The serotonin has been known to play important roles in pathology of the mood disorders. We summerize the evidences of serotonin in pathology of the mood disorders in a view of neuroanatomical and neurochemical aspects. Nowaday, the selective serotonin reuptake inhibitors(SSRIs)may be practically the first line of antidepressants with traditional tricyclic antidepressants(TCAs. Authors review the role of serotonin in the treatment of the mood disorders, in a view of the general considerations in selecting antidepressants, pharmacology, therapeutic, indications, side effects, doses of medication, drug-discontinuation syndrome, drug-to-drug interactions, and special therapeutic situations.
Antidepressive Agents ; Mood Disorders* ; Pathology* ; Pharmacology ; Serotonin*

No abstract available.
Lithium*

The aging process makes the changes of pharmacokinetics and pharmacodynamics of psychotropic drugs. The author discussed the biological treatment of geriatric mood disorders in this review. In the acute treatment of geriatric mood disorder, there are some different considerations about the biological treatment, such as the poor physical health, the high suicidal risk, the impaired judgment and reality testing, the likelihood of poor compliance, the impaired cognitive functioning, and the lack of social supports. Psychiatrists who prescribe for the mood disorder of the elderly must bear in mind the risks and benifits of pharmacotherpy in a view of pharmacokinetic and pharmacodynamics. The author reviewed the properties and cautions of the classical antidepressant TCAs and newer atypical antidepressants, such as trazodone and venlafaxine. And also the author reviewed the special situations in geriatric mood disorders, which are the delusional depression, the treatment-resistent depression, and the neuropsychiatric disorder.
Aged ; Aging ; Antidepressive Agents, Second-Generation ; Compliance ; Delusions ; Depression ; Humans ; Judgment ; Mood Disorders* ; Pharmacokinetics ; Psychiatry ; Psychotropic Drugs ; Reality Testing ; Trazodone ; Venlafaxine Hydrochloride

The aging process makes the changes of pharmacokinetics and pharmacodynamics of psychotropic drugs. The author discussed the biological treatment of geriatric mood disorders in this review. In the acute treatment of geriatric mood disorder, there are some different considerations about the biological treatment, such as the poor physical health, the high suicidal risk, the impaired judgment and reality testing, the likelihood of poor compliance, the impaired cognitive functioning, and the lack of social supports. Psychiatrists who prescribe for the mood disorder of the elderly must bear in mind the risks and benifits of pharmacotherpy in a view of pharmacokinetic and pharmacodynamics. The author reviewed the properties and cautions of the classical antidepressant TCAs and newer atypical antidepressants, such as trazodone and venlafaxine. And also the author reviewed the special situations in geriatric mood disorders, which are the delusional depression, the treatment-resistent depression, and the neuropsychiatric disorder.
Aged ; Aging ; Antidepressive Agents, Second-Generation ; Compliance ; Delusions ; Depression ; Humans ; Judgment ; Mood Disorders* ; Pharmacokinetics ; Psychiatry ; Psychotropic Drugs ; Reality Testing ; Trazodone ; Venlafaxine Hydrochloride

The dysfunction of either or both noradrenaline and serotonin system are important in the pathophysiology of depression. Previous reports have suggested that there may be an important interaction between these two systems. Recently, some investigators have suggested that the combination of tricyclic antidepressants(TCAs and selective serotonin reuptake inhibitors(SSRIs would produce a rapid synergistic effect on down-regulation of either or both of these two systems and that this combination may produce a more rapid and absolute antidepressant effect. We compared the treatment efficacy, treatment associated side effects, treatment satisfaction, and the quality of life between the combination therapy of dothiepin-sertraline as well as the therapy of dothiepin alone in the treatment of major depressive disorder and dysthymic disorder. In our study, the combination therapy of dothiepin and sertraline produced a more rapid and absolute antidepressant effect than dothiepin alone. And the patients with combination therapy experienced relatively high treatment satisfaction than the patients with dothiepin therapy. The patients quality of life improved more rapidly in the combination therapy, especially, in the health perception, social behavior, and life satisfaction, that dothiepin alone. These results support the hypothesis that the combination of TCA an SSRI may produce a rapid synergistic effect on either or both norepinephrine and serotonin system, and more rapid antidepressant effect and high treatment satisfaction.
Depression ; Depressive Disorder* ; Depressive Disorder, Major ; Dothiepin* ; Down-Regulation ; Dysthymic Disorder ; Humans ; Norepinephrine ; Quality of Life ; Research Personnel ; Serotonin ; Sertraline ; Social Perception ; Treatment Outcome

