Whenever a clinician manages the patients with depression, he may meet various problems that make it difficult to treat them. Even though he has good skills and knowledge about depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treat...
Whenever a clinician manages the patients with depression, he may meet various problems that make it difficult to treat them. Even though he has good skills and knowledge about depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather than the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used during pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms during pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes following prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.
Whenever a clinician manages the patients with depression, he may meet various problems that make it difficult to treat them. Even though he has good skills and knowledge about depression, some barriers will be appear during his practice. In general, the difficulties in treating depression are treatment-resistance, adverse effects of antidepressants, pregnancy in female patients, comorbid medical conditions, poor compliance, drug-drug interactions, and so on, which are related with pharmacological treatments. Here, only the two of them, the treatment-resistant depression and difficult problems concerned with pregnancy, were discussed. Some level of treatment resistance is the norm rather than the exception. As the treatment failure stems from inadequate treatment, it is important that the clinician should prescribe medications with sufficient doseage and adequate duration. And to overcome the treatment resistant depression the polypharmacy is necessary, in that case, the side effects and toxicities should be explored and managed immediately. So the clinician have to learn more about the pharmacokinetic and pharmacodynamic mechanisms of each drugs used in treatment of depression. When the risk of the fetus by the exposure is higher than the risk of untreated maternal psychiatric disorder, psychotropic medications should be used during pregnancy. Women who are maintained on psychotropics and become pregnant, as well as women with the new onset of psychiatric symptoms during pregnancy, should be carefully reassessed. However, data concerning the potential risk of long-term behavioral changes following prenatal exposure to psychotropics is rare, so further longitudinal follow-up studies are needed.
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문제 정의
우울증을 치료함에 있어서 흔히 부딪히는 문제로서 치료 저항 우울증과 임신과 연관된 어려움에 대해 알아보았다. 치료 저항 우울증은 예외적이라기 보다는 우울증 환자를 치료 하는 중에 드물지 않게 접하게 되는 일상적인 경우로 받아들이는 것이 타당하다.
뿐만 아니라 약물에 대한 부작용, 임신과 연관된 문제, 신체적인 질병이 동반된 경우, 약물 상호 작용의 문제 등 우울증의 약물 치료에 있어 고려해야 할 점들이 많이 있다. 이러한 것들 하나 하나가 다 중요한 문제로 다루어질 수 있는 내용들이나 여기서는 치료 저항과 임신에 관한 것을 다루고자 한다.
제안 방법
두가지 이상의 서로 다른 종류의 항우울제를 병합한다.
후속연구
그런데 정신 활성 약물에 자궁 내 노출의 절대적인 위험성도 수량화하기 곤란하지만, 치료되지 않은 정신장애의 위험성은 수량화하기 힘들다(Cohen 1997). 또한 치료되지 않은 정신장애의 유병율과 이로 인한 사망률은 약물에 대한 산전 노출의 위험성과 비교 평가해야 한다.
약물을 중단하는 것이 정신장애 환자의 안녕에 심각한 장애를 초래할 수 있으므로 임신 중에 새로운 정신과적 증상이 시작된 환자 뿐 아니라 정신과 약물을 유지하면서 임신을 하는 여성은 주의 깊은 재평가가 필요하다. 약물 사용 후에 발생하는 장기간의 행동적 변화에 대한 자료는 앞으로 더 연구되어야 한다.
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