Even the pharmacotherapy is more effective than placebo for the treatment of depression, the outcome of pharmacoltherapy remains unsatisfactory for many patients. Apart from side effects, there are two major limitations of antidepressant therapy. One is the delayed onset of improvement and another i...
Even the pharmacotherapy is more effective than placebo for the treatment of depression, the outcome of pharmacoltherapy remains unsatisfactory for many patients. Apart from side effects, there are two major limitations of antidepressant therapy. One is the delayed onset of improvement and another is partial response. In order to address these clinical dilemmas, many psychiatrists more commonly employ add-on therapy. In past, the practice of using multiple drugs to enhance treatment response was called polypharamcy, and was disparaged as poor clinical practice. However, with improved understanding of how drugs affects the central nervous system and increased communication in journals and on computer networks about the relative merits of specific combinations, the scientific basis for the combining drugs is being defined. Indeed, the use of multiple medications as a stratege to enhance response has become both acceptable and widespread now a days. It is now referred to more positively as add-on therapy, co-medication, combination therapy, or drug augmentation. Thus, as the methods of practical strategies for treatment of depression, switching classes antidepressant drugs, combination therapy, augmentation strategies and brief treatment algorithm will be presented with items of considerations. However, when combination of drugs being tried, knowledges about the action of mechanism, pharamcokinetics, and pharmacodynamics are essential to cope with the possible adversive reactions and to get the appropriate responses for the treatment of depressive symptoms.
Even the pharmacotherapy is more effective than placebo for the treatment of depression, the outcome of pharmacoltherapy remains unsatisfactory for many patients. Apart from side effects, there are two major limitations of antidepressant therapy. One is the delayed onset of improvement and another is partial response. In order to address these clinical dilemmas, many psychiatrists more commonly employ add-on therapy. In past, the practice of using multiple drugs to enhance treatment response was called polypharamcy, and was disparaged as poor clinical practice. However, with improved understanding of how drugs affects the central nervous system and increased communication in journals and on computer networks about the relative merits of specific combinations, the scientific basis for the combining drugs is being defined. Indeed, the use of multiple medications as a stratege to enhance response has become both acceptable and widespread now a days. It is now referred to more positively as add-on therapy, co-medication, combination therapy, or drug augmentation. Thus, as the methods of practical strategies for treatment of depression, switching classes antidepressant drugs, combination therapy, augmentation strategies and brief treatment algorithm will be presented with items of considerations. However, when combination of drugs being tried, knowledges about the action of mechanism, pharamcokinetics, and pharmacodynamics are essential to cope with the possible adversive reactions and to get the appropriate responses for the treatment of depressive symptoms.
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문제 정의
이러한 가운데 약물병합의 필요성과 타당성이 높아지고 있는 것은 당면한 과제이며 현실이기도 하다. 이에 우울증의 약물치료에 있어 약물의 여러 병합치료방법을 소개하고 주의할 점들에 대해 기술함으로써 우울증 치료의 약물병합에 대한 이해를 도모하고자 한다.
여기서는 앞서 구분한 증강(augmentation)과 병합(combination)등 용어의 의미에 관계없이 우울증에 대한 치료효과를 증가시키기 위한 약물병합 방법을 통합하여 기술할 것이다.
우울증에서 약물치료가 효과적이나 몇 가지 단점이 여전히 지속되는 가운데 약물의 병합투여는 관심이 증대되고 있다. 이에 우울증의 약물병합 치료를 이해하기 위하여 몇 가지 전략들을 검토하였다.
후속연구
하지만 아직 분명한 기전과 안전성이 확증되지 못한 상태이다. 향후 중추신경계의 신경전달물질(neurotransmitter)들 사이의좀 더 분명한 상호작용을 이해하고, 생물학적 배경에 근거한 우울증의 아형분류 등에 대한 좀 더 많은 연구가 이루어지면 우울증의 치료목표, 증상에 초점을 맞춘 약물병합의 임상적 경험들이 축적될 것이며, 그에 따라 약물병합의 타당성과 안전하고 효과적인 방법들이 마련될 것이다.
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