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1 REVIEW ARTICLE pissn: eissn: Korean J Clin Geri 2015;16(1): 항우울제의우울증외적응증 이동국 대구가톨릭대학교의과대학신경과학교실 Indication of Antidepressants Other than Depression Dong-Kuck Lee Department of Neurology, Catholic University of Daegu, School of Medicine, Daegu, Korea Antidepressants is one of the most frequently used drug in clinical field. Except for depression, these drugs have many therapeutic potentials. So the aim of this article is to review the reported effects of antidepressants in clinical fields other than depression. Those fields include various pains, dementia, sleep disorders, irritable bowel syndrome, smoking cessation, urinary incontinence, premature ejaculation, anxiety, obesity, epilepsy, and attention deficit-hyperactivity disorder, et al. Key Words: Antidepressants, Other than depression 서론 각종항우울제는임상에서가장흔히처방되는약중하나이다 (Table 1). 원칙적으로항우울제는우울증에만처방되겠지만우울증이외에도다양한병에서효과를볼수있다. 우선 Stone 등 1) 은선택적세로토닌재흡수억제제 (SSRI) 는범불안장애, 조기사정 (premature ejaculation), 편두통, 당뇨병성신경병, 섬유근통, 및심장신경성실신등에효과가있다고하였다 (Table 2). Mostert 등 2) 은 fluoxetine이동물실험상에서는뇌졸중, 다발성경화증, 및뇌전증등에효과가있고인간에서는알츠하이머병, 뇌졸중, 헌팅턴병, 다발성경화증, 외상성뇌손상, 및뇌전증등의신경증상을호전시킨다고하였다. Bossini 등 3) 은 trazodone이불면증과불안에효과가있고그외에도폭 식증 (bulimia), 벤조다이아제핀남용, 술금단후수면장애, 섬유근통, 및치매환자의행동장애, 정신분열병, 신경이완제에의한급성정좌불능증 (akathisia), 만성통증질환, 및성적장애등에도도움이된다고하였다. 따라서이종설에서는다양한항우울제가우울증이외에도어떤병에서어떤효과가있는지간략하게살펴보고자한다. 본론 1. 통증 1) 신경병통증체감각계의손상이나병때문에생기는통증인신경병통증은아주흔한증상이며대개만성이고난치성인 Received: April 23, 2015 Revised: May 11, 2015 Accepted: June 10, Corresponding author: Dong-Kuck Lee Department of Neurology, Catholic University of Daegu, School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-gu, Daegu , Korea Tel: , Fax: , dklee@cu.ac.kr Copyright C 2015 The Korean Academy of Clinical Geriatrics This is an open access article distributed under the term s of the C reative Com m ons Attribution N on-c om m ercial License ( licenses/by-nc/4.0) which perm its unrestricted non-comm ercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

2 이동국 : 항우울제의우울증외적응증 9 Table 1. Types of antidepressants 1. TCAs: Imipramine, Amitriptyline, Clomipramine, Desipramine, Dothiepin, Ortriptyline, Amoxapine, Doxepin, Protriptyline, Trimipramine, Maprotiline 2. MAOIs a) Irreversible & nonselective classical MAOIs: Isocarboxazid, Pheneizine, Tranylcypromine b) Reversible inhibitor of MAOIs: Moclobemide 3. SSRIs: Citalopram, Excitalopram, Fluvoxamine, Fluoxetine, Paroxetine, Sertraline 4. Dual SNRIs: Duloxetine, Milnacipran, Venlafaxine 5. Serotonin HT 2 antagonist and reuptake inhibitors (SARIs): Nefazodone, Trazodone 6. NaSSAs: Mirtazapine 7. NRIs: Reboxetine 8. NDRIs: Bupropion 9. Other synthetic antidepressants, e.g. melatonergic