Bipolar disorder is the main approved indication of mood stabilizers. In clinical practice, however, they are commonly used for 1) patients showing aggressive behavior regardless of the diagnosis and 2) schizophrenia patients. A literature review was performed to find evidence supporting this clinical “common sense.” The authors found no sufficient evidence supporting the efficacy of mood stabilizers either for aggressive behavior or for schizophrenia. The authors suggest that off-label use of mood stabilizers should be based on judicious clinical judgment, based on the understanding “what particular treatment for this patient does the behavior warrant at this time?”

Bipolar disorder is the main approved indication of mood stabilizers. In clinical practice, however, they are commonly used for 1) patients showing aggressive behavior regardless of the diagnosis and 2) schizophrenia patients. A literature review was performed to find evidence supporting this clinical “common sense.” The authors found no sufficient evidence supporting the efficacy of mood stabilizers either for aggressive behavior or for schizophrenia. The authors suggest that off-label use of mood stabilizers should be based on judicious clinical judgment, based on the understanding “what particular treatment for this patient does the behavior warrant at this time?”

Bipolar disorder is the main approved indication of mood stabilizers. In clinical practice, however, they are commonly used for 1) patients showing aggressive behavior regardless of the diagnosis and 2) schizophrenia patients. A literature review was performed to find evidence supporting this clinical “common sense.” The authors found no sufficient evidence supporting the efficacy of mood stabilizers either for aggressive behavior or for schizophrenia. The authors suggest that off-label use of mood stabilizers should be based on judicious clinical judgment, based on the understanding “what particular treatment for this patient does the behavior warrant at this time?”

Bipolar disorder is the main approved indication of mood stabilizers. In clinical practice, however, they are commonly used for 1) patients showing aggressive behavior regardless of the diagnosis and 2) schizophrenia patients. A literature review was performed to find evidence supporting this clinical “common sense.” The authors found no sufficient evidence supporting the efficacy of mood stabilizers either for aggressive behavior or for schizophrenia. The authors suggest that off-label use of mood stabilizers should be based on judicious clinical judgment, based on the understanding “what particular treatment for this patient does the behavior warrant at this time?”

Since selective serotonin reuptake inhibitors were introduced in clinical practice in the 1990s, antidepressant prescriptions have steadily increased. In addition to the prescriptions by psychiatrists, antidepressant prescriptions by non-specialists have also increased. An advanced understanding of the pharmacological and clinical characteristics of antidepressants is essential to improving the treatment response of depressive disorders and the quality of life of patients. Antidepressant withdrawal or discontinuation syndrome can frequently occur if antidepressant maintenance is discontinued without a pre-planned clinical strategy. Nevertheless, it is often unrecognized or mistaken for other clinical situations. This causes patient distress and ultimately reduces long-term treatment compliance. Inappropriate therapeutic decisions can be made if clinicians do not recognize antidepressant discontinuation syndrome. Antidepressant withdrawal is common and preventable. This issue must be recognized because it can be adjusted through appropriate clinical management. This article systematically reviews the clinical features, biological mechanisms, coping strategies, and antidepressant discontinuation strategies related to antidepressant discontinuation syndrome.

Objective: This study investigated the neurocognitive characteristics of patients who visited an outpatient clinic requesting diagnosis and treatment for adult attention-deficit/hyperactivity disorder (ADHD). Methods: The patients’ electronic medical records were retrospectively reviewed. Neurocognitive test results were compared using Student’s t-test according to their chief complaint, depressive symptoms, childhood history, and intelligence quotient (IQ). Neurocognitive characteristics affecting subjective symptoms of ADHD were analyzed by linear regression. Results: The study included 106 patients. They did not have significant deficits in neurocognitive tests. Patients with depressive symptoms showed more impulsive responses (hit reaction time [p=0.037] and commission error [p=0.024]) and self-reported ADHD symptoms (p=0.001). Verbal (p=0.036) and visual memory (p=0.020) were significantly deficient in patients with a childhood ADHD diagnosis. Patients with a low IQ had significant deficits in various domains. Depressive symptoms and vigilance were significantly related to subjective symptoms of ADHD (adjusted R2=0.430, β=0.457, p=0.002). Conclusion Our results imply that the neurocognitive function of patients with subjective ADHD symptoms was not abnormal but was affected by depressive symptoms.

Clonazepam, a 7-nitrobenzodiazepine, has been used for the treatment of various neuropsychiatric disorders such as seizures, sleep disorders, panic disorders, anxiety, and movement disorders. However, clonazepam is officially approved as a therapeutic drug only for epilepsy and panic disorders in Korea. This raises ethical issues in clinical practice, as clonazepam is prescribed off-label for most neuropsychiatric disorders in many other countries as well. The misuse and abuse of clonazepam as a recreational drug have also been commonly reported in global literature. In this review, as a therapeutic drug as the authors aim to highlight the pharmacological aspects, clinical effects, and potential addictive risks of clonazepam use, by reviewing the current literature on clonazepam to increase its clinical use by accurately understanding and identifying its psychopharmacological benefits and characteristics. However, establishing the risk/benefit ratio of clonazepam for use in specific clinical situations is difficult because of the lack of adequate updated data. Therefore, the use of clonazepam needs to be approached from the point of view of personalized drug treatment rather than following fixed guidelines which would not reflect the current real-world clinical practices.

Benzodiazepines have been widely used as anxiolytics, sedatives, hypnotics, anticonvulsants, or central muscle relaxants since the 1960s despite significant adverse effects, the potential for misuse, and consequent overdose. Benzodiazepines exert their pharmacological action by binding to gamma-aminobutyric acid type A (GABA-A) receptors in the brain and facilitateing the inhibitory actions of the neurotransmitter GABA. Recent findings have also elucidated the effects of benzodiazepines on the allosteric modulation of GABA-A receptors, including receptor subtypes and transmembrane proteins, which is a significant step in our understanding of GABA pharmacology. In clinical practice, the use of benzodiazepines to treat psychiatric disorders has been limited due to the challenges associated with the long-term use, namely the risks of abuse, misuse, and overdose, as well as withdrawal effects. Furthermore, the approval of selective serotonin reuptake inhibitors for anxiety disorders has led to their extensive use as a first-line pharmacological option and they have also been promoted in various practice guidelines for the treatment of anxiety disorders. However, although recent systematic reviews and meta-analyses have shown that benzodiazepines are useful and effective drugs for the treatment of various neuropsychiatric disorders, including anxiety, debates over the clinical use of benzodiazepines continue. More than 60 years after the introduction of benzodiazepines in clinical practice, it is necessary to revisit the controversies associated with benzodiazepine use and to update the discussion current approach to practice with thethrough an understanding of the new data on their pharmacological actions and to identify appropriate indications according to the new diagnostic systems of psychiatric disorders through an extensive literature review.

Recently, drugs with a potential for abuse are regaining attention as antidepressants. These drugs are mood enhancers and reduce negative feelings. Therefore, they can be effective in the treatment of depression. However, mood enhancement is insufficient for the real improvement of depressive symptoms. Additionally, treating depression using drugs with dependency risks raises concerns regarding autonomy issues. In this article, the authors discuss issues that a psychiatrist should consider when prescribing “drugs of abuse” as antidepressants from medical, philosophical, and legal perspectives. The limitations of the current psychiatric diagnosis system in depression, questions concerning pleasure-seeking with antidepressants, dilemmas with autonomy, and problems of enhancement are discussed.