OBJECTIVE: Activation of one or more serotonin (5-HT) receptors may play a role in mediating the antidepressant effects of serotonergic antidepressants. The serotonin 2C (5HT 2C) receptor is known to be associated with antidepressant action and weight gain. We sought to determine whether the 5-HTR 2C receptor -759C/T polymorphism was associated with weight gain and treatment response to mirtazapine in major depressive disorder (MDD) patients. METHODS: The 5-HT 2C receptor -759C/T polymorphism was analyzed in 323 MDD patients. All patients were evaluated using the 21-item Hamilton Depression Rating Scale at the beginning of the study and at 1, 2, 4, and 8 weeks of mirtazapine treatment. RESULTS: There was no significant difference in the 5-HT 2C receptor -759C/T genotype distribution between responder and non-responder groups. The 5-HT 2C receptor -759C/T polymorphism was not associated with weight change over time after mirtazapine administration. CONCLUSION: The 5-HT 2C receptor -759C/T polymorphism does not appear to be a predictor of treatment response to mirtazapine. This polymorphism was not associated with weight change after 8 weeks of mirtazapine treatment. Further investigation on other polymorphisms of the 5-HT 2C gene is required to determine whether the 5-HT 2C gene influences treatment response and weight change after mirtazapine administration in patients with major depressive disorder.
Antidepressive Agents ; Depression ; Depressive Disorder, Major ; Genotype ; Humans ; Mianserin ; Negotiating ; Receptor, Serotonin, 5-HT2C ; Serotonin ; Weight Gain

Sexual violence crime causes severe trauma to victim's family as well as the victim, and its aftereffect which is hard to be healed can last for the entire lifetime. And thus plenty of social cost is incurred due to the crime. It has long been reported that paraphilia is associated with sexual offenders and sexual violence. In this study, the previous foreign data on the psychiatric medication used for sexual offender or paraphilia were summarized for the first time in Korea, and the possibility of medication in Korea was examined. As for the drugs used for sexual offender or paraphilia, SSRI was most frequently reported and besides that, tricyclic antidepressant, antipsychotics, antiepileptic drugs, mirtazapine, and naltrexone were reported.
Anticonvulsants ; Antipsychotic Agents ; Crime ; Criminals ; Humans ; Korea ; Mianserin ; Naltrexone ; Paraphilic Disorders ; Sex Offenses

Late-life depression (LLD) refers to depressive syndromes defined in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) and in the International Classification of Diseases-10 (ICD-10) that arise in adults older than age 65 years. LLD often affects people with chronic medical diseases, cognitive impairment, or other forms of disability. The phenomenology of LLD differs in part from that of early-life depression. Antidepressants appear to have a neutral or protective effect against suicidal ideation or behavior in the elderly despite having the risk of opposite effect in children, adolescents, and young adults. The treatment of depression may be divided into acute, continuation, and maintenance phases. Currently available antidepressant medications represent several classes of agents with similar antidepressant efficacy. Differences in side effect profile, interactions, and out-of-pocket cost are important determinants in the choice of medication for an elderly patient. To minimize side effects, starting doses for older adults may be lower than those for younger adults, but older adults often require full adults doses for an adequate response. Antidepressants are as effective when given to elderly individuals as they are when given to younger adults. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) the antidepressants of choice, followed by bupropion, and mirtazapine. Tricyclic antidepressants (TCAs) are effective but are no longer considered to be first-line treatments because of their side effects.
Adolescent ; Adult ; Aged ; Antidepressive Agents ; Antidepressive Agents, Tricyclic ; Bupropion ; Child ; Depression ; Depressive Disorder ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Mianserin ; Serotonin Uptake Inhibitors ; Suicidal Ideation ; Young Adult

Reported herein is a case of recurrent major depression with impulse control difficulty in a 33-year-old man with Dandy-Walker variant. He was diagnosed as having major depressive disorder a year before he presented himself to the authors' hospital, and had a history of three-time admission to a psychiatric unit in the previous 12 months. He was readmitted and treated with sodium valporate 1,500 mg/day, mirtazapine 45 mg/day, and quetiapine 800 mg/day during the three months that he was confined in the authors' hospital, and the symptoms were reduced within three months but remained thereafter. This is the only case so far reporting recurrent depression with impulse control difficulty associated with Dandy-Walker variant. This case implies that any cerebellar lesion may cause the appearance of recurrent depression with impulse control difficulty in major depressive disorder.
Adult ; Aggression ; Cerebellar Diseases ; Cerebellum ; Dandy-Walker Syndrome* ; Depression* ; Depressive Disorder, Major ; Dibenzothiazepines ; Humans ; Impulsive Behavior* ; Mianserin ; Valproic Acid ; Quetiapine Fumarate

OBJECTIVE: Recently, the pharmacotherapy including antidepressants in treating depression is widely used. However, as a result of newer agents that are continuously introduced, pharmacological treatment strategy is also changing. To catch up this trend, Korean Medication Algorithm Project for Depressive Disorder was developed in 2002 and revised in 2006. Since the last revision, the third revision reflected the new research result and the latest trends in the areas of pharmacological treatment. METHODS: One hundred and twenty three psychiatrists who have vast clinical experiences in depressive disorder are primarily selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. RESULTS: For dysthymic disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) [(es)citalopram, fluoxetine, sertraline, paroxetine], serotonin-norepinephrine reuptake inhibitor (SNRI) (venlafaxine, duloxetine, milacipran), and mirtazapine, was recommended as the first line medications. For melancholic type, SSRI, SNRI, and mirtazapine were recommended as the first line medications. For atypical type and seasonal pattern, bupropion as well as SSRI, SNRI, and mirtazapine, were recommended as the first line medications. CONCLUSION: The preferences of antidepressants in experts were different according to the subtype of depression. These results suggest that clinicians have to consider the subtype of depression in the treatment of depressive disorders.
Antidepressive Agents ; Bupropion ; Depression ; Depressive Disorder ; Depressive Disorder, Major ; Dysthymic Disorder ; Fluoxetine ; Mianserin ; Postal Service ; Psychiatry ; Surveys and Questionnaires ; Seasons ; Serotonin ; Sertraline ; Thiophenes ; Duloxetine Hydrochloride

