Prostatitis is a common syndrome that is confusing and frustrating for urologists. Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) is the most common form of prostatitis. The etiology of CP/CPPS is unknown, but possibilities include infectious, autoimmune, neurological and psychiatric causes. Clinical, laboratory, and imaging evaluations for the patient presenting prostatitis can be categorized as basic or mandatory evaluations, further or recommended evaluations, and optional evaluations in selected patients. Evaluation can aid in diagnosis and follow-up of the patient's response to therapy. Treatment for CP/CPPS is empiric and limited by a lack of randomized, placebo-controlled clinical trials. Antimicrobials are commonly used to treat patients with prostatitis. Other commonly used drugs include alpha-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic antidepressants, and anticholinergic agents. Also, minimally invasive procedures are considered in patients with CP/CPPS. Although much progress has been made in therapy, there is no distinct treatment for patients with CP/CPPS. It is possible to treat intractable patients with 'care' not 'cure'.
Antidepressive Agents, Tricyclic ; Cholinergic Antagonists ; Diagnosis ; Humans ; Pelvic Pain ; Prostatitis*

Depressive illness is a major public health problem with important medical, social and economic implications. The efficacy of various antidepressants in treating depression has been demonstrated in randomized controlled trials (RCTs). However, these studies do not adequately address the complexities of clinical practice. Although most of RCTs assumed there was no difference in efficacy between the tricyclic antidepressants (TCAs) and serotonin specific reuptake inhibitors (SSRIs), naturalistic studies show that patients who take TCAs often receive subtherapeutic doses for inadequate duration than those with SSRIs. Because the benefits of the implementation of current guidelines are limited, the optimal choice of medication must be guided by detailed history and careful consideration of the real-world efficacy of antidepressants and long-term health care costs.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Depression ; Health Care Costs ; Humans ; Public Health ; Serotonin

New antidepressants have become available for clinical use in the 1990s. Before this decade, the drugs available to treat depression consisted essentially of monoamine oxidase inhibitors, tricyclic antidepressants, and lithium. Following the introduction of SSRIs, the options have expanded and now include SSRIs nefazodone, venlafaxine, mirtazapine, reboxetine, tianeptine. Newer antidepressants possess a variety of pharmacological characteristics that are relevant to the choice of an antidepressant for clinical use. This review summarizes some of the major pharmacological characteristics among the drugs.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Depression ; Lithium ; Monoamine Oxidase Inhibitors ; Venlafaxine Hydrochloride

OBJECTIVES: The diagnosis of depression is based on a highly variable set of symptoms. Therefore, depression should not be viewed as a single disease, but a heterogenous syndrome comprised of different pathophysiologies. There are several subtypes of depression which were already incorporated in DSM-IV. This article provides a systematic review of pharmacological treatments of two recognized subtypes of depression-dysthymic disorder and atypical depression. METHODS: Systematic search of relevant literatures on dysthymic disorder and atypical depression was performed by proposed search strategy of the Clinical Research Center for Depression of Korean Health 21 R&D Project. All identified literatures were carefully reviewed and classified according to SIGN grading system and summarized in a narrative manner. RESULT: For the treatment of dysthymic disorder and atypical depression, selective serotonin reuptake inhibitors(SSRIs) and moclobemide have more evidence than the other antidepressants. SSRIs and moclobemide showed superior tolerability than tricyclic antidepressants. CONCLUSION: The authors proposed treatment recommendations for dysthymic disorder and atypical depression by the methods of evidence-based medicine(EBM). However, guideline developing methods of EBM also have several inevitable limitations. Therefore, in the absence of clear and significant differences in efficacy, the choice of medication must be individualized for a particular patient based on psychiatrist's own clinical decision.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Depression* ; Diagnosis ; Diagnostic and Statistical Manual of Mental Disorders ; Dysthymic Disorder* ; Evidence-Based Medicine ; Humans ; Moclobemide ; Serotonin

