항 우울제의 회귀한 부작용

Unusual Side Effects of Antidepressants

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