OBJECTIVE: Pharmacogenomic-based antidepressant treatment (PGATx) may result in more precise pharmacotherapy of major depressive disorder (MDD) with better drug therapy guidance. METHODS: An 8-week, randomized, single-blind clinical trial was conducted to evaluate the effectiveness and tolerability of PGATx in 100 patients with MDD. All recruited patients were randomly allocated either to PGATx (n=52) or treatment as usual (TAU, n=48) groups. The primary endpoint was a change of total score of the Hamilton Depression Rating Scale-17 (HAMD-17) from baseline to end of treatment. Response rate (at least 50% reduction in HAMD-17 score from baseline), remission rate (HAMD-17 score ≥7 at the end of treatment) as well as the change of total score of Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER) from baseline to end of treatment were also investigated. RESULTS: The mean change of HAMD-17 score was significantly different between two groups favoring PGATx by −4.1 point of difference (p=0.010) at the end of treatment. The mean change in the FIBSER score from baseline was significantly different between two treatment groups favoring PGATx by −2.5 point of difference (p=0.028). The response rate (71.7 % vs. 43.6%, p=0.014) were also significantly higher in PGATx than in TAU at the end of treatment, while the remission rate was numerically higher in PGATx than in TAU groups without statistical difference (45.5% vs. 25.6%, p=0.071). The reason for early drop-out associated with adverse events was also numerically higher in TAU (n=9, 50.0%) than in PGATx (n=4, 30.8%). CONCLUSION: The present study clearly demonstrate that PGATx may be a better treatment option in the treatment of MDD in terms of effectiveness and tolerability; however, study shortcomings may limit a generalization. Adequately-powered, well-designed, subsequent studies should be mandatory to prove its practicability and clinical utility for routine practice.
Antidepressive Agents ; Depression ; Depressive Disorder ; Depressive Disorder, Major* ; Drug Therapy ; Generalization (Psychology) ; Humans ; Precision Medicine

Although pharmacological treatment constitutes the main therapeutic approach for depression, non-pharmacological treatments (self-care or psychotherapeutic approach) are usually regarded as more essential therapeutic approaches in clinical practice. However, there have been few clinical practice guidelines concerning self-care or psychotherapy in the management of depression. This study introduces the 'Evidence-Based, Non-Pharmacological Treatment Guideline for Depression in Korea.' For the first time, a guideline was developed for non-pharmacological treatments for Korean adults with mild-to-moderate depression. The guideline development process consisted of establishing several key questions related to non-pharmacologic treatments of depression, searching the literature for studies which answer these questions, assessing the evidence level of each selected study, drawing up draft recommendation, and peer review. The Scottish Intercollegiate Guidelines Network grading system was used to evaluate the quality of evidence. As a result of this process, the guideline recommends exercise therapy, bibliotherapy, cognitive behavior therapy, short-term psychodynamic supportive psychotherapy, and interpersonal psychotherapy as the non-pharmacological treatments for adult patients with mild-to-moderate depression in Korea. Hence, it is necessary to develop specific methodologies for several non-pharmacological treatment for Korean adults with depression.
Adult ; Bibliotherapy/*methods ; Clinical Protocols ; Cognitive Therapy/*methods ; Combined Modality Therapy/*methods ; Depression/*drug therapy/psychology/*therapy ; Exercise Therapy ; Humans ; Placebos/therapeutic use ; Questionnaires ; Republic of Korea

OBJECTIVETo observe the differences in onset time and the overall efficacy of the acupuncture therapy of dredging Governor Vessel and regulating mentality combined with fluoxetine and the fluoxetine for post-stroke depression(PSD).

METHODSSixty-three patients were randomly divided into an acupuncture intervention of dredging Governor Vessel and regulating mentality group(acupuncture and medication group, 33 cases) and a control group (medication group, 30 cases). In the medication group, 20 mg fluoxetine was used by oral administration, once a day at 7:00 in the morning, continuously for 4 weeks. In the acupuncture and medication group, based on the oral administration of fluoxetine, the acupuncture intervention of dredging Governor Vessel and regulating mentality was applied mainly at Baihui(GV 20), Fengfu(GV 16), Shenting(GV 24), Shuigou(GV 26), Dazhui(GV 14) and Shendao(GV 11), once a day, 6 times a week, continuously for 4 weeks. Twenty-four items in Hamilton Depression Scale(HAMD), modified Edinburgh Scandinavia Stroke Scale(MESSS) and activity of daily life scale(ADL, Barthel index, BI) were used before and after 2-week and 4-week treatment. The efficacy was compared between the two groups.