In clinical setting, treatment-refractoriness, medication induced tardive dyskinesia and amenorrhea in chronic schizophrenia are frequently problematic. However, there are few guideline solving these problem available to clinicians. The goal of this study was collecting clinical data on clinical effeciveness and predictors of response of switching to olanzapine. We attempted to switch to olanzapine from risperidone and clozapine in chronic 31(risperidone 17, clozapine 14) schizophrenia and schizoaffective disorder patients suffering from sustained symptoms, weekly blood monitoring, medication induced tardive dyskinesia and amenorrhea. Previous antipsychotics dosage was gradually decreased for 2 or 3 weeks, at the same time olanzapine dosage was gradually increased. At baseline, after 1 week, after 2 weeks and after 4 weeks we checked Brief Psychiatric Rating Scale, Clinical Global Impression Scale, Sympson-Angus Rating Scale, Barnes Akathisia Rating Scale and Followed up after 12 months. Successful switch after 4 weeks was achieved in 25 patients(clozapine 9(64.2%), risperidone 16(94.1%). Overall, mean BPRS and CGI scores increased significantly. Successful maintenance after 12 months was achieved in 17 patients(clozapine 5(35.7%), risperidone 2(70.5%). Overall, mean BPRS and CGI scores increased significantly too. Switching to olanzapine from other atypical antipsychotics is recommendable in chronic schizophrenia with treatment refreactoriness and drug induced side effect.
Amenorrhea ; Antipsychotic Agents ; Brief Psychiatric Rating Scale ; Clozapine* ; Female ; Follow-Up Studies* ; Humans ; Movement Disorders ; Psychomotor Agitation ; Psychotic Disorders ; Risperidone* ; Schizophrenia

OBJECTIVES: The pathophysiology of restless legs syndrome (RLS) is not obvious, but many promising theories involve dopaminergic deficiency and genetic causes. The RLS is presumed to occur more frequently among schizophrenic patients who take antipsychotics, most of which blocks the dopamine receptors. This study aimed to investigate whether dopamine transporter gene (DAT1) 40 base pair (bp) variable number of tandem repeat (VNTR) polymorphism is associated with the antipsychotic-induced RLS in schizophrenia. METHODS: We determined the diagnosis of RLS among the 190 Korean schizophrenic patients by the diagnostic criteria of the International Restless Legs Syndrome Study Group (IRLSSG). Genotyping was performed for the 40bp VNTR in DAT1 gene using polymerase chain reaction. RESULTS: We separated the schizophrenic patients into 44 patients with RLS and 146 patients without RLS. The genotype and allele frequencies did not differ significantly between two groups. CONCLUSIONS: These results suggest that DAT1 gene 40bp VNTR is not associated with the antipsychotic-induced RLS in schizophrenia. To confirm these results, larger-scale association study is needed in the future.
Antipsychotic Agents ; Base Pairing ; Dopamine ; Dopamine Plasma Membrane Transport Proteins ; Gene Frequency ; Genotype ; Humans ; Receptors, Dopamine ; Restless Legs Syndrome ; Schizophrenia ; Tandem Repeat Sequences

OBJECTIVE: This study was a open clinical trial aimed at exploring the effectiveness of combined treatment with estrogen and antipsychotics to the chronic female schizophrenics. METHOD: 40 female patients who met DSM-VI criteria for schizophrenia who were chronically ill were randomly assigned to estrogen group(EG) and control group(CG). EG patients were received estrogen 1.25mg for 8 weeks in addition to their routine antipsychotic regimens. CG patients were received their routine antipsychotic regimens only. Both groups were evaluated by PANSS(Positive and Negative Syndrome Scale), CGI(Clinical Global Impression) at 0, 4, 8 week during the trial period and compaired with each other. RESULTS: 40 female patients have completed the study during 8 weeks. EG was significantly improved in PANSS and CGI scores than CG during the 8 weeks. In EG patients, all symptom subtypes(positive symptoms, negative symptoms, general psychopathology symptoms) of PANSS were significantly improved and positive symptoms were most significantly improved at 8 weeks. CONCLUSIONS: This results support the clinical value of combined estrogen therapy among chronic female schizophrenics.
Antipsychotic Agents* ; Chronic Disease ; Estrogens* ; Female* ; Humans ; Psychopathology ; Schizophrenia*

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

OBJECTIVES: The purpose of this study is to evaluate the effect of geriatric depression in activities of daily living for self maintenance (ADL) and instrumental activities of daily living (IADL) under control for effect of cognitive impairment which can be originated by other reasons. METHODS: The author had interviews with 100 old peoples using various scales (KGDS, MMSE-K, Karnofsky Performance Status Scale, ADL, IADL, QOL questionnaire, HDRS). This study also attempts to compare three groups (depression group, recovered group, normal control group) in their functional status. RESULTS: 1) Self-maintenance skills are more affected by physical states than by depressive symptoms. But the effect of depression is more prominent in instrumental activities of daily living. 2) Korean Geriatric Depression Scale (KGDS) correlated well with activities of daily living for self maintenance (ADL) and instrumental activities of daily living (IADL), but Hamilton Depression Rating Scale (HDRS) did not show significant correlation. This reflects that KGDS is a more specific measure for geriatric depression patients. When the effect of physical illness state was eliminated, partial correlation between KGDS and ADL/IADL showed no significant association. This means that the patient's physical functioning status is very important in functional level of geriatric patient. 3) When the patient is recovered from geriatric depression through appropriate treatment, patient's functional level showed no significant differences with normal control. CONCLUSION: This article emphasizes the importance of appropriate treatment for geriatric depression. After the effect of cognitive function was controlled, geriatric depression itself showed significant functional impairment. This functional deficit can threaten the patient's independence and self-respect. So appropriate treatment for depression in geriatrics is indispensable for enhancing quality of life in old people.
Activities of Daily Living ; Depression* ; Geriatrics ; Humans ; Karnofsky Performance Status ; Quality of Life ; Surveys and Questionnaires ; Weights and Measures