agonist and serotonin 5-HT 2c antagonists: Agomelatine 10. Herbal preparations: St. John s wort MAOIs: monoamine oxidase inhibitors, NaSSAs: noradrenergic and specific serotonergic antidepressants, NDRIs: noradrenaline and dopamine reuptake inhibitors, NRIs: noradrenaline reuptake inhibitors, SNRIs: serotonin noradrenaline (norepinephrine) reuptake inhibitors, SSRIs: selective serotonin reuptake inhibitors, TCAs: tricyclic antidepressants. CNS Drugs 2012;26(4): Table 2. Off-Label applications of SSRIs Condition Medication and recommend dosages Efficacy/recommendations Levelofevidence Generalized anxiety disorder Premature ejaculation Diabetic neuropathy Migraine headaches (prophylaxis) Fibromyalgia Neurocardiogenic syncope Fluvoxamine (Luvox), 50 to 300 mg daily Paroxetine (Paxia), 20 to 60 mg daily (generalized anxiety disorder is not an off-label use) Paroxetine, 20 mg daily or as needed a few hours before anticipated sexual activity Sertraline (Zoloft), 25 to 50 mg daily or as needed a few hours before anticipated sexual activity Fluoxetine (Proze), 20 mg daily Paroxetine, 40 mg daily Fluoxetine, 20 to 40 mg daily Fluoxetine, 20 mg daily Citalopram (Celexa), 20 to 40 mg daily Paroxetine, 20 mg daily Sertraline, 50 mg daily Fluoxetine, 20 mg daily Am Fam Physician 2003;68: Effective; maybe a good long-term alternative to benzodiazepines of other anxiolytics - Effective; consider as first-line treatment Possibly effective; other trugs should be consideredfirst. One meta-analysis found no difference between placebo and SSRIs May be useful if patient cannot use standard prophylactic agents of if other agents fail; good choice if patient has concomitant depression or other illness treatable with SSRI Possibly effective, particularily when combined with amitriptyline (Elavil) Studies on citalopram showed no significance May be useful if standard treatment is fail Has been studied in children B: lower quality RCT B: lower quality RCT B: lower quality RCT B: nonrandomized, small, prospective trial B: nonrandomized, small, prospective trial

3 10 Korean J Clin Geri 2015;16(1):8-16 경우가많다. 신경병통증의가장흔한원인으로는당뇨병, 수술후신경통을포함한신경외상, 및신경뿌리병 (radiculopathy) 등이있다. 그외에도대상포진, 척추퇴행, 및뇌졸중등도노인에서흔히만성신경병통증을잘일으킨다. 난치성신경병통증은심각한통증을일으켜신체기능을저하시키고삶의질을떨어뜨린다. 현재 nortriptyline과 desipramine같은 2차아민과 amitriptyline과 imipramine같은 3차아민을포함한다양한삼환계항우울제 (TCAs) 와 duloxetine과 venlafaxine같은선택적노에피네프린재흡수억제제 (SNRI) 등이신경병통증의치료에자주쓰인다. 4) (1) 대상포진후신경통 : 항우울제는오랫동안다양한신경병통증치료에널리쓰여왔다. 최근까지도 TCAs 가가장흔하게쓰여왔지만혼돈, 입마름, 진정, 및소변저류등의다양한부작용과심장독성으로인해처방하기가힘든경우가있었다. 그러나대상포진후신경통의치료에는아직도 TCAs가유용하다. 항우울제중 SSRI 는만성통증에서는효과가없지만 venlafaxine, bupropion, 및 duloxetine 등은신경병통증에도움이된다. 