Madde Kullanım Bozuklukları Psikofarmakolojisi
Özet
Madde kullanım bozuklukları, beyindeki dopaminerjik yolakları aktive ederek bağımlılık sürecini pekiştiren ve hem bireyi hem de toplumu etkileyen küresel bir sağlık sorunudur. Bu bozuklukların tedavisinde, özellikle opioid ve opioid dışı maddelere yönelik çeşitli psikofarmakolojik ajanlar kullanılmaktadır. Opioid kullanım bozukluğunun arındırma ve idame tedavilerinde μ-opioid reseptör parsiyel agonisti buprenorfin (kötüye kullanımı önlemek için sıklıkla nalokson ile kombine edilir) ve tam agonist metadon en önemli iki ajan olarak öne çıkmaktadır. Ayrıca, opioid reseptör antagonisti naltrekson ile uzun yarı ömürlü LAAM gibi ilaçlar da tedavi seçenekleri arasında yer almaktadır. Kokain, amfetamin ve esrar gibi opioid dışı madde kullanım bozukluklarında ise FDA onaylı standart bir farmakoterapi bulunmamakla birlikte; modafinil, bupropion gibi psikostimülanlar, çeşitli antidepresanlar, kısıtlı durumlarda antipsikotikler, gabapentinoidler, VMAT inhibitörleri ve vanokserin gibi ajanlar klinik pratikte denenmekte veya endikasyon dışı kullanılmaktadır. Mevcut farmakolojik yaklaşımlarla birçok hastada remisyon sağlansa da yeni ilaçların geliştirilmesine duyulan ihtiyaç sürmekte ve tedavinin başarısı için psikososyal desteklerin eş zamanlı yürütülmesi kritik önem taşımaktadır.
Substance use disorders are a global health problem that reinforces the addiction process by activating dopaminergic pathways in the brain, affecting both the individual and society. Various psychopharmacological agents target both opioid and non-opioid substances in the treatment of these disorders. In the detoxification and maintenance treatment of opioid use disorder, buprenorphine, a μ-opioid receptor partial agonist (frequently combined with naloxone to prevent intravenous abuse), and methadone, a full agonist, stand out as the two most important agents. Additionally, the opioid receptor antagonist naltrexone and LAAM, which has a long half-life, serve as alternative treatment options. For non-opioid substance use disorders such as cocaine, amphetamine, and cannabis, there is no FDA-approved standard pharmacotherapy; however, psychostimulants like modafinil and bupropion, various antidepressants, antipsychotics in limited conditions, gabapentinoids, VMAT inhibitors, and vanoxerine are tested in clinical practice or used off-label. Although remission is achieved in many patients through current pharmacological approaches, the need for developing novel agents continues, and the presence of psychosocial interventions alongside pharmacological treatments enhances the chances of successful outcomes.
Referanslar
Mundt AP, Baranyi G, Gabrysch C, Fazel S. Substance use during imprisonment in low-and middle-income countries. Epidemiologic reviews. 2018;40(1):70-81.
Kozak K, Lucatch AM, Lowe DJ, Balodis IM, MacKillop J, George TP. The neurobiology of impulsivity and substance use disorders: implications for treatment. Annals of the New York Academy of Sciences. 2019;1451(1):71-91.
Anderson AL, Li S-H, Markova D, Holmes TH, Chiang N, Kahn R, et al. Bupropion for the treatment of methamphetamine dependence in non-daily users: a randomized, double-blind, placebo-controlled trial. Drug and alcohol dependence. 2015;150:170-4.
Whelan PJ, Remski K. Buprenorphine vs methadone treatment: A review of evidence in both developed and developing worlds. Journal of neurosciences in rural practice. 2012;3(01):45-50.
McCance-Katz EF. Office-based buprenorphine treatment for opioid-dependent patients. Harvard review of psychiatry. 2004;12(6):321-38.
Bell J, Strang J. Medication treatment of opioid use disorder. Biological psychiatry. 2020;87(1):82-8.
