1.A Pharmacogenomic-based Antidepressant Treatment for Patients with Major Depressive Disorder: Results from an 8-week, Randomized, Single-blinded Clinical Trial.
Changsu HAN ; Sheng Min WANG ; Won Myong BAHK ; Soo Jung LEE ; Ashwin A PATKAR ; Prakash S MASAND ; Laura MANDELLI ; Chi Un PAE ; Alessandro SERRETTI
Clinical Psychopharmacology and Neuroscience 2018;16(4):469-480
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
3.Do Somatic Symptoms Predict the Severity of Depression? A Validation Study of the Korean Version of the Depression and Somatic Symptoms Scale.
Sang Won JEON ; Seo Young YOON ; Young Hoon KO ; Sook Haeng JOE ; Yong Ku KIM ; Changsu HAN ; Ho Kyoung YOON ; Chia Yih LIU
Journal of Korean Medical Science 2016;31(12):2002-2009
This study aimed at exploring the psychometric characteristics of the Korean Version of the Depression and Somatic Symptoms Scale (DSSS) in a clinical sample, and investigating the impact of somatic symptoms on the severity of depression. Participants were 203 consecutive outpatients with current major depressive disorders (MDD) or lifetime diagnosis of MDD. The DSSS was compared with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the 17-items Hamilton Depression Rating Scale (HAMD). The DSSS showed a two-factor structure that accounted for 56.8% of the variance, as well as excellent internal consistency (Cronbach’s alpha = 0.95), concurrent validity (r = 0.44–0.82), and temporal stability (intraclass correlation coefficient = 0.79). The DSSS had a high ability to identify patients in non-remission (area under receiver operating characteristic [ROC] curve = 0.887). Maximal discrimination between remission and non-full remission was obtained at a cut-off score of 22 (sensitivity = 82.1%, specificity = 81.4%). The number of somatic symptoms (the range of somatic symptoms) and the scores on the somatic subscale (SS, the severity of somatic symptoms) in non-remission patients were greater than those in remission patients. The number of somatic symptoms (slope = 0.148) and the SS score (slope = 0.472) were confirmed as excellent predictors of the depression severity as indicated by the MADRS scores. The findings indicate that the DSSS is a useful tool for simultaneously, rapidly, and accurately measuring depression and somatic symptoms in clinical practice settings and in consultation fields.
Depression*
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Depressive Disorder, Major
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Diagnosis
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Discrimination (Psychology)
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Humans
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Outpatients
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Psychometrics
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ROC Curve
;
Sensitivity and Specificity
4.The Emotion-Regulation Benefits of Implicit Reappraisal in Clinical Depression: Behavioral and Electrophysiological Evidence.
Jiajin YUAN ; Yueyao ZHANG ; Yanli ZHAO ; Kexiang GAO ; Shuping TAN ; Dandan ZHANG
Neuroscience Bulletin 2023;39(6):973-983
Major depressive disorder (MDD) is characterized by emotion dysregulation. Whether implicit emotion regulation can compensate for this deficit remains unknown. In this study, we recruited 159 subjects who were healthy controls, had subclinical depression, or had MDD, and examined them under baseline, implicit, and explicit reappraisal conditions. Explicit reappraisal led to the most negative feelings and the largest parietal late positive potential (parietal LPP, an index of emotion intensity) in the MDD group compared to the other two groups; the group difference was absent under the other two conditions. MDD patients showed larger regulatory effects in the LPP during implicit than explicit reappraisal, whereas healthy controls showed a reversed pattern. Furthermore, the frontal P3, an index of voluntary cognitive control, showed larger amplitudes in explicit reappraisal compared to baseline in the healthy and subclinical groups, but not in the MDD group, while implicit reappraisal did not increase P3 across groups. These findings suggest that implicit reappraisal is beneficial for clinical depression.
Humans
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Depressive Disorder, Major/psychology*
;
Emotional Regulation
;
Depression
;
Emotions/physiology*
;
Cognition/physiology*
5.Psychosocial Factors Associated with Suicidal Idea among Korean Elderly.
