No abstract available.
Depression* ; Depressive Disorder

No abstract available.
Sleep Disorders, Circadian Rhythm*

Depressive disorders have many faces in clinical features, long-term course, prognosis, and the patients with depressive disorders are not homogeneous group. So, there have been many subtypes of depression suggested and described by clinicians and researchers. But, there is few evidences which support unique pathophysiology and clinical implication about each subtype. The treatment of various subtype of depression is not also specified according to scientific evidence. Nowadays, the rapid development of psychopharmacology and many new antidepressants are making it more possible for clinician to choose antidepressant according to the subtypes of depression and to the characteristics of patients. Therefore, we reviewed the clinical evidence of the treatment for various subtypes of depressive disorders and tried to recommend more efficient antidepressant treatment, although there is a few data for subtypes of depressive disorders. We concluded that the specific choice of antidepressant for each subtypes of depression is not yet possible, because the current subtyping of depression is not clear in many aspects, and the clinical trials have focused mainly in depression in a whole. From now on, more efforts is needed about the more specified subtyping and more specified treatment in order to get more efficacy, safety, and the satisfaction of patients with depressive disorders.
Antidepressive Agents ; Depression ; Depressive Disorder ; Humans ; Prognosis ; Psychopharmacology

Amisulpride, a substituted benzamide derivative, is a newer atypical antipsychotics. It mainly blocks presynaptic dopamine D2/D3 autoreceptors which is preferentially located in prefrontal area and blocks postsynaptic dopamine D2/D3 receptors in the limbic system. By these mechanism, amisulpride can improve both negative and positive symptoms. In addition to these action, its property of fast dissociation (Koff) and selectivity to D2/D3 receptors can explain more favorable side effects profiles. A lot of studies showed that amisulpride has equivalent or better efficacy and safety to other atypical antipsychotics. Meta-analysis studies is very informative because it contains many cases of previous studies. So we reviewed some meta-analysis studies which compared amisulpride with placebo or other antipsychotics. On positive symptoms of acute schizophrenia, the most pooled analyses of amisulpride have shown to be equally effective with conventional antispychotics. One meta-analysis study have shown that amisulpride is more effective than conventional drugs. On primary negative symptoms, amisulpride is only agents which is investigated for the efficacy in patients with predominantly negative symptoms. as a results of meta-analysis, amisulpride was shown to be more effective than placebo in primary negative symptoms and have a trend of superiority to conventional agents. The safety and tolerability of amisulpride was equal to or better than other atypical drugs on pooled analysis. The drop out rate was also more favorable than conventional antipsychotics. In Summary, amisulpride showed efficacy similar to that of other atypical antipsychotics in reducing positive symptoms. Moreover, its better properties for negative and affective symptoms, and favorable side effects profiles provides another alternative for treatment of schizophrenia. These results show that amisulpride is a favorable `atypical' antipsychotics, and that 5-HT2/D2 antagonism is not only mechanism of `atypicality'.
Affective Symptoms ; Antipsychotic Agents ; Autoreceptors ; Dopamine ; Humans ; Limbic System ; Meta-Analysis as Topic ; Schizophrenia

5-HT(1A) receptor is implicated in the pathogenesis and the therapeutic mechanism of various psychiatric disorders. Especially, the mechanism of action of selective serotonin reuptake inhibitors (SSRIs) was hypothesized that 5-HT(1A) autoreceptor desensitization plays an important role in the treatment of depression and anxiety. 5-HT(1A) receptor stimulation may also mediate the neurogenesis of prefrontal cortex and hippocampus. The 5-HT(1A) agonism has an important meaning in the treatment of schizophrenia. Most atyptical antipsychotics have the property of 5-HT(2A) antagonist, and some have that of 5-HT(1A) agonist. In the various regions of brain, 5-HT(1A) and 5-HT(2A) have the functionally antagonistic properties. Recently, 5-HT(1A) receptor-related agents have been investigated in the treatment of acute ischemic stroke and Alzheimer's disease. Therefore, the further understanding about the 5-HT(1A) receptors in the brain functions will provide the development of future drugs and the advancement of psychopharmacology.
Alzheimer Disease ; Antipsychotic Agents ; Anxiety ; Autoreceptors ; Brain ; Depression ; Drug Therapy* ; Felodipine ; Hippocampus ; Neurogenesis ; Prefrontal Cortex ; Psychopharmacology ; Receptor, Serotonin, 5-HT1A* ; Schizophrenia ; Serotonin ; Serotonin Uptake Inhibitors ; Stroke