Prostatitis is a common disease that is confusing and frustrating for urologists. Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS) is the most common form of prostatitis. The etiology of CP/CPPS is unknown, but possibilities include infectious, autoimmune, neurological, endocrine and psychological causes. Clinical evaluation can aid in diagnosis and follow-up of the patient's response to therapy. Treatment for CP/CPPS is empiric and limited by a lack of randomized, placebo- controlled clinical trials. Antimicrobials are commonly used to treat patients with prostatitis. Other commonly used drugs include alpha-adrenoceptor antagonists, anti-inflammatory drugs, tricyclic antidepressants, and anticholinergic agents. Also, minimally invasive procedures are considered in patients with CP/CPPS and It is possible to treat intractable patients with invasive treatment. Although much progress has been made in therapy, there is no distinct treatment for patients with CP/CPPS. If the concept of neurogenic inflammation with pain is solved, it is possible to treat patients with CP/CPPS at future.
Antidepressive Agents, Tricyclic ; Cholinergic Antagonists ; Follow-Up Studies ; Humans ; Neurogenic Inflammation ; Pelvic Pain ; Prostatitis

PURPOSE: The role of a point of care test (POCT) is currently becoming important when treating patients and making decisions in the emergency department. It also plays a role for managing patients presenting with drug intoxication. But the availability of the test has not yet been studied in Korea. Therefore, we investigated the utility and the availability of POCT for drug screening used in the emergency department. METHODS: This was a retrospective study for those patients with drug intoxication between January 2007 and December 2010 in an urban emergency department. RESULTS: Between the study period, 543 patients were examined with a Triage(R)-TOX Drug Screen. Among those, 248 (45.7%) patients showed negative results and 295 (54.3%) patients showed positive results. The sensitivity of the test for benzodiazepine, acetaminophen and tricyclic antidepressants were 85.9%, 100%, 79.2%, respectively. CONCLUSION: POCT of drug screening in emergency department showed good accuracy especially in patient with benzodiazepine, acetaminophen and tricyclic antidepressant intoxication. Therefore, it can be useful diagnostic tool for the management of intoxicated patients.
Acetaminophen ; Antidepressive Agents, Tricyclic ; Benzodiazepines ; Drug Evaluation, Preclinical ; Emergencies ; Humans ; Korea ; Mass Screening ; Retrospective Studies

The objective of this review is to propose the Korean practice guideline for pharmacological treatment of attentiondeficit hyperactivity disorder(ADHD). For making the guideline, the authors used the evidence-base approaches derived from a detailed review of literature including wide range of controlled clinical trials, studies of side effects of drugs, toxicological reports, and meta-analyses published in United States and Europe, as well as inside Korea. The review committee composed of experts in ADHD in Korea has reviewed the parameter. The practice parameter for pharmacological treatment describes the use of stimulants, atomoxetine, modafinil, bupropion, tricyclic antidepressants, and alpha-adrenergic agonists and their side effects. The recommendations of pharmacological treatment are proposed at the end of the article.
Adrenergic alpha-Agonists ; Advisory Committees ; Antidepressive Agents, Tricyclic ; Bupropion ; Europe ; Korea ; United States ; Atomoxetine Hydrochloride

While in the past the almost sole availability of tricyclic antidepressants had limited antidepressant drug selection, newer drugs such as selective serotonin reuptake inhibitors, bupropion, mirtazapine and venlafaxine have vastly simplified treating depression in patients with medical illness. Appropriate selection of an antidepressant agent in medically ill patients requires a careful risk-benefit assessment of the antidepressant treatment considering the pharmacokinetic and pharmacodynamic properties of drugs, potential for drug interaction, the patient's general medical conditions, and primary symptoms of the patient's depression. The effective and safe approach to antidepressant treatment is to reduce initial dosage, to titrate upward more slowly, and to monitor closely adverse effects in patients with medical illness.
Antidepressive Agents, Tricyclic ; Bupropion ; Depression* ; Drug Interactions ; Humans ; Risk Assessment ; Serotonin Uptake Inhibitors ; Venlafaxine Hydrochloride

