Áõ°¡½ÃŲ´Ù.
LithiumÀº norepinephrineÀ» ÀúÇϽÃŲ´Ù.
a.¿ì¿ïÁõ(depression)
¿ì¿ïÁõÀº ȯÀÚ¿¡ µû¶ó ¾àÈ¿ÀÇ °µµ¿Í ºÎÀÛ¿ëÀ¸·Î ÁøÁ¤ÀÛ¿ë, Ç×Äݸ°ÀÛ¿ë, ±â¸³¼ºÀúÇ÷¾Ð, ºÎÁ¤¸Æ, °£Áú¹ß»ý µîÀÇ Á¤µµ¸¦ ÆÇ´ÜÇÏ¿© ¾à¹°À» ¼±ÅÃÇÏÁö¸¸ 1Â÷ÀûÀ¸·Î TCAÀ̳ª SSRIÁß¿¡¼ ¼±ÅÃÇÑ´Ù.(A)
ȯÀÚ°¡ ºÒ¾È ¹× ¼ö¸éÀå¾Ö Áõ»óÀ» °¡Áö°í ÀÖ´Â °æ¿ì¿¡´Â Ç׺ҾÈÁ¦¸¦ »ç¿ëÇÑ´Ù.(B)
ȯÀÚ°¡ Á¤½Åº´ Áõ»óÀ» °¡Áö°í ÀÖ´Â °æ¿ì¿¡´Â Ç×Á¤½Åº´Á¦¸¦ Ãß°¡ÇÑ´Ù.(C)
ÇÊ¿äÇϸé Áõ»ó°³¼±Á¦¸¦ Åõ¿©ÇÑ´Ù.(D)
b.Á¶¿ïÁõ(manic-dep-ression)
Á¶¿ïÁõÀº ȯÀÚ¿¡ µû¶ó ¾àÈ¿ÀÇ °µµ¿Í ºÎÀÛ¿ëÀ¸·Î ÁøÁ¤ÀÛ¿ë, Ç×Äݸ°ÀÛ¿ë, ±â¸³¼ºÀúÇ÷¾Ð, ºÎÁ¤¸Æ, °£Áú¹ß»ý µîÀÇ Á¤µµ¸¦ ÆÇ´ÜÇÏ¿© ¾à¹°À» ¼±ÅÃÇÏÁö¸¸ 1Â÷ÀûÀ¸·Î TCA³ª SSRIÁß¿¡¼ ¼±ÅÃÇÑ´Ù.(A)
Á¶Áõ Áõ»óÀ» °³¼±Çϱâ À§ÇØ lithiumÀ» Åõ¿©ÇÑ´Ù.(B)
ȯÀÚ°¡ ºÒ¾È ¹× ¼ö¸éÀå¾Ö Áõ»óÀ» °¡Áö°í ÀÖ´Â °æ¿ì¿¡´Â Ç׺ҾÈÁ¦¸¦ »ç¿ëÇÑ´Ù.(C)
ÇÊ¿äÇϸé Áõ»ó°³¼±Á¦¸¦ Åõ¿©ÇÑ´Ù.(D)
Á¤½Å½Å°æ°èÅë¾à¹°
<Ç׿ì¿ïÁ¦ Antidepressants>
* »ïȯ°èÇ׿ì¿ïÁ¦(TCAs, Tricyclic antidepressants)
¢Â 3±Þ¾Æ¹Î(Tertiary amines)
Amineptine(¾ÆÁ¶¶ó Á¤, ÇÑÈ) 50-100-mg PO bid
Amitriptyline(¿¡³ªÆù Á¤, ȯÀÎ) Initi-ally 25mg PO tid or 75mg PO hs
Comipramine(¾Æ³ªÇª¶ó´Ò Á¤, ÇÑ< ÀúÀÛ±ÇÀÚ © ¾à±¹½Å¹® ¹«´ÜÀüÀç ¹× Àç¹èÆ÷±ÝÁö > |
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