Shulman M, Wai JM, Nunes EV. Buprenorphine treatment for opioid use disorder: an overview. CNS drugs. 2019;33(6):567-80.
Rettig RA, Yarmolinsky A. Pharmacology and medical aspects of methadone treatment. Federal Regulation of Methadone Treatment: National Academies Press (US); 1995.
Koehl JL, Zimmerman DE, Bridgeman PJ. Medications for management of opioid use disorder. American Journal of Health-System Pharmacy. 2019;76(15):1097-103.
Palpacuer C, Duprez R, Huneau A, Locher C, Boussageon R, Laviolle B, et al. Pharmacologically controlled drinking in the treatment of alcohol dependence or alcohol use disorders: a systematic review with direct and network meta‐analyses on nalmefene, naltrexone, acamprosate, baclofen and topiramate. Addiction. 2018;113(2):220-37.
Nielsen S, Larance B, Degenhardt L, Gowing L, Kehler C, Lintzeris N. Opioid agonist treatment for pharmaceutical opioid dependent people. Cochrane Database of Systematic Reviews. 2016(5).
Moeller FG, Schmitz JM, Herin D, Kjome KL. Use of stimulants to treat cocaine and methamphetamine abuse. Current psychiatry reports. 2008;10(5):385-91.
Pani PP, Trogu E, Vecchi S, Amato L. Antidepressants for cocaine dependence and problematic cocaine use. Cochrane Database of Systematic Reviews. 2011(12).
Cornelius JR, Bukstein OG, Douaihy AB, Clark DB, Chung TA, Daley DC, et al. Double-blind fluoxetine trial in comorbid MDD–CUD youth and young adults. Drug and alcohol dependence. 2010;112(1-2):39-45.
Levin FR, Mariani J, Brooks DJ, Pavlicova M, Nunes EV, Agosti V, et al. A randomized double‐blind, placebo‐controlled trial of venlafaxine‐extended release for co‐occurring cannabis dependence and depressive disorders. Addiction. 2013;108(6):1084-94.
Marshall K, Gowing L, Ali R, Le Foll B. Pharmacotherapies for cannabis dependence. Cochrane Database of Systematic Reviews. 2014(12).
Zorick T, Sugar CA, Hellemann G, Shoptaw S, London ED. Poor response to sertraline in methamphetamine dependence is associated with sustained craving for methamphetamine. Drug and alcohol dependence. 2011;118(2-3):500-3.
Ciketic S, Hayatbakhsh MR, Doran CM, Najman JM, McKetin R. A review of psychological and pharmacological treatment options for methamphetamine dependence. Journal of Substance Use. 2012;17(4):363-83.
Mason BJ, Crean R, Goodell V, Light JM, Quello S, Shadan F, et al. A proof-of-concept randomized controlled study of gabapentin: effects on cannabis use, withdrawal and executive function deficits in cannabis-dependent adults. Neuropsychopharmacology. 2012;37(7):1689-98.
Schwan S, Sundström A, Stjernberg E, Hallberg E, Hallberg P. A signal for an abuse liability for pregabalin—results from the Swedish spontaneous adverse drug reaction reporting system. European journal of clinical pharmacology. 2010;66(9):947-53.
Schifano F. Misuse and abuse of pregabalin and gabapentin: cause for concern? CNS drugs. 2014;28(6):491-6.
Evoy KE, Morrison MD, Saklad SR. Abuse and misuse of pregabalin and gabapentin. Drugs. 2017;77(4):403-26.
Elkashef A, Vocci F, Hanson G, White J, Wickes W, Tiihonen J. Pharmacotherapy of methamphetamine addiction: an update. Substance Abuse. 2008;29(3):31-49.
Rothman RB, Mele A, Reid AA, Akunne HC, Greig N, Thurkauf A, et al. GBR12909 antagonizes the ability of cocaine to elevate extracellular levels of dopamine. Pharmacology Biochemistry and Behavior. 1991;40(2):387-97.