Jin Sook CHEON ; Sang Shin LEE ; Jong Rae ROH ; Byoung Hoon OH
Journal of Korean Geriatric Psychiatry 2005;9(2):132-139
OBJECTIVES: The aim of this study was to analyze psychosocial factors associated with suicidal idea among Korean elderly. METHODS: The sociodemographic data and psychopathology were evaluated by questionnaire and psychiatric interview in community-dwelling elderly with age over 60 (N=100) and adults with age 30-49 (N=60). Suicidal idea was assessed by 9th item of Beck Depression Inventory (BDI). To analyze factors associated with suicidal idea in Korean elderly, we assessed family function (Family Adaptation Partnership Growth Affection Resolve, APGAR), alcohol problem (Cut Annoyed Guilty Eye-Opener, CAGE), depressive symptoms (HAM-D, BDI), cognitive function (CDR, MMSE-K, GDS), and functional activities (ADL, I-ADL). RESULTS: 1) The frequency of suicidal idea of the elderly with age over 60 (20.0%) was significantly higher than that of adult with age 30-49 (6.7%)(p<0.05). 2) The factors associated with suicidal idea were major depressive disorder (OR=42.17, 95% C.I. : 2.62-679.03), physical illness (OR=27.01, 95% C.I. : 1.18-616.50), depressive symptoms (OR=12.18, 95% C.I. : 2.91-49.98), poor economic status (OR=7.18, 95% C.I. : 1.05-48.86). 3) The means of variables in the elderly with suicidal idea were ADL 6.4+/-1.1, HAM-D 17.8+/-7.7, BDI 30.0+/-9.5, APGAR 4.8+/-2.6, which were significantly higher than those of the elderly without suicidal idea (p<0.05, respectively). 4) The HAM-D score in the Korean elderly had statistically significant correlation with APGAR (gamma=0.376, p<0.01), BDI (gamma=0.808, p<0.01), ADL (gamma=0.316, p<0.01), GDS (gamma=0.282, p<0.01), CDR (gamma=0.258, p<0.01) and education level (gamma=-0.208, p<0.05). The BDI score had statistically significant correlation with APGAR (gamma=0.341, p<0.01), HAM-D (gamma=0.808, p<0.01), GDS (gamma=0.340, p<0.01), CDR (gamma=0.301, p<0.01), ADL (gamma=0.325, p<0.05) and I-ADL (gamma=0.206, p<0.05). CONCLUSION: These results suggested early detection, psychogeriatric intervention of the elderly with high risk factors and active treatment of medical illness could reduce suicidal idea among them.
Activities of Daily Living
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Adult
;
Aged*
;
Depression
;
Depressive Disorder, Major
;
Education
;
Humans
;
Psychology*
;
Psychopathology
;
Surveys and Questionnaires
;
Risk Factors
6.The Relationship between Low Self-Esteem and Suicide Attempt in Patients with Major Depressive Disorder: A Pilot Study.
Hankaram JEON ; Duk In JON ; Hyun Ju HONG ; Narei HONG ; Eun Hee PARK ; Myung Hun JUNG
Korean Journal of Psychopharmacology 2013;24(4):180-185
OBJECTIVE: Depression is a major risk factor for suicide, and several psychological factors such as low self-esteem are involved in suicide. The aim of this study was to investigate the difference in self-esteem between non suicide attempters and suicide attempters with major depressive disorder. METHODS: The study subjects consisted of 52 patients who received inpatient or outpatient treatments at the Hallym University Sacred Heart Hospital. All participants were diagnosed as major depressive disorder by Korean version of the Mini-International Neuropsychiatric Interview. Columbia Suicide Severity Rating Scale (C-SSRS) was used to evaluate patient's suicide attempt. They completed a questionnaire that included Rosenberg Self-Esteem Scale, Beck Depression Inventory (BDI) and Beck Scale for Suicide Ideation (BSI). RESULTS: A total of 52 subjects were evaluated by C-SSRS, and among them, 32 were non suicide attempters and 20 were suicide attempters. Compared to non suicide attempters, suicide attempters showed significantly lower levels of self-esteem (t=3.492, p=0.001) and higher levels of BSI (t=-4.890, p<0.001). Although there was no significant difference between two groups for severity of overall depressive symptoms, negative attitude subscale of BDI was higher in suicide attempters than non suicide attempters (t=-2.596, p=0.014). A stepwise multivariate logistic regression analysis showed that low self-esteem was significant association with suicide attempt after adjusted by negative attitude subscale of BDI and BSI (odds ratio=0.779, p=0.042). CONCLUSION: The present study indicated that low self-esteem plays a significant role in suicide attempters with major depressive disorder. Assessment of suicide risk should include not only suicide ideation and severity of overall depressive symptoms but also low self-esteem.