OBJECTIVES: The purpose of this study was to investigate the differences between potential neuroanatomical sites of action of(1) a typical antipsychotic drug (haloperidol), (2) an atypical antipsychotic drug (clozapine), and (3) three combinations of both haloperidol and serotonergic agents (haloperidol+buspirone, haloperidol+cyproheptadine, haloperidol+fluoxetine) by comparing their effects on c-fos expression in the rat brain. METHODS: Twenty-four Wistar rats of male sex, weighing 300-450 g, were divided into 6 groups according to the type of the agents tested [vehicle (0.14 M acetic acid 1 ml/kg), haloperidol (1.0 mg/kg), clozapine (20 mg/kg), haloperidol+buspirone (1.0 mg/kg+1.0 mg/kg), haloperidol+cyproheptadine (1.0 mg/kg+1.0 mg/kg), haloperidol+fluoxetine (1.0 mg/kg+0.25 mg/kg)]. The brain of variously treated rat was examined 2 hours after subcutaneousely injection in the neck. The brain was removed immediately after perfusion with 4% paraformaldehyde and placed in a fresh fixative of the same solution. After 12-hr fixation, brain sections (30 mum) of the areas including the medial prefrontal cortex, nucleus accumbens, and lateral striatum were stained by Fos immunohistochemistry, and subjected to light microscopic analytical observations. RESULTS: 1) The number of Fos-positive neurons in the medial prefrontal cortex was significantly increased in the clozapine, haloperidol+buspirone, haloperidol+cyproheptadine, and haloperidol+fluoxetine treated groups than in the control group (p<0.05). But, the haloperidol treated group shows no significant difference. 2) The number of Fos-positive neurons in the nucleus accumbens was significantly increased in the haloperidol clozapine, haloperidol+buspirone, haloperidol+cyproheptadine, haloperidol+fluoxetine treated groups than in the control group (p<0.05). 3) The number of Fos-positive neurons in the lateral striatum was significantly increased in the haloperidol, haloperidol+buspirone, haloperidol+cyproheptadine, haloperidol+fluoxetine treated groups than in the control group (p<0.05). But, the clozapine treated group shows no significant difference. CONCLUSION: These results suggest that differential expression of c-fos in rat brain induced by haloperidol, clozapine, and haloperidol combined serotonergic agents is associated with their clinical and pharmacological differences.
Acetic Acid ; Animals ; Brain* ; Clozapine* ; Haloperidol* ; Humans ; Immunohistochemistry ; Male ; Neck ; Neurons ; Nucleus Accumbens ; Perfusion ; Prefrontal Cortex ; Rats* ; Rats, Wistar ; Serotonin Agents*

Depressive disorders often develop into chronic course and relapse of symptoms is prevalent. Long-term treatment with antidepressants consolidates the improvement of residual symptoms and prevents relapses and recurrences. In the long-term treatment, the long-term tolerability of antidepressant is a major factor which impact on the compliance and the success of treatment. Although new antidepressants have better side effect profiles than TCA and MAOI, the safety issues of the former are also a concern during continuation and maintenance phases of treatment. Nowadays, weight gain and sexual dysfunction are at a center of concern in this field. SSRI, venlafaxine and mirtazapine can cause weight gain in some patients. Many studies report that weight gain and sexual dysfunction cause significant sufferings and act as major reasons of non-compliance. Bupropion SR is a new antidepressants that has a unique pharmacological property. It produce neither substantial weight gain nor sexual side effect. It was also shown to be effective and well-tolerated in decreasing the risk for relapse of depression. So, Bupropion SR can be used preferentially as a first-line antidepressant or augmentation on other agents in the long-term treatment without significant weight gain and sexual side effects.
Antidepressive Agents* ; Bupropion* ; Compliance ; Depression ; Depressive Disorder ; Humans ; Recurrence ; Weight Gain ; Venlafaxine Hydrochloride