5) (2) 당뇨병성신경병통증 : 만성당뇨병환자중 10 20% 에서신경병통증이생겨신체기능을저하시키고기분이나수면같은기본적인삶의질을떨어뜨린다. 이런환자에서가장흔히쓰이는주요약에 TCAs와 SNRI가포함된다. 현재까지당뇨병성신경병통증에가장효과가있다고알려진약은 duloxetine과 pregabalin이다. 그러나만약금기증이없다면 TCAs가우선처방될수있다 (Figure 1). 6) (3) 소섬유신경병통증 : 소섬유신경병은다양한원인에의해생기고대부분병력과진찰로진단되며불에타는느낌, 욱신거림, 이질통증 (allodynia), 또는감각과민 (hyperesthesia) 등을보인다. 치료는기저원인에따라다르며신경병통증을줄이는것이가장중요하다. 다양한약제중항우울제가널리쓰인다. 특히 TCAs는모든치료지침에서첫번째로추천된다. 또한 SNRI인 duloxetine과 venlafaxine도흔히쓰인다. 7) (4) 화학요법에의한통증성말초신경병 : 화학요법후통증을심하게호소하는말초신경병에대해아직도효과적인치료법은적지만 SNRI인 duloxetine을 5주일정도써보니위약에비해통증이많이줄었다고한다. 8) (5) 다발성경화증에의한통증 : 다발성경화증에서통증은흔한증상으로많게는환자의 75% 에서통증을 Figure 1. Managment of diabetic peripheral neuropathic pain. Am Fam Physician 2010;82: 호소한다. 통증은병의경과중언제라도생길수있으며강직, 피로, 및기분장애등이있어도통증이발생한다. 다양한진통제중 amitriptyline, nortriptyline, 및 clomipramine 같은 TCAs가우선적으로추천된다. 이런약들은신경세포연접부에작용하여세로토닌과노에피네프린전달을증가시키고 sodium 통로를활성화한다. 이런약의부작용으로는입마름, 의식저하, 변비, 소변저류, 및저혈압등이있으므로참고하여처방해야한다. 9) 2) 환지통사지가절단되면 80 85% 환자에서절단된원위부에환지통이생긴다. 증상으로는불에타는느낌, 욱신거림, 또는조이는느낌등이발생한다. 발병기전은자세히모르며다양한치료법이제시되고있지만아직도난치성이다. Kuiken 등 10) 은세로토닌과노에피네프린대사에작용하는 mirtazapine이환지통에효과적이며더불어수면과

4 이동국 : 항우울제의우울증외적응증 11 기분상승에도도움이된다고하였다. 따라서부작용이많은 TCAs보다 mirtazapine이환지통에우선적으로사용되어야한다고했다. Spiegel 등 11) 은 duloxetine과 pregabalin 이환지통치료에도움이된다고했고 Nagoshi 등 12) 은 SNRI인 milnacipran이우선적으로추천된다고했다. 3) 두통수면 (hypnic) 두통은주로 50세이후수면중나타나는일차성두통이다. 이런두통의예방적치료로서 venlafaxine 및 amitriptyline을포함한 TCAs을단독으로쓰던지아니면 lithium을포함한다른약과같이쓰면약간효과가있다고한다. 13) Diener 등 14) 은만성매일두통에서 fluoxetine을 20 mg부터시작하여치료반응을보아가며 40 mg까지쓴후 3개월지나평가해보니대조군에비해두통빈도가줄었다고했다. 4) 섬유근통섬유근통은만성전신성다발성통증, 수면장애, 인지장애, 및피로등을보이는질환이다. 따라서이런환자들은만성통증으로인해삶의질이많이떨어져있으며과민성대장증후군, 불안, 우울증, 또는염증성류마티스성질환등을동반하고있는경우가많다. 섬유근통에가장효과적이라고추천되는약으로는 TCAs 중 amitriptyline과 SNRIs 중 milnacipran과 duloxetine이있다. 그러나일부에서는효과가있지만많은환자들이부작용 을호소하기도하므로신중히약을선택한후경과를잘살펴야한다. 현재섬유근통에자주쓰이는약의종류와작용기건, 배설, 및흔한부작용은 Table 3과같다. 15,16) 2. 치매 Seitz 등 17) 은현재까지항우울제가치매환자의정신병과흥분을치료하는데대한보고는적었으나 SSRI인 sertraline과 citalopram이속임약과비교해서흥분을줄이는데효과가있다고했다. 또한 SSRI와 trazodone은속임약이나정신병약보다복용하기도편했다고한다. 그러므로앞으로도 SSRI, trazodone, 또는기타항우울제가치매환자의흥분과정신병을치료하는데대한안전성과약효에대한연구가더필요하다고했다. 또한 Drye 등 18) 도 citalopram이알츠하이머치매의인지기능과기분의호전에도움이된다고했다. 특히이런치매에서는환자의흥분이가장힘든증상인데항우울제는이런증상을호전시켜환자를돌보는가족과간병인을편하게해주었다고하였다. 한편 Cirrito 등 19) 은 SSRI인 citalopram을쥐에게장기간복용시킨결과뇌판 (palque) 생성이줄었다고하였다. 또한장기간항우울제를복용한사람의뇌에서도아미로이드와판의량이적었다고한다. 따라서세로토닌 signaling은인지기능이정상인에서는 amyloid beta-peptide (Abeta) 축적이적은것과연관이있다고하였다. Small 20) 은 citalopram을쓰면치매환자의흥분을줄이는데효과 Table 3. Drugs for treatment of fibromyalgia Drug Mechanisms of action Elimination Most frequent side effects Amipriptyline Cyclobenzaprine Duloxetine Pregabalin Milnacipran - Inhibition of NA and 5-HT reuptake - Na and Ca channel blocker - -adrenergic and NMA receptor antagonism - Potassium channel activator - Increase of