Depression
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Depressive Disorder, Major*
;
Heart
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Humans
;
Inpatients
;
Logistic Models
;
Outpatients
;
Pilot Projects*
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Psychology
;
Surveys and Questionnaires
;
Risk Factors
;
Suicide*
7.Heart Rate Variability and the Efficacy of Biofeedback in Heroin Users with Depressive Symptoms.
I Mei LIN ; Jiun Min KO ; Sheng Yu FAN ; Cheng Fang YEN
Clinical Psychopharmacology and Neuroscience 2016;14(2):168-176
OBJECTIVE: Low heart rate variability (HRV) has been confirmed in heroin users, but the effects of heart-rate-variability-biofeedback in heroin users remain unknown. This study examined (1) correlations between depression and HRV indices; (2) group differences in HRV indices among a heroin-user group, a group with major depressive disorder but no heroin use, and healthy controls; and (3) the effects of heart-rate-variability-biofeedback on depressive symptoms, HRV indices, and respiratory rates within the heroin group. METHODS: All participants completed a depression questionnaire and underwent electrocardiogram measurements, and group differences in baseline HRV indices were examined. The heroin group underwent electrocardiogram and respiration rate measurements at baseline, during a depressive condition, and during a happiness condition, before and after which they took part in the heart-rate-variability-biofeedback program. The effects of heart-rate-variability-biofeedback on depressive symptoms, HRV indices, and respiration rates were examined. RESULTS: There was a negative correlation between depression and high frequency of HRV, and a positive correlation between depression and low frequency to high frequency ratio of HRV. The heroin group had a lower overall and high frequency of HRV, and a higher low frequency/high frequency ratio than healthy controls. The heart-rate-variability-biofeedback intervention increased HRV indices and decreased respiratory rates from pre-intervention to post-intervention. CONCLUSION: Reduced parasympathetic and increased sympathetic activations were found in heroin users. Heart-rate-variability-biofeedback was an effective non-pharmacological intervention to restore autonomic balance.
Autonomic Nervous System
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Biofeedback, Psychology*
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Depression*
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Depressive Disorder, Major
;
Electrocardiography
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Happiness
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Heart Rate*
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Heart*
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Heroin*
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Respiratory Rate
8.A 12-Week Multi-Domain Lifestyle Modification to Reduce Depressive Symptoms in Older Adults: A Preliminary Report.
Ki Jung CHANG ; Chang Hyung HONG ; Hyun Woong ROH ; Kang Soo LEE ; Eun Hee LEE ; Jinju KIM ; Hyun Kook LIM ; Sang Joon SON
Psychiatry Investigation 2018;15(3):279-284
OBJECTIVE: The objective of this study was to compare the effectiveness of usual care management (UCM) and a newly-developed lifestyle modification with contingency management (LMCM) for geriatric depressive symptoms in the community. METHODS: A randomized controlled trial was conducted in 93 older adults with major depressive disorder at community mental health centers. A 12 week multi-domain LMCM was developed by providing positive reinforcement using ‘gold medal stickers’ as a symbolic incentive to motivate their participation and adherence. Participants were allocated to LMCM (n=47) and UCM (n=46) groups. They were then subjected to the 12 week treatment. Effects of the two intervention methods on Geriatric Depression Scale were determined using mixed model analysis. RESULTS: Participants in the LMCM group had greater decline in GDS score per month than participants in the UCM group after adjusting for age, sex, years of education, living alone, and MMSE scores at baseline examination [coefficient for GDS score (95% CI): -1.08 (-1.51, -0.65), p < 0.001, reference: UCM group]. CONCLUSION: LMCM is safe and easy to use with a low cost. LMCM is suitable as psychosocial intervention for older adults with depressive symptoms in the community.
Adult*
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Aged
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Community Mental Health Centers
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Depression*
;
Depressive Disorder, Major
;
Education
;
Humans
;
Life Style*
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Motivation
;
Numismatics
;
Reinforcement (Psychology)
9.A case-control study on the risk factors for attempted suicide in patients with major depression.