RESULTSAfter 2-week treatment, the HAMD score and the MESSS score in the acupuncture and medication group were obviously decreased and the BI score was apparently increased(all P<0. 01). In the medication group, however, the score of every scale was not statistically different from that before treatment(P'>0. 05). After 4-week treatment, HAMD scores and MESSS scores in the two groups were obviously decreased and the BI scores I were apparently increased(all P<0. 01). After 2-week and 4-week treatment, the HAMD scores and the MESSS scores in the acupuncture and medication group were lower than those in the medication group and the BI scores were higher than those in the medication group(P<0. 01, P<0. 05). The total effective rate of anti-depression (97. 0%, 32/33) the total effective rate of nerve function impairment(90. 9%, 30/33) and the total effective rate of daily life activity(97. 0% 32/33) in the acupuncture and medication group were better than 80. 0% (24/30), 80. 0%(24/30), 83. 3%(25/30) in the medication group(all P<0. 05).

CONCLUSIONThe acupuncture therapy of dredging Governor Vessel and regulating mentality could reduce the onset time of anti-depression medicine treatment of PSD and enhance the overall efficacy. Therefore, it enhances the clinical compliance.

Acupuncture Therapy ; Adult ; Aged ; Antidepressive Agents ; administration & dosage ; Combined Modality Therapy ; Depression ; drug therapy ; etiology ; therapy ; Female ; Humans ; Male ; Meridians ; Middle Aged ; Stroke ; complications ; psychology

OBJECTIVE: There have been much effort to find reliable indicators predicting treatment response in panic disorder. This study aimed to find the effect of pharmacotherapy on biofeedback measurement variables in panic disorder patients. METHOD: We recruited 38 panic disorder patients (M:25, F:13) in the Samsung Medical Center, who were diagnosed by the ADIS-IV (Anxiety Disorder Interview Schedule-IV), and 33 normal control subjects (M:21 F:12). Panic patients were treated with paroxetine for 3 months. All subjects were assessed on forearm and frontal electromyography (EMG), electrodermal response (EDR), and skin temperature in baseline, stress, recovery phases using the Procomp & Biograph biofeedback instrument. Psychological measures such as Hamilton anxiety rating scale (HAM-A), Hamilton depression rating scale (HAM-D), Beck depression inventory (BDI), Spielberger state-trait anxiety inventory (STAI-S, STAI-T), and Anxiety sensitivity index (ASI) were also assessed. All measurements were performed at the beginning of the study and after 3 months of paroxetine treatment. RESULT: Panic patients had significantly higher scores on psychological measures such as HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) before treatment. After 3months of treatment, panic patients showed significant improvement on baseline EDR (z=-2.824, p=0.005), stress EDR (z=-2.691, p=0.007), and recovery EDR (z=-3.416, p=0.001). They also showed significant improvement on HAM-A, HAM-D, BDI, STAI-S, STAI-T, and ASI (all p values<0.001) after treatment. CONCLUSION: Electrodermal response, one of the biofeedback measurement variables, was suggested to be the possible indicator predicting treatment response in panic disorder.
Anxiety ; Biofeedback, Psychology* ; Depression ; Drug Therapy* ; Electromyography ; Forearm ; Galvanic Skin Response ; Humans ; Panic Disorder* ; Panic* ; Paroxetine* ; Skin Temperature

Anxiety ; epidemiology ; China ; epidemiology ; Depression ; epidemiology ; Female ; Heroin Dependence ; drug therapy ; psychology ; Humans ; Male ; Methadone ; administration & dosage ; therapeutic use