GABABreceptor function Not well known Inhibition of NA and 5-HT reuptake (NA 5-HT) Binding to the 2 subunitof the voltage-gated Ca channels Inhibition of NA and 5-HT reuptake (NA>5-HT) mild NMDA receptor antagonism Curr Rheumatol Rep 2012;14: Hepatic (mainly CYP2C19) Hepatic (mainly CYP3A4 and CYP 1A2) Hepatic (oxidative pathways) [moderate inhibitor of the CYP2D6) Renal - 50% renal - 50% hepatic (mainly glucuronidation) Dry mouth, constipation, sedation, blurred vision, urinary retention, orthostatic hypotension, tachycardia, arrhythmias Drowsiness, dry mouth, fatigue, headache Nausea, dry mouth, constipation, dizziness, fatigue, insomnia, sexual dysfunction Dizziness, somnolence, weight gain, peripheral edema Nausea, headache, hot flushes, hyperhidrosis, palpitations

5 12 Korean J Clin Geri 2015;16(1):8-16 가있다고하였다. 그러나 citalopram, escitalopram, 및 amitriptyline 등은심전도에서이상소견을보일수있으므로주의해야한다고하였다. 3. 수면장애 Moller과 Ostergaard 21) 는허탈발작 (cataplexy) 과입면환각 (hypnagogic hallucination) 의치료에서과거에는 TCAs가주로쓰였으나요즈음은 venlafaxine이부작용도적으면서효과적이라고하였다. 그러나 venlafaxine은자살위험이높아진다는보고도있다. Nishino와 Okuro 22) 는허탈발작의치료에 TCAs, SSRIs, SNRIs, 및노에피네프린재흡수억제제 (NRI) 등이쓰인다고했다 (Table 4). 또한 Zaharna 등 23) 도허탈발작과자동행동의치료에 TCAs, SSRIs, SNRIs, 및 NRI가쓰인다고했다. Morrison과 Riha 24) 는허탈발작에서는 TCAs와 SSRIs가도움이되지만졸림증과발작수면 (narcolepsy) 치료시에는이런약이도움이되지않는다고 하였다. Mignot 25) 는발작수면의치료에 protriptyline, clomopramine, venlafaxine, duloxetine, atomoxetine, 및 fluoxetine 등이쓰인다고하였다. Lopez와 Dauvilliers 26) 도허탈발작의치료에 TCAs, MAOI, SSRIs, SNRIs, 및기타아민재흡수억제제등이쓰인다고하였다. 4. 과민성대장증후군과민성대장증후군의중증도와치료에영향을주는뇌-장의관계는 Figure 2와같으며항우울제의작용기전은 Table 5와같다. 또한과민성대장증후군에서흔히처방되는 TCAs, SSRIs, SNRIs, 비전형항정신약, tetracylic 항우울제, 및 azaspirodecanedione 등의용량은 Table 6과같다. 27) 5. 금연최근에는금연에대해새로개발된약은별로없는 Table 4. Current used anticataplectic agents Antidepressant Usual daily doses Half-life effects (h) Notes/side effects Tricyclics Imipramine Protriptyline Desipramine Clomipramine SSRIs Fluoxetine Fluvoxamine SNRIs Venlafaxine Milnaciplan mg 5 60 mg mg mg mg mg mg mg Dry mouth, anorexia, sweating, constipation, drowsines (NE>5-HT>DA) reported to improve vigilance measures anticholinergic effects (NE>5-HT>DA) a desmethyl metabolite of imiparmine, effects and side effects similar to those of imipramine (5-HT>NE>>DA) digestive problem, dry mouth, sweating, tiredness, impotence, anticholinergic effects, dismethyl-chlorpramine (NE>>5-HT>DA) is an active metabolite Noanticholinergic or antihistaminergic effects, good anticataplectic effect but less potent than clomipramine, active metabolite No active metabolite, pharmacological profile similar to fluoxetine less active than clomipramine, gastrointestinal side effects New serotonergic and adrenergic uptake