BACKGROUND: Optimal use of tricyclic antidepressants (TCAs) requires serum monitoring to determine if the appropriate therapeutic range has been attained and to assess possible side effects. This study was to evaluate the resolution capacity of the following four mobile phases which were previously reported; mobile phase I (methanol, acetonitrile and 5 mmol/L Na2HPO4: 41/15/44 by volume), II (methanol, acetonitrile and 5 mmol/L Na2HPO4,: 15/60/25 by volume), III (acetonitrile and 2-propanol: 95/5 by volume) and IV (methanol and n-butylamine: 99.5/0.5 by volume). METHODS: Amitriptyline (AT), nortriptyline (NT), imipramine (IMI) and doxepin (DOX) were used for the selection of appropriate mobile phase in high performance liquid chromatographic (HPLC) determination. TCAs were extracted from serum with hexane, isoamyl alcohol (99:1). The drug was re-extracted into 0.1 N HCl and an aliquot was injected into the HPLC. The analytical column was C-18 reversed phase column (3.9 mm x 30 cm; Waters, USA) with the flow rate of 1.5 mL/min. The UV detector signal was monitored at 254 nm. RESULTS: Mobile phase I disclosed 9.8-15.8 retention time (min), 5.1-8.8 capacity ratio and 1.0-2.2 resolution factors for the above four TCAs. Precision studies using this mobile phase demonstrated a coefficient variation of 2.4-4.7% in the concentration range of 500-125 ng/mL. Analytical recovery of AT and IMI was 85-90% at a concentration of 125 ng/mL and 250 ng/mL. CONCLUSIONS: Mobile phase I provided a reliable and excellent resolution of TCAs in the use of HPLC with the C-18 reversed phase column and UV absorbance detector.
2-Propanol ; Amitriptyline ; Antidepressive Agents, Tricyclic* ; Chromatography, High Pressure Liquid ; Doxepin ; Imipramine ; Nortriptyline

OBJECTIVE: This study aimed to investigate antidepressant prescribing patterns, including initial choice, switching and combining, and concomitant use of non-antidepressant agents, for depressive disorders in naturalistic clinical care settings in Korea. METHODS: Patients with depressive disorder were recruited from both outpatient and inpatient settings in 18 hospitals from all over Korea. Treatment was performed in naturalistic patterns based on each clinician's decision. Data were collected on the prescription of antidepressants and concomitant agents from baseline to 12-week follow-up. RESULTS: Selective serotonin reuptake inhibitors (SSRIs) were the most commonly prescribed initial antidepressant (48.9%), followed by newer dual-action antidepressants (45.8%). When an SSRI was the initial antidepressant, 46.2% of patients whose medication was changed were moved to newer dual-action antidepressants, and 67.4% of combination cases were combined with newer dual-action ones. When a newer dual-action antidepressant was the initial antidepressant, 70.6% of patients whose medication was changed were moved to SSRIs, and other antidepressants including tricyclic antidepressants were most commonly added for combination treatment (50% of combination cases). During the treatment period, 20.6% of antidepressants prescribed were augmented by non-antidepressant agents, and 75.1% were used concomitantly with anxiolytics or hypnotics. The most commonly used concomitant non-antidepressant agent was quetiapine. CONCLUSION: The selection of antidepressants and the concomitant use of non-antidepressant agents are becoming increasingly diversified, and the results of this study reflect changes in the prescribing pattern in actual Korean practices.
Anti-Anxiety Agents ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Depression ; Depressive Disorder ; Humans ; Hypnotics and Sedatives ; Inpatients ; Korea ; Outpatients ; Prescriptions ; Serotonin Uptake Inhibitors