As the advantages of atypical antipsychotics in bipolar disorder have been known, the approval of indications of these drugs is expanding. According to APA practice guidelines, in addition to lithium and valproate, atypical antipsychotics are recommended as the first-line agent in treating acute manic or mixed episode with mild severity. Quetiapine like other atypical antipsychotics such as risperidone or olanzapine is an effective antipsychotic drug in treating bipolar disorder. Based on currently available clinical evidences, quetiapine was approved in Korea and United States as a monotherapy or combination therapy in treating bipolar disorder. It is expecting that the use of quetiapine in patients with bipolar is increasing considering the efficacy and favorable side effect profiles. But more studies are needed to investigate the long-term efficacy and tolerability of mono-therapy or combination therapy in the maintenance period.
Antipsychotic Agents ; Bipolar Disorder ; Humans ; Korea ; Lithium ; Risperidone ; United States ; Valproic Acid

Bipolar disorders affect about 1-2.5% of the population. They are leading causes of disability and associated with significant health care costs. Antipsychotic medicaitons have a long history of use in bipolar disorders, for example, chlorpromazine has been used since early 1950s. Conventional antipsychotics are effective against mania, but it has some risks such as inducing depression, tardive dyskinesia. But atypical antipsychotics such as clozapine and olanzapine exhibit antimanic properties in addition to their antipsychotic properties with a far lower risk of extrapyramidal motor side effects than typcial neuroleptics. So they are now the antipsychotics of choice in the treatment of bipolar disorders. Risperidone is a serotonin-dopamine antagonist which was approved by FDA in 1994 and introduced into Korea in 1996. Risperidone appeared effective in controlling manic symptoms but also to have risks for inducing manic symptoms. Recent double-blind studies showed risperidone to be effective for acute mania, both as monotherapy and in combination with mood stabilizers. In summary, risperidone is considered as a mood stabilizer exhibiting both antimanic and antidepressant activity. Nowadays the use of aytpical antipsychotics including risperidone for treating patients with bipolar disorder has been increased. Mounting evidence supports its efficacy, low incidence of extrapyramidal side effects and tardive dyskinesia. With the advance of psychopharmacolgy, psychiatrists can have hope in treating bipolar patients.
Antipsychotic Agents ; Bipolar Disorder* ; Chlorpromazine ; Clozapine ; Depression ; Double-Blind Method ; Health Care Costs ; Hope ; Humans ; Incidence ; Korea ; Movement Disorders ; Psychiatry ; Risperidone*

Posttraumatic stress disorder (PTSD) is relatively common and chronic illness that causes severe functional impairment. Though many studies have been done, PTSD is still difficult to understand because of heterogeneity of its nature and other psychiatric comorbidities. But the last decades have brought new appreciation for the complexity and the diversity of clinical features and improved treatment approaches. Achieving complete remission from PTSD through pharmacotherapy alone appears out of reach currently. Antidepressants appear to demonstrate the best overall efficacy for the treament of PTSD, especially in patients with combined depression, insomnia, intrusive and hyperarousal symptoms. Though data for different efficacy among antidepressants are not known, tricyclic antidepressants and monoamine oxidase inhibitor appear to be effective in severe war PTSD patients and SSRIs appear to be more effective in avoidance/numbness symptoms. Considering their ease of use and tolerability, it is reasonable to choose SSRIs such as paroxetine and sertraline as a first-line treatment. Mood stabilizers are effective, especially for impulsivity, irritability and unstable mood. More studies are needed to confirm the efficacy of benzodiazepine, though it is used for inosmnia, panic symptoms and anxiety. Though there is little empirical date demonstrating the efficacy of antipsychotics, they may provide effective strategy if psychotics symptoms are combined. The future of therapy for PTSD holds much hope with the rapid development of psychopharmacology and elucidation of pathophysiology of PTSD.
Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Antipsychotic Agents ; Anxiety ; Benzodiazepines ; Chronic Disease ; Comorbidity ; Depression ; Drug Therapy* ; Hope ; Humans ; Impulsive Behavior ; Monoamine Oxidase Inhibitors ; Panic ; Paroxetine ; Population Characteristics ; Psychopharmacology ; Sertraline ; Sleep Initiation and Maintenance Disorders ; Stress Disorders, Post-Traumatic*