網 路 成 癮 之 治 療 物 高 雄 市 立 凱 旋 醫 院 劑 科 師 李 欣 雅 陳 彥 宏 高 雄 醫 大 附 設 中 和 紀 念 醫 院 劑 部 師 劉 建 宏 摘 要 (Internet addiction) 90 escitalopram bupropion naltrexonevalproate lithium quetiapinemethylphenidate 壹 前 言 90 (addiction) (preoccupation/anticipation) (impulsivity) (binge/intoxication) (compulsivity) (withdrawal/negative) 110 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015
1 貳 網 路 成 癮 治 療 物 (case reports) 15 表 一 網 路 成 癮 物 治 療 的 研 究 報 告 Liu 2 (functional magnetic resonance imaging, fmri) (reward) 公 31 Escitalopram (30 mg/ ) 3 Sattar and Ramaswamy (2004) 4 Dell'Osso et al 10 +9 19 (2008) 5 Han et al (2010) 7 Han and Renshaw (2011) 8 - (casecontrol study) 12 (8 4 ) Escitalopram (20 mg/ ) 10 Hamilton Depression Rating Scale; Addiction Survey Index Clinical Global Impressions- Improvement Scale 11 Bupropion 7-point visual analog + 8 sustained-release 6 Scale; fmri ( ( N/A) ) 50 Bostwick and Bucci (2008) 10 31 Atmaca (2007) 13 23 Han et al 8 (2009) 6 62 ADHD Bupropion ( N/ A) Naltrexone (150 mg/ ) 3 Quetiapine (200 mg/ )+ citalopram ( N/A N/A) Methylphenidate (30.5 mg/ ) 8 Beck Depression Inventory; Young Internet Addiction Scale Scores ( 36.8 16.5 ) - - Korean DuPaul's ADHD Rating Scale; Young Internet Addiction Scale Scores 31 2 Jun. 30 2015 雜 誌 123 111
一 抗 憂 鬱 劑 (Antidepressants) (selective serotonin reuptake inhibitors, SSRIs) (obsessive-compulsive) 3 escitalopram 30 mg3 4 19 escitalopram 20 mg 10 64.7% 5 10 escitalopram 9 9 11 8 Han fmri 6 (FDA) (norepinephrine/dopamine reuptake inhibitor, NDRI) -bupropion 7,8 6 bupropion 9 二 鴉 片 類 接 受 器 拮 抗 劑 (Opioid receptor antagonists) (mesolimbic dopamine) (nucleus accumbens) naltrexone 10 31 sertraline naltrexone 150 mg 三 情 緒 穩 定 劑 (Mood stabilizers) (lithium) (anticonvulsants) valproate valproate lithium 11 四 抗 精 神 病 物 (Antipsychotics) risperidone olanzapine quetiapine aripiprazole aripiprazole olanzapine 112 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015
12 23 quetiapine 200 mg citalopram 4 13 五 其 他 物 (psychostimulants) 2 glutamatergic (attention-deficit/hyperactivity disorder, ADHD) 33% 14 Han 62 methylphenidate 30.5 mg 6 clonidine guanfacine glutamatergic memantine (Ebixa) riluzole (Rilutek) 參 結 論 escitalopram bupropion naltrexone valproate lithium quetiapine methylphenidate 公 The Treatment of Internet Addiction Hsin-Ya Lee 1, Yeng-Hung Chen 1, Chien-Hung Liu 2 Department of Pharmacy, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital 1 Department of Pharmacy, Kaohsiung Medical University Chung-Ho Hospital 2 Abstract Internet addiction is a new disorder in recent year. When Internet is popular, it takes us lots of conveniences and also takes some risks for health. At present, there have the specific guidelines and treatments for heroin or cigarette abuse, but it lacks of a treatment strategy for Internet addiction in Taiwan. Although the pharmacotherapy for Internet addiction 31 2 Jun. 30 2015 雜 誌 123 113
deeply plays an important role, we will introduce the current treatment and medications for treatments of Internet addictions. However, case reports or randomized clinical trials for the pharmacotherapy of Internet addiction are still limited. As Internet addiction, substance abuse or gambling were suggested that shares the common psychopathological pathways, the choices of medications may include: (1) antidepressants, e.g. escitalopram and bupropion; (2) opioid receptor antagonists, e.g. naltrexone; (3) mood stabilizers, e.g. valproate and lithium; (4) antipsychotics, e.g. quetiapine; (5) psychostimulants, e.g. methylphenidate. To date, there still lacks of a complete treatment strategy for Internet addiction, and thus, future studies should investigate the combination of different pharmacotherapy to improve adherence and outcome. 參 考 資 料 : 1. Koob GF, Le Moal M: Drug abuse: hedonic homeostatic dysregulation. Science 1997; 278: 52-8. 2. Liu J, Gao XP, Osunde I, et al: Increased regional homogeneity in internet addiction disorder: a resting state functional magnetic resonance imaging study. Chin Med J (Engl) 2010; 123: 1904-8. 3. Goddard AW, Shekhar A, Whiteman AF, et al: Serotoninergic mechanisms in the treatment of obsessive-compulsive disorder. Drug Discov Today 2008; 13: 325-32. 4. Sattar P, Ramaswamy S: Internet gaming addiction. Can J Psychiatry 2004; 49: 869-70. 5. Dell'Osso B, Hadley S, Allen A, et al: Escitalopram in the treatment of impulsive-compulsive internet usage disorder: an open-label trial followed by a double-blind discontinuation phase. J Clin Psychiatry 2008; 69: 452-6. 6. Han DH, Lee YS, Na C, et al: The effect of methylphenidate on Internet video game play in children with attention-deficit/hyperactivity disorder. Compr Psychiatry 2009; 50: 251-6. 7. Han DH, Hwang JW, Renshaw PF: Bupropion sustained release treatment decreases craving for video games and cue-induced brain activity in patients with Internet video game addiction. Exp Clin Psychopharmacol 2010; 18: 297-304. 8. Han DH, Renshaw PF: Bupropion in the treatment of problematic online game play in patients with major depressive disorder. J Psychopharmacol 2012; 26: 689-96. 9. Goldberg JF, Whiteside JE: The association between substance abuse and antidepressant-induced mania in bipolar disorder: a preliminary study. J Clin Psychiatry 2002; 63: 791-5. 10. Bostwick JM, Bucci JA: Internet sex addiction treated with naltrexone. Mayo Clin Proc 2008; 83: 226-30. 11. Pallanti S, Quercioli L, Sood E, et al: Lithium and valproate treatment of pathological gambling: a randomized single-blind study. J Clin Psychiatry 2002; 63: 559-64. 12. McElroy SL, Nelson EB, Welge JA, et al: Olanzapine in the treatment of pathological gambling: a negative randomized placebo-controlled trial. J Clin Psychiatry 2008; 69: 433-40. 13. Atmaca M: A case of problematic internet use successfully treated with an SSRI-antipsychotic combination. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31: 961-2. 14. Yoo HJ, Cho SC, Ha J, et al: Attention deficit hyperactivity symptoms and internet addiction. Psychiatry Clin Neurosci 2004; 58: 487-94. 15. Camardese G, De Risio L, Di Nicola M, et al: A role for pharmacotherapy in the treatment of "internet addiction". Clin Neuropharmacol 2012; 35: 283-9. 114 THE JOURNAL OF TAIWAN PHARMACY Vol.31 No.2 Jun. 30 2015