주의력결핍-과잉운동장애의 비중추신경흥분제 치료의 최신지견 = New Options of Nonstimulants in the Pharmacotherapy of Attention-Defict/Hyperactivity Disorder

다국어 초록 (Multilingual Abstract)

Methylphenidate (MPH), amphetamine, and pemoline are cerebrostimulants that have been commonly prescribed for more than half century in the treatment of attention-deficit/hyperactivity disorder (ADHD). The use of such drugs, however, is often followed by untoward effects such as loss of appetite, insomnia, nausea, abdominal pain, vomiting, irritability, and etc. There are also debates about decrements in height and weight percentiles and drug dependency. Thus, in this study, we discussed new therapeutic drugs, non cerebro-stimulants, with possibly less adverse effects and more efficacies.
Atomoxetine, highly selective inhibitor of the presynaptic noradrenaline transporter with little or no affinity for other neurotransmitter transporters and receptors, is a non-excitatory drug with a strong possibility to replace CNS excitatory drugs. It is also safer in relation to drug dependency since it does not affect nucleus accumbens or the striatum. Atomoxetine, therefore, can be used in patients who do not respond to the CNS excitatory drugs.
Tricyclic antidepressants, imipramine and desipramine are also most extensively studied drugs as ADHD treatment modalities. They also exert inhibitory effect on the reuptake of norepinephrine. The use of these drugs in children, however, is limited because of cardiovascular effects.
Bupropion is one of promising drugs in treating prepubertal children with ADHD. It is also useful for comorbid depression and conduct problems.
Increasing attention is being given to a narcolepsy drug, modafinil. Modafinil acts on histamine pathway resulting in wakefulness. This effect is similar to that of neuropeptide orexin. Since the effect of modafinil is independent of catecholamine, drug dependency adverse effect is not expected.
Recently, some new drugs, such as reboxetine, are reported as safe and efficacious for children with ADHD, but they need long-term safety and controlled studies.