This study investigated the antidepressant efficacy and it's impact on the quality of life of depressed patients. We performed Hamilton Depression Rating Scale(HDRS), and Montgomery-Asberg Depression Rating Scale(MADRS), and Health-related Quality of Life Questionnaire(HQLQ) to both tricyclic antidepressant(TCA) and sertraline groups. There were 16 subjects in the study. The tricyclic group had 9 subjects and the sertraline group had 7. The TCA and sertraline produced a similar degree of response. Both groups experienced a reduction of 70% or more in mean HDRS and MADRS total score after 6wks. In HQLQ, the TCAs group also showed improved bed disability days, alertness behavior, and social interaction, the sertraline group showed improved health perception, alertness behavior, home management, and social interaction. We suggested that the improvement of "Quality of life" were not in proportion to the clinical symptom's improvement. Therefore, clinicians should consider the benefit of antidepressant treatment in terms of quality of life.
Depression ; Humans ; Interpersonal Relations ; Quality of Life* ; Sertraline

The phamacotherapy of depression has reduced morbidity and improved outcome for many depressive patients. A wide range of classical and new antidepressants are available for their treatment. However, 30-40% of all patients do not respond sufficiently to the initial treatment and present adverse effects. Pharmacogenetics studies the genetic basis of an individual's ability to respond to pharmacotherapy. Recently, some reports on serotonin transporter gene polymorphisms and their influence on the response to antidepressive therapy provide an interesting diagnostic tool in assessing the chances of response to antidepressants. We also investigated the relationship between serotonin transprter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. 128 depressive patients were enrolled into 2nd year study. The therapeutic response of each subset was not different at 8th, 16th week. but the subset with homozygote(l/l) of long variant showed a better therapeutic response to antidepressant than the heterozygote(l/s) of long and short variant, which showed a better therapeutic response than the subset with homozygote(s/s) of short variant at 1st year and 2nd year after the antidepressant treatment. This result shows that the serotonin transporter polymorphisms may be related to the long-term effect of antidepressant treatment. The potential for pharmacogenomics. the use of genetic increasing attention pharmacogenomics will contribute to individualize drug choice by using genotype to predict positive clinical outcomes, adverse reactions, and levels of drug metabolism. Personalized medicine the use of marker-assisted diagnosis and targeted therapies derived from an individual molecular profile, will impact the antidepressant therapy and this approach will replace the traditional trial-and-error practice of medicine.
Antidepressive Agents ; Depression ; Depressive Disorder* ; Diagnosis ; Drug Therapy ; Genotype ; Humans ; Precision Medicine ; Metabolism ; Pharmacogenetics* ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

OBJECTIVES: It is very important to understand the personality characteristics of chronic insomniacs far diagnosis and treatment in clinical practice. The authors investigated the personality factors and the ways of coping to define the personality characteristics which underly the development of insomnia. METHODS: The authors used the diagnostic criteria of International Classification of Sleep Disorders to diagnose chronic insomnia, and performed 16 Personality Factors(PF) test and the Ways of Coping Checklist to both chronic insomniacs and normal controls. The diagnosis of chronic insomnia included psychophysiologic insomnia, poor sleep hygiene, and hypnotics dependent insomnia. The subjects were 21 chronic insomniacs and 26 normal controls. RESULTS: The chronic insomniacs showed significantly lower stableness(C factor ; 4.57 +/-1.89 VS 7.38+/-1.83), intelligence(B factor ; 3.76+/-2.23 VS 6.54+/-1.96), motivation distorsion(B factor ; 3.76+/-2.23 VS 6.54+/-1.96) factor scores, and higher guilt-proneness(O factor ; 6.67+/-2.11 VS 3.81+/-1.65), tension and anxiety(Q4, factor ; 7.57+/-2.29 VS 3.46+/-1.88) factor scores than controls in 16 PF. The chronic insomniacs had significantly higher emotional-focused coping(30.30+/-9.53 VS 24.52+/-5.71) and passive coping pattern scores(50.75+/-13.76 VS 43.26+/-8.73) than controls in the Ways of Coping Checklist. CONCLUSION: The authors suggest that chronic insomniacs are characterized by depressive mood and anxiety-proneness from low ego strength, high levels of anxiety and guilty feelings, and passive and emotion-concentrated coping pattern. This traits are supposed to be factors contributing the state of emotional arousal and resultant physiological activation that has developed and maintained the insomnia.
Anxiety ; Arousal ; Checklist ; Classification ; Diagnosis ; Ego ; Hygiene ; Hypnotics and Sedatives ; Motivation ; Sleep Wake Disorders ; Sleep Initiation and Maintenance Disorders

Suicide is a significant public health issue and a major cause of death in Korea. Almost 95% of all persons who commit or attempt suicide have a diagnosed mental disorder. Depressive disorders account for 80% of this figure; schizophrenia accounts for 10%. Stress has an impact on the onset and course of psychiatric disorders. The stress response is monitored by measuring the activity of the hypothalamic-pituitary-adrenal (HPA) axis. Numerous studies have identified changes in HPA axis activity and glucocorticoid action in psychiatric disorders. Various stressful life experiences (prenatal stress, adverse early life experiences, ongoing or recent psychosocial stress) are important environmental factors enhancing the sensitivity of some individuals to stress in adulthood. In this review, we introduce the association between stress and psychiatric disorders.
Axis, Cervical Vertebra ; Cause of Death ; Depressive Disorder ; Humans ; Korea ; Life Change Events ; Mental Disorders ; Public Health ; Schizophrenia ; Suicide

