Çocuk ve Ergenlerde Dikkat Eksikliği ve Hiperaktivite Bozukluğu Tedavisinde Kullanılan İlaçlar
Özet
Dikkat Eksikliği ve Hiperaktivite Bozukluğu (DEHB), çocuk ve ergen psikiyatristlerinin sıkça karşılaştığı, prefrontal korteksteki dopamin ve norepinefrin düşüklüğüyle ilişkili heterojen bir nörogelişimsel hastalıktır. Tedavide psikoeğitimi merkezine alan multimodal ve bireyselleştirilmiş bir yaklaşım benimsenmektedir. Farmakolojik tedavide ilk seçenek, MSS sinapslarından katekolamin salınımını artıran metilfenidat ve amfetamin gibi psikostimulanlardır; bu kontrole tabi ilaçların kısa ve uzun etkili formları mevcuttur. Stimulan olmayan alternatiflerden atomoksetin, kötüye kullanım riski taşımayan bir selektif noradrenalin geri alım inhibitörüdür. Alfa-2 adrenerjik agonistler (klonidin ve guanfasin) prefrontal korteksteki noradrenerjik nörotransmisyonu güçlendirirken, yakın zamanda FDA onayı alan viloksazin ise serotonin-norepinefrin modüle edici bir ajandır. Onaylı tedavilere yanıt alınamadığında trisiklik antidepresanlar, bupropion ve modafinil gibi ajanlar off-label olarak tercih edilebilmektedir. İlaçların en belirgin yan etkileri arasında iştahsızlık, uykusuzluk, taşikardi, sedasyon ve intihar düşüncesi riski bulunmakta olup, hastaların düzenli takibi hayati önem taşımaktadır.
Attention-Deficit/Hyperactivity Disorder (ADHD) is a heterogeneous neurodevelopmental disorder frequently encountered by child and adolescent psychiatrists, associated with low levels of dopamine and norepinephrine in the prefrontal cortex. A multimodal and individualized approach centering on psychoeducation is adopted in its treatment. The first-line options in pharmacological treatment are psychostimulants, such as methylphenidate and amphetamine, which increase catecholamine release from CNS synapses; these controlled substances are available in short- and long-acting forms. Among non-stimulant alternatives, atomoxetine is a selective noradrenaline reuptake inhibitor that carries no potential for abuse. While alpha-2 adrenergic agonists (clonidine and guanfacine) strengthen noradrenergic neurotransmission in the prefrontal cortex, viloxazine, which recently received FDA approval, is a serotonin-norepinephrine modulating agent. When approved treatments yield insufficient response, agents such as tricyclic antidepressants, bupropion, and modafinil can be preferred off-label. The most prominent side effects of these medications include anorexia, insomnia, tachycardia, sedation, and the risk of suicidal ideation, making regular follow-up of patients critically important.
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