Yu-qi ZHANG ; Guo-zhen YUAN ; Gui-lin LI ; Jian-jun YAO ; Zao-huo CHENG ; Xing CHU ; Chao-jun LIU ; Qing-hai LIU ; Ai-rong WANG ; Gui-zhi SHI ; Bao-heng WANG ; Yi-ren CHENG ; Ming-lian ZHANG ; Ke LI
Chinese Journal of Epidemiology 2007;28(2):131-135
OBJECTIVETo understand the environmental risk factors on attempted suicide in patients with major depression, and to study the interaction between factors as single nucleotide polymorphism(SNP) of TPH2 gene rs7305115 associated to attempted suicide in major depression.
METHODSPaired case-control study on 215 suicide attempters with major depression (92 male, 123 female) and molecular biological techniques were used to study the relation between TPH2 gene rs7305115 SNP,interrelated environmental factors and the rate of attempted suicide. Controls were paired with cases according to the same gender, similar age (no more than 3 years) and from the same district.
RESULTSThere were remarkably significant differences in gene types and gene frequency between case and control groups (P < 0.001). Data from multivariate conditional logistic regression model analysis showed that hopelessness, negative life-events and family history of suicide were relationship of attempted suicide in patients with major depression with OR values as 0.33 (95% CI: 0.22-0.99), 7.68 (95% CI: 5.79-13.74), 6.64 (95% CI: 2.48-11.04), 2.98 (95% CI: 1.17-5.04) respectively. There was no first level interaction between any of the two risk factors.
CONCLUSIONResults from the study supported the idea that hopelessness, negative life-events and family history of suicide were risk factors of attempted suicide in major deprbssion while TPH2 gene rs7305115 A/A might be the protective factor.
Case-Control Studies ; China ; epidemiology ; Depressive Disorder, Major ; genetics ; psychology ; Humans ; Odds Ratio ; Polymorphism, Single Nucleotide ; Risk Factors ; Suicide, Attempted ; psychology ; statistics & numerical data ; Tryptophan Hydroxylase ; genetics
10.Association between Perceived Stressfulness of Stressful Life Events and the Suicidal Risk in Chinese Patients with Major Depressive Disorder.
Jing-Yu LIN ; Yu HUANG ; Yun-Ai SU ; Xin YU ; Xiao-Zhen LYU ; Qi LIU ; Tian-Mei SI
Chinese Medical Journal 2018;131(8):912-919
BackgroundPatients with major depressive disorder (MDD) usually have high risk of suicidality. Few studies have investigated the effects of stressful life events (SLEs) on the risk of suicide in Chinese patients who have developed MDD. This study aimed to investigate the impact of SLEs on suicidal risk in Chinese patients with MDD.
MethodsIn total, 1029 patients with MDD were included from nine psychiatric hospitals to evaluate the impact of SLEs on suicidal risk. Patients fulfilling the Mini-International Neuropsychiatric Interview (MINI) criteria for MDD were included in the study. Patients were excluded if they had lifetime or current diagnoses of psychotic disorder, bipolar disorder, and alcohol or substance dependence. Depressive symptoms were assessed by the 17-item Hamilton Depression Scale (HAMD-17). The suicidal risk of MDD patients was determined by the suicide risk module of MINI. SLEs were assessed by the Life Events Scale.
ResultsNo gender difference was found for suicidal risk in MDD patients. Patients with suicidal risk had younger ages, lower education levels, more drinking behavior, and lower marriage rate, and fewer people had child and more severe depressive symptoms than nonsuicidal risk group. High-level perceived stressfulness (HPS) and number of SLEs that patients were exposed to were significantly greater in patients with suicidal risk than patients without. In multivariate logistic analysis, HPS of SLEs (odds ratio [OR] = 1.54, 95% confidence interval [CI]: 1.16-2.05, P = 0.003) and depressive symptoms (OR = 1.08, 95% CI: 1.05-1.11, P < 0.001) were associated with suicidal risk even after adjustment of gender, age, marriage, drinking behavior, and childless.
ConclusionsHPS of SLEs is associated with suicide risk in Chinese patients with MDD. Further suicide prevention programs targeting this risk factor are needed.
Trial RegistrationClinicalTrials.gov: NCT02023567; https://clinicaltrials.gov/ct2/show/NCT02023567?term=NCT02023567&rank=1.
Adolescent ; Adult ; Asian Continental Ancestry Group ; Bipolar Disorder ; epidemiology ; psychology ; Depressive Disorder, Major ; epidemiology ; psychology ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Odds Ratio ; Psychiatric Status Rating Scales ; Risk Factors ; Suicide ; psychology ; statistics & numerical data ; Young Adult