OBJECTIVES: We surveyed this study for knowing the relation within stress, depression and medical comorbidities, and finding the risk factors of major depression. METHODS: 1764 subjects were enrolled from Jan. 2009 to Dec. 2009 who visit Korea University Guro hospital healthcare center. The subjects answered the questionnaire of PSS(Perceived Stress Scale), PHQ-9(Patient Health Questionnaire-9) and the demographic data. We categorized them as the stress group, depressive group, medical comorbidity group and analyzed the correlation analyses and logistic regression analyses. RESULTS: 198 of 1764 subjects(11.8%) were applied to major depression, and the depressive group showed the higher mean stress score(23.19) and mean depression score(12.95) than the normal group. The total PHQ-9 score was increased by perceiving more stress, having more medical comorbidities. The subjects with female, visiting due to recent health problems, irregular exercise, current smoking, history of angina and cerebrovascular disease showed the increased risk of major depression. CONCLUSIONS: In this study, we find the PSS, PHQ-9 were valuable for mental health screening in healthcare center. As perceiving more stress and having more medical comorbidity, risk of major depression were increased. Accordingly the individuals with medical diseases or unhealthy lifestyle would need the mental health screen.
Comorbidity ; Delivery of Health Care ; Depression ; Female ; Humans ; Korea ; Life Style ; Logistic Models ; Mass Screening ; Mental Health ; Questionnaires ; Risk Factors ; Smoke ; Smoking

Currently, pharmacotherapy is the primary treatment modality for depression. Various classes of antidepressants have been developed and are widely used at present. Although the antidepressant effects of these drugs are thought to be similar, there are numerous differences between drugs in pharmacologic characteristics, side effects, and tolerabilities. Furthermore, 40~50% of patients may not respond sufficiently to the first-line antidepressants they take. As the response rates are substantially insufficient, and the side effects are not uncommon, the optimal treatment of antidepressants is somewhat difficult. Therefore, the clinicians treating depression should understand the characteristics of various antidepressants and also the optimal treatment strategy. In this review, we introduce various antidepressants and optimal treatment strategies for the treatment of depression.
Antidepressive Agents ; Depression ; Humans

Depression is a frequent cause of suicide. Although there have been reports that SSRIs might increase suicidal ideations and behaviors, most studies found antidepressants are effective treatments of suicidal ideations and behaviors. Antidepressants have also been shown to have prophylactic effects in preventing suicidal behaviors. Most double-blind studies do not suggest a causal relationship between antidepressant and the increased suicidality. Our review results suggest that the undertreatments of depression are more significant problems with the use of antidepressants in suicidal patients.
Antidepressive Agents ; Depression ; Double-Blind Method ; Humans ; Suicidal Ideation ; Suicide*

Depressive disorders have strong genetic components. However, conventional linkage and association studies have not yielded definitive results. These might be due to the absence of objective diagnostic tests, the complex nature of human behavior or the incomplete penetrance of psychiatric traits. Imaging genetics explores the influences of genetic variation on the brain function or structure. This technique could provide a more sensitive assessment than traditional behavioral measures in psychiatric studies. Imaging genetics is a relatively new field of psychiatric researches, and may improve our understanding on neurobiology of psychiatric disorders. In this review, current understanding in neurobiology of depressive disorders, especially imaging genetic studies on serotonin transporter will be discussed.
Brain ; Depressive Disorder ; Diagnostic Tests, Routine ; Genetic Variation ; Humans ; Neurobiology ; Penetrance ; Serotonin ; Serotonin Plasma Membrane Transport Proteins

To review the recent progress of machine learning for the early diagnosis of depression (major depressive disorder). The source of data was 32 original studies in the Web of Science. The search terms were “depression” (title) and “random forest” (abstract). The eligibility criteria were the dependent variable of depression, the interventions of machine learning (the decision tree, the naïve Bayesian, the random forest, the support vector machine and/or the artificial neural network), the outcomes of accuracy and/or the area under the receiver operating characteristic curve (AUC) for the early diagnosis of depression, the publication year of 2000 or later, the publication language of English and the publication journal of SCIE/SSCI. Different machine learning methods would be appropriate for different types of data for the early diagnosis of depression, e.g., logistic regression, the random forest, the support vector machine and/or the artificial neural network in the case of numeric data, the random forest in the case of genomic data. Their performance measures reported varied within 60.1–100.0 for accuracy and 64.0–96.0 for the AUC. Machine learning provides an effective, non-invasive decision support system for early diagnosis of depression.

OBJECTIVE: Many evidences raise the possibility that the panic disorder (PD) patients with respiratory subtype (RS) may have characteristic structural abnormalities. We aimed to explore the structural differences between PD patients with and without the respiratory symptoms. METHODS: Patients with PD were recruited from the Department of Psychiatry at Korea University Anam Hospital. Respiratory subtype (RS) was diagnosed when at least 4 out of 5 of the following respiratory symptoms were present during the panic attack: fear of dying, chest pain/discomfort, shortness of breath, paresthesias, and a choking sensation. We acquired high-resolution MRI scans and used FreeSurfer to obtain a measure of cortical thickness for each patient. RESULTS: Cluster based analysis revealed significantly decreased cortical thickness in the left hemisphere in the caudal-middle-frontal, superior frontal, and posterior parietal areas in the RS group. No significant difference was observed in any of the limbic areas. CONCLUSION: Respiratory symptoms of panic disorder were associated with a reduction in cortical thickness in the left frontal and parietal areas. This finding leads to the assumption that the frontoparietal network is the crucial component in a larger cortical network underlying the perception of dyspnea in RS.
Airway Obstruction ; Dyspnea ; Humans ; Korea ; Magnetic Resonance Imaging ; Panic Disorder* ; Panic* ; Paresthesia ; Rabeprazole ; Sensation ; Thorax