OBJECTIVES: Cognitive complaints are reported frequently after breast cancer treatments. The causes of cognitive decline are multifactorial, a result of the effect of cancer itself, chemotherapy, and psychological factors such as depression and anxiety. However, cognitive decline does not always correlate with neuropsychological test performance. The purpose of this study was to examine the relationship of subjective cognitive decline with objective measurement and to explore associated factors of cognitive function in breast cancer survivors. METHODS: We included 29 breast cancer survivors who complain cognitive decline at least 6 months after treatment and 20 age-matched healthy controls. Neuropsychological tests were performed in all participants. Multivariable regression analysis evaluated associations between neuropsychological test scores and psychological distress including depression and anxiety, also considering age, education, and comorbidity. RESULTS: There were no statistically significant differences in neuropsychological test performances. However, the breast cancer survivors showed a significantly higher depression(p=0.002) and anxiety(p < 0.001) than the healthy controls did. Among the cancer survivors, poorer executive function was strongly associated with higher depression(β=−0.336, p=0.001) and anxiety(β=−0.273, p=0.009), after controlling for age, education, and comorbidity. In addition, poorer attention was also significantly related with depression(β=−0.375, p=0.023) and anxiety (β=−0.404, p=0.013). CONCLUSIONS: The results of this study showed the discrepancies between subjective complaints and objective measures of cognitive function in breast cancer survivors. It suggests that subjective cognitive decline could be indicators of psychological distress such as depression and anxiety.
Anxiety ; Breast Neoplasms ; Breast ; Cognition ; Comorbidity ; Depression ; Drug Therapy ; Education ; Executive Function ; Humans ; Neuropsychological Tests ; Psychology ; Survivors

PURPOSE: This study aimed to develop and test a structural model for chemotherapy-related cognitive impairment of breast cancer patients based on a literature review and Hess and Insel's chemotherapy-related cognitive change model. METHODS: The Participants consisted of 250 patients who were ≥19 years of age. The assessment tools included the Menopause Rating Scale, Symptom Experience Scale, Hospital Anxiety and Depression Scale, Everyday Cognition, and Functional Assessment of Cancer Therapy-Breast Cancer. Data were analyzed using the SPSS 21.0 and AMOS 21.0 programs. RESULTS: The modified model was a good fit for the data. The model fit indices were χ2=423.18 (p<.001), χ2/df=3.38, CFI=.91, NFI=.91, TLI=.89, SRMR=.05, RMSEA=.09, and AIC=515.18. Chemotherapy-related cognitive impairment was directly influenced by menopausal symptoms (β=.38, p=.002), depression and anxiety (β=.25, p=.002), and symptom experiences (β=.19, p=.012). These predictors explained 47.7% of the variance in chemotherapy-related cognitive impairment. Depression and anxiety mediated the relations among menopausal symptoms, symptom experiences, and with chemotherapy related cognitive impairment. Depression and anxiety (β=−.51, p=.001), symptom experiences (β=−.27, p=.001), menopausal symptoms (β=−.22, p=.008), and chemotherapy-related cognitive impairment (β=−.15, p=.024) had direct effects on the quality of life and these variables explained 91.3%. CONCLUSION: These results suggest that chemotherapy-related toxicity is highly associated with cognitive decline and quality of life in women with breast cancer. Depression and anxiety increased vulnerability to cognitive impairment after chemotherapy. Nursing intervention is needed to relieve chemotherapy-related toxicity and psychological factor as well as cognitive decline for quality of life in patients undergoing chemotherapy.
Anxiety ; Breast Neoplasms ; Breast ; Cognition ; Cognition Disorders ; Depression ; Drug Therapy ; Female ; Humans ; Menopause ; Models, Structural ; Nursing ; Psychology ; Quality of Life

OBJECTIVE: To investigate the effect of antidepressant and psychological intervention on the blood pressure and quality of life in hypertensive patients with depression. METHODS: After evaluating 950 patients with essential hypertension by Hospital Anxiety and Depression Scale (HAD), patients with HAD positive results were evaluated with Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA). The positive subjects with HAMD were randomly divided into an antidepressant and psychological intervention group (n=30, including routine treatment, mental state intervention, and antidepressant treatment) and a control group (n=30, routine treatment alone). The blood pressure, quality of life, and level of depression were compared between the 2 groups. RESULTS: The depression symptoms were significantly improved in the antidepressant and psychological intervention group. The HAMD score fell from 30.03+/-1.83 at entrance to 17.43+/-1.96 at the end of study. The blood pressure control was more effective in the antidepressant and psychological intervention group than in the control group. The mean systolic blood pressure (SBP) and diastolic blood pressure (DBP) decreased by 26.17 mmHg and 13.63 mmHg in the antidepressant and psychological intervention group, while there were only 14.32 mmHg and 7.18 mmHg decrease in SBP and DBP respectively in the control group. Patients in the antidepressant and psychological intervention group had a higher score in the quality of life. The total score of GQOLI-74 increased from 65.97+/-4.68 before the treatment to 71.20+/-5.13 after the treatment. CONCLUSION Psychological intervention and antidepressant can improve the blood pressure control and quality of life in hypertensive patients with depression.
Adult ; Antidepressive Agents ; therapeutic use ; Blood Pressure ; drug effects ; Depression ; complications ; therapy ; Female ; Humans ; Hypertension ; complications ; drug therapy ; psychology ; Male ; Middle Aged ; Psychotherapy ; Quality of Life

OBJECTIVETo study the effect of classic ancient prescription Kaixin San (KXS) on learning and memory abilities in chronic stress depression model rats and its possible mechanisms.

