학술논문
항 우울제의 회귀한 부작용
이용수 7
- 영문명
- Unusual Side Effects of Antidepressants
- 발행기관
- 대한신경정신의학회
- 저자명
- 이범상
- 간행물 정보
- 『신경정신의학』제25권 제3호, 531~538쪽, 전체 8쪽
- 주제분류
- 의약학 > 정신과학
- 파일형태
- 발행일자
- 1986.08.31
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국문 초록
영문 초록
Common side effects of antidepressants, particularly
tricyclic antidepressants, are the autonomic effects expected
as a result of their anticholinergic pharmacological
properties: dry mouth, palpitation, tachycardia, loss of
accommodation, blurred vision, postural hypotension
fainting, dizziness, constipation, vomiting, edema, and
aggravation of narrow angle glaucoma, urinary retention.
Occasionally, antidepressants also include uncommon
side effects such as skin rashes, jaundice, leukopenia or
leukocytosis, agranulocytosis, gynecomastia in the male,
prolonged ejaculation, disturbed concentration, delirium,
hallucination, disorientation, confusional states, nightmares,
black-outs, and seizures. An extensive computerized
literature search shows that only one article
mentions the occurrence of amnestic episodes during
antidepressant drug treatment.
The author discusses the dissociative episodes with
total amnesia and seizures induced by antidepressants
using case presentations and also reviews existing articles
obtained through computer search. Two cases of
the dissociative episodes with amitriptyline hydrochloride
and two cases of seizure, one associated with desipramine
hydrochloride overdose in a suicide attempt and
the other with maprotiline therapy, are discussed and
reviewed.
Case 1:A 57 year-old divorced caucasian female had
a nine year history of severe depression with suicidal
ideations. She had had several psychiatric hospitalizations
and had been treated with multiple antidepressants,
thioridazine, chlorpromazine, and lithium. She started
taking amitriptyline 300 mg daily for severe relapse of
depression with suicidal risk. Approximately three
months later, she developed a fugue state with total
amnesia of more than hour-long durations. Her EEG and
brain CT scan were all within normal limits.
Case 2: A 39 year-old divorced caucasian male had a
long history of alcoholism, pancreatitis and depression.
He started taking amitriptyline 150 mg daily for depression
with sleep disturbance. He responded favorably to
amitriptyline and two months later, the dosage was
increased to 200 mg daily. Approximately three weeks
later, he developed an acute dissociative episode with
with violent behaviors.
Case 3: A 29 year-old married Korean woman was
admitted to a hospital ICU via the emergency room for
desipramine overdose. She had ingested about fifty 25
mg tablets of desipramine in a suicide attempt. She had
developed acute delusional depression approximately
eight months prior to this admission and had been
hospitalized in another hospital at that time. She immigrated
from Korea to the United States about ten years
before her psychotic depression was precipitated by her
father’s death. She had a grand-mal seizure while she
was in the emergency room and had another seizure in
the ICU. Her seizures were treated with phenytoin I.V.
injections, and physostigmine I.V. injections were given
to counteract the anticholinergic effects of desipramine.
She recovered three days later with a complication of
mild pleurisy.
Case 4: A 32 year-old single caucasian female had
suffered from severe depression and anxiety for the
past five years. She had tried imipramine and desipramine
without favorable response. She started taking
maprotiline 50 mg twice a day at her own request
because her mother responded well to the same medication.
The dosage was increased to 100 mg twice a day,
four days later. Nine days later, this dosage was
incresed to 100 mg three times daily. She responded
well to maprotiline and she was able to work for the
first time in five months. Seven days later, she experienced
an epileptic seizure at work. She had no past
history of epilepsy. Maprotiline therapy was immediately
discontinued, and she suffered no further seizures for
the following ten months.
Acknowledgement: Special thanks to Ofelia Bernier,
RN at East San Fernando Valley M.H.S. for
목차
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증례보고 및 본론
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