blocker; no anticholinergic effects, effective on cataplexy and sleepiness, nausea New serotonergicand adrenergic uptake blocker; no anticholinergic or antihistaminergic effects, effective on cataplexy NRI Atomotexin mg 5.2 Normally indicated for ADHD Compounds improving disturbed night time sleep and cataplexy Sodium oxybate Overdoses (a single dose of mg/kg) induce dizziness, nausea, vomiting, (GHB) mg/kg/night confusion, agitation, epileptic seizures, and hallucinations and coma with bradycardiaand respiratory depression; no cataplexy rebound reported upon discontinuation SSRIs: selective serotonin reuptake inhibitors, SNRIs: serotonin noradrenaline (norepinephrine) reuptake inhibitors, NRIs: noradrenaline reuptake inhibitors. Expert Opin Emerging Drugs 2010;15(1):

6 이동국 : 항우울제의우울증외적응증 13 Figure 2. IBS-brain-gut influences on severity and treatment. IBS: irritable bowel syndrome. Expert Opin Investig Drugs 2013; 22(3): Table 5. Rational of antidepressants in IBS - Alterations in the brain-gut axis play a major role in IBS pathophysiology - Comorbid psychopathology is frequently seen in IBS - Antidepressants are helpful in similar mind-body conditions (fibromyalgia) - Some antidepressants have analgesic properties that are independent of their psychiatric effects - Antidepressants have a synergetic effect with other IBS treatment options behavioral treatment, hypnosis - Antidepressants affect gastrointestinal motility Expert Opin Investig Drugs 2013;22(3): 상태로서항우울제인 bupropion이 Zyban이란상품명으로널리쓰인다. 28) 이약은금연을하기 2주일전부터복용해야한다. 작용기전은잘모르지만뇌에서니코틴수용체를차단한결과니코틴효과를감소시키는것으로생각한다. 그러나경련, 자살우려가있는경우, 및양극성 (bipolar) 질환등에서는처방해서는안된다. 부작용으로는불면증, 두통, 및입마름등이있다. 29) 6. 비뇨기장애스트레스성요실금에서 duloxetine을쓰면천골 (sacrum) 척수의연접전신경원에서세로토닌과노에피네프린재흡수를억제하여요도폐쇄압력을증가시켜요실금증상을호전시킨다. Duloxetine을쓴환자의 50% 이상에서증상의반이상이줄었다고한다. 특히이약은여성에서효과적이며부작용으로는가벼운메스꺼움이있다. 30) 한편조기사정 (premature ejaculation) 을치료하는데는 TCAs의일종인 clomipramine과 SSRIs 중 fluoxetine, sertraline, paroxetine, 및 citalopram 등이효과적이다. 31) 7. 불안 Bereza 등 32) 은범불안장애의치료에 paroxetine, escitalopram, sertraline, 및 venlafaxine 등이우선적으로쓰인다고했다. Somashekar 등 33) 은모든종류의항우울제는신체화장애에효과가있으며특히 SSRI는건강염려증과신체불유쾌 (dysmorphic) 질환에효과가있고 SNRI는특히통증을동반한경우에도움이된다고하였다. 8. 비만 Lee와 Fujioka 34) 는아편유사제인 naltrexone은경미한체중감소효과가있지만만약 bopropion과같이쓰면더욱효과적이라고했다. Plodkowski 등 35) 도같은결과를보고하였다. Greydanus 등 36) 은비만청소년들의치료시 fluoxetine이효과가있으며그외에도입맛을감소시키는약으로는 sertraline과 bupropion 등이있다고했다. 그러나이런약들은우울증에적응증을가진것이지비만치료에공인된것은아니라고했다. 9. 뇌전증 Cardamone 등 37) 은뇌전증환자에게는우울증이잘동반되지만 TCAs나 bupropion 같은약은경련의빈도를증가시키므로 SSRI나 SNRI가효과적이라고했다. 현재뇌전증에서항우울제의효과는 Table 7과같다. 10. 기타 Berridge와 Devilbis 38) 는주의력결핍-과다활동장애 (attention deficit-hyperactivity disorder) 의치료에는 desipramine, nortriptyline 및 atomoxetine 등이효과가있다고했다.