METHODRats were randomly assigned to six groups: the control group, the model group, the positive drug group (fluoxetine 10 mg x kg(-1)) and KXS groups (1000, 500, 250, 125 mg x kg(-1)). KXS were orally administrated to CMS rats for 21 days. The anti-depression activity of KXS was assessed using the sucrose consumption and the open-field test. The protecting effect for learning and memory abilities was assessed using the Morris water maze (MWM) test. Furthermore, the levels of monoamine neurotransmitters, acetylcholine (Ach) and acetyl cholinesterase (AchE) in the total brain and brain-derived neurotrophic factor (BDNF) protein in the hippocampus were determined.

RESULTThe behavior test showed that KXS significantly increased the sucrose consumption and total distance in the open-field test and notably reduce the incubation period of location and navigation in the MWM test. It could also help increase the number of times passing through the platform, the swimming distance and time in quadrant of original platform, the levels of serotonin (5-HT) and dopamine (DA) , noradrenergic (NE), Ach, BDNF protein and reduce the level of AchE in the CMS-induced rats.

CONCLUSIONKXS can ameliorate the CMS-induced depression behavior in rats and improved their learning and memory abilities, which may be related to the increase in monoamine neurotransmitters, Ach and BDNF levels.

Animals ; Chronic Disease ; psychology ; therapy ; Depression ; drug therapy ; psychology ; Disease Models, Animal ; Drugs, Chinese Herbal ; administration & dosage ; Humans ; Learning ; drug effects ; Male ; Maze Learning ; drug effects ; Memory ; drug effects ; Rats ; Rats, Sprague-Dawley

BACKGROUNDLate onset hypogonadism negatively impacts on men's psychological well-being. This study was conducted to examine the interrelationship among symptoms of testosterone deficiency, psychological well-being, and quality of life.

METHODSEligible subjects were randomized into active treatment and control groups, and were asked to complete the following questionnaires at baseline and month 6: aging male's symptoms (AMS) rating scale, hospital anxiety and depression scale (HADS), perceived stress scale (PSS) and the short form health survey-12 (SF-12). In this study, men were treated and monitored for 6 months with oral testosterone undecanoate (TU) capsules or vitamin E/C capsules in a single-blinded fashion. All in the active treatment group were administered a total of 120 - 160 mg TU orally on a daily basis. Total and free T levels between baseline and month 6 were compared.

RESULTSOne hundred and sixty eligible subjects were recruited and followed up. In the active treatment group, total serum testosterone concentrations before and after intervention were (7.98 ± 0.73) nmol/L and (13.7 ± 1.18) nmol/L. The mean HADS anxiety subscale scores for the subjects at baseline and at month 6 were 3.47 ± 0.4 and 1.72 ± 0.2, respectively (t = 1.526, P < 0.05). Additionally, the mean HADS depression subscale scores were 4.91 ± 0.6 and 2.39 ± 0.3, respectively (t = 3.466, P < 0.05). The mean scores on PSS for the subjects at baseline and at month 6 were 12.88 ± 2.1 and 9.83 ± 1.7, respectively (t = 4.009, P < 0.05). Significantly improved SF-12 could be observed (t = 1.433 and 1.118, respectively; both P < 0.05). No significant changes were observed in the control group at month 6.

CONCLUSIONAndrogen replacement not only improves androgen deficiency associated symptoms, but also enhances comprehensive improvement in psychological issues.

Age of Onset ; Aged ; Anxiety ; drug therapy ; Depression ; drug therapy ; Hormone Replacement Therapy ; Humans ; Hypogonadism ; blood ; drug therapy ; psychology ; Male ; Middle Aged ; Quality of Life ; Single-Blind Method ; Testosterone ; blood ; deficiency ; therapeutic use