항우울제 과량복용에 의한 심장 독성 증상과 치료 = Characteristics of Cardiac Toxicity in Antidepressant Overdose and Its Treatment

다국어 초록 (Multilingual Abstract)

The mortality and morbidity in tricyclic antidepressants (TCAs) overdose still remained high due to fatal cardiac
toxicities despite their decreased prescriptions. Also, monoamine oxidase inhibitors (MAOIs) may show relatively
high cardiac toxicities in excess or mixed overdoses. Selective serotonin reuptake inhibitors (SSRIs) and newer
antidepressants have been known to be safe in overdose until recently. However, many researchers have found that
SSRIs and newer antidepressants also showed serious and fatal toxicities in case of excess or mixed overdoses.
Citalopram or escitalopram overdoses showed a relatively high incidence of cardiac toxicity with a dose-dependent
manner. Also, venlafaxine, bupropion and trazodone overdoses showed significant cardiac toxicities, although
degrees of the toxicities are different each other. Especially, venlafaxine’s pattern and incidence of cardiac toxicities
are the similar to those of TCAs. Mirtazapine and reboxetine show no significant toxicities in overdose
although the present toxicological data are insufficient. To conclude, assessment of compliance, pharmacology
education for patients and effective treatment may reduce the incidence and severity of toxicities in overdose.

국문 초록 (Abstract)

치명적인 심장 독성으로 잘 알려진 TCA는 여전히 높
은 사망률과 이환율을 기록하고 있으며 넓은 치료용량범
위로 안전하다는 선택적 가역성 MAOI 역시 많은 양의
단일약물이나 복합약물 과량복용 상황에서 높은 비율로
심장 독성 증상을 보인다. SSRI 및 이후의 새로운 항우
울제들 역시 과량복용 상황에서 안전한 것으로 알려졌으
나, 많은 양의 단일약물이나 복합약물을 과량복용한 최근
의 사례 보고나 연구결과들에서 알 수 있는 바와 같이 심
각한 중독 증상과 심장 독성 증상을 보인다. 특히, citalopram,
escitalopram은 정해진 용량을 초과하는 경우 높
은 비율의 심장 독성 증상을 보이며 venlafaxine, bupropion,
trazodone도 용량의존성의 독성 증상과 심장 독
성 증상을 보인다. 특히, venlafaxine은 심각한 심장 독
성 증상의 발현 비율이 TCA와 거의 비슷하다고 한다. mirtazepine과
reboxetine은 과량복용 환자에 대한 독성 정
보가 충분하지 않지만 지금까지의 연구결과로 미루어 중
독 상황에서 심각한 중독 증상 및 심장 독성 증상을 보
이는 것 같지 않다. 따라서 항우울제를 처방할 경우 약물
순응도를 확인하고 적절한 약물 교육을 실시하며 효과적
으로 증상을 안정시킴으로써 약물 과량복용으로 인한 심
각한 부작용을 줄일 수 있을 것이다.

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