7 14 Korean J Clin Geri 2015;16(1):8-16 Table 6. Common interventions used in IBS TCAs SSRIs SNRIs Drug Drug (daily dose range [mg]) Comments Atypical antipsychotics Azaspirodecanediones Tetracyclic antidepressant Desipramine (25 150) Nortriptyline (25 150) Amitriptyline (25 150) Paroxetine (20 60) Escitalopram (10 20) Venlafaxine (25 300) Duloxetine (20 80) Quetiapine (25 100) Buspiron (10 60) Mirtazapine (15 45) Begin with low dose and titrate by response Allow 4 8 weeks for maximal response Begin with low dose and titrate by response Psychological and analgesic effects Preliminary reports Improves gastric receptive relaxation Anti-emetic properties IBS: irritable bowel syndrome, TCAs: tricyclic antidepressants, SSRIs: selective serotonin reuptake inhibitors, SNRIs: serotonin noradrenaline (norepinephrine) reuptake inhibitors. Expert Opin Investig Drugs 2013;22(3): Table 7. Effects of antidepressants in patients with epilepsy Study group Antidepressants Follow up Seizure frequency in treatment group 9 PWE 36 PWE and MDD 100 PWE and depression or OCD 39 PWE and depression 11 PWE 17 PWE 43 PWE and HAMD score>15 75 PWE and HAMD score> PWE 28 PWE FLX SRT, FLX SRT CIT CIT FLX CIT MIR, CIT, REB Various 1 st and 2 nd gen. drugs FLV 3 months 1 year 1 year 4 months 8 10 months 14 months 2 months 7.5 months 1 year days 4 Px increase in seizure frequency by >50%; 5 Px not increased 2 Px increase in seizure frequency; 34 Px not increased (number of Px with reduced seizures not mentioned) 6 Px increase in seizure frequency; 94 Px not increased (number of Px with reduced seizures not mentioned) 2 Px had 50% increase in seizures; 37 Px with 50% decrease in seizures All Px showed improvements: 64.1% mean reduction in seizure frequency Seizures disappeared in 6 Px; in others, seizure frequency reduced by 30% No change in seizure frequency No change in seizure frequency No change in seizure frequency compared to not-treated Px No change in seizure frequency CIT: citalopram, FLV: fluvoxamine, FLX: fluoxetine, HAMD: hamilton depression rating scale, MDD: major depressive disorder, MIR: mirtazapine, OCD: obsessive compulsive disorder, PWE: people with epilepsy, Px: ppatients, REB: reboxetine, SRT: sertraline. British J Pharmacology 2013;168: 결 론 REFERENCES 최근다양한항우울제가개발되어우울증치료에흔히쓰이고있지만각종항우울제는우울증외에도신경병통증, 환지통, 두통, 및섬유근통등의각종통증, 치매, 수면장애, 과민성대장증후군, 금연, 비뇨기장애, 불안, 비만, 뇌전증, 및주의력결핍-과다활동장애의치료에도널리쓰이고있다. 따라서각종항우울제의종류와특성을알고있으면다양한난치병의치료에큰도움을받을수있을것이라고생각한다. 1. Stone KJ, Viera AJ, Parman CL. Off-label applications for SSRIs. American Family Physician 2003;68: Mostert JP, Koch MW, Heerings M, Heersema DJ, De Keyser J. Therapeutic potential of fluoxetine in neurological disorders. CNS Neuroscience & Therapeutics 2008;14: Bossini L, Casolaro I, Koukouna D, Cecchini F, Fagiolini A. Off-label uses of trazodone: a review. Expert Opin Pharmacother 2012;13: Haanpaa ML, Gourlay GK, Kent JL, Miaskowski C, Raja SN, Schmader KE, et al. Treatment considerations for patients with neuropathic pain and other medical comorbidities. Mayo Clin Pmc 2010;85(suppi):S15-S25.

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9 16 Korean J Clin Geri 2015;16(1):8-16 국문요약 현대사회가점점복잡해지고피곤해짐에따라우울증이증가하고따라서항우울제가임상에서가장흔히쓰이는약물중하나가되었다. 최근다양한항우울제가개발되어우울증치료에널리쓰이고있지만각종항우울제는우울증외에도신경병통증, 환지통, 두통, 및섬유근통등의각종통증, 치매, 수면장애, 과민성대장증후군, 금연, 비뇨기장애, 불안, 비만, 뇌전증, 및주의력결핍-과다활동장애의치료에도흔히쓰이고있다. 따라서각종항우울제의종류와특성및적응증을잘알고있으면임상에서우울증외에도다양한난치병의치료에큰도움을받을수있을것이라고생각한다. 중심단어 : 항우울제, 우울증외적응증

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<30332DB1E8C1A4C7F62DC6EDC1FD2DBDBD2D4F4B2E687770> 분당서울대학교병원정신건강의학과 김정현 Classification of Psychiatric Drugs 1) antipsychotic drugs or neuroleptics 2) anti-manic drugs or mood stabilizers 3) antidepressants 4) anti-anxiety drugs or anxiolytics 5) hypnotics