Memantine and other glutamatergic agents have been currently investigated in some off-label indications due to glutamatergic involvement in several psychoneurological disorders. We assumed that memantine similarly to ketamine may positively influence mood, moreover having a potential to improve cognition and general quality of life. We report a case of a 49-year-old male hospitalized during a manic and a subsequent moderate depressive episode. After an ineffective use of lithium, olanzapine and antidepressive treatment with mianserin, memantine was added up to 20 mg per day for 10 weeks. The mental state was assessed using the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Hamilton Anxiety Scale, the Clinical Global Inventory, the World Health Organization Quality of Life Scale and psychological tests. After 10 weeks the patient achieved a partial symptomatic improvement in mood, anxiety and quality of sleep, but his activity remained insufficient. We also observed an improvement in the parameters of cognitive functioning and quality of life. There was neither significant mood variations during the memantine use nor mood changes after its termination. No significant side effects were noted during the memantine treatment. We conclude that using memantine in bipolar depression may improve mood, cognitive functioning and quality of life.
Anxiety ; Bipolar Disorder* ; Cognition ; Depression ; Excitatory Amino Acid Agents ; Glutamic Acid ; Humans ; Ketamine ; Lithium ; Male ; Memantine* ; Mianserin ; Middle Aged ; Psychological Tests ; Quality of Life* ; World Health Organization

OBJECTIVES: Many patients diagnosed with cancer suffer from various psychiatric symptoms such as depression, anxiety and insomnia as well as cancer itself. Patients with cancer are more vulnerable to possible adverse events of psychotropic medications. Although antidepressants are widely used among cancer patients, there is little information about tolerability of antidepressants. This study was conducted to compare tolerability of antidepressants in cancer patients referred for psychiatric consultation. METHODS: The participants were cancer patients who had been referred to psychiatrist for their psychiatric symptoms. We retrospectively analyzed the data of patients diagnosed with cancer from 9 general hospitals in Korea. The discontinuation rate for a 6 months period after treatment initiation for three antidepressants(Escitalopram, Mirtazapine, Paroxetine) were compared. RESULTS: Antidepressants were prescribed for 96.3% of subjects and Escitalopram 150(47.2%), Mirtazapine 92 (28.9%) and Paroxetine 76(23.9%) were prescribed frequently in order There were no significant differences in discontinuation rates among the three antidepressants during the 6 month period after initiation of pharmacotherapy. But there was a difference in discontinuation rates between inpatients versus outpatients(p<0.0001). CONCLUSIONS: In a naturalistic setting for the antidepressant treatment for cancer patients, it seems that there are no differences in discontinuation rates among these three antidepressants. It is therefore essential that such interactions are carefully considered when treating patients of antidepressants who already have cancer.
Antidepressive Agents ; Anxiety ; Citalopram ; Depression ; Hospitals, General ; Humans ; Inpatients ; Korea ; Mianserin ; Paroxetine ; Psychiatry ; Retrospective Studies ; Sleep Initiation and Maintenance Disorders

OBJECTIVE: There was a recent study to explore the cerebral regions associated with sexual arousal in depressed women using functional magnetic resonance imaging (fMRI). The purpose of this neuroimaging study was to investigate the effects of antidepressant treatment on sexual arousal in depressed women. METHODS: Seven depressed women with sexual arousal dysfunction (mean age: 41.7+/-13.8, mean scores of the Beck Depression Inventory (BDI) and the 17-item Hamilton Rating Scale for Depression (HAMD-17): 35.6+/-7.1 and 34.9+/-3.1, respectively) and nine healthy women (mean age: 40.3+/-11.6) underwent fMRI before and after antidepressant treatment. The fMRI paradigm contrasted a 1 minute rest period viewing non-erotic film with 4 minutes of sexual stimulation viewing an erotic video film. Data were analyzed by SPM 2. The relative number of pixels activated in each period was used as an index of activation. All depressed women were treated with mirtazapine (mean dosage: 37.5 mg/day) for 8 to 10 weeks. RESULTS: Levels of brain activity during sexual arousal in depressed women significantly increased with antidepressant treatment (p<0.05) in the regions of the hypothalamus (3.0% to 11.2%), septal area (8.6% to 27.8%) and parahippocampal gyrus (5.8% to 14.6%). Self-reported sexual arousal during visual sexual stimulation also significantly increased post-treatment, and severity of depressive symptoms improved, as measured by the BDI and HAMD-17 (p<0.05). CONCLUSION: These results show that sexual arousal dysfunction of depressed women may improve after treatment of depression, and that this improvement is associated with increased activation of the hypothalamus, septal area, and parahippocampal gyrus during sexual arousal.
Arousal ; Brain ; Depression ; Female ; Humans ; Hypothalamus ; Magnetic Resonance Imaging ; Mianserin ; Neuroimaging ; Parahippocampal Gyrus ; Septum of Brain

OBJECTIVES: Antidepressants are frequently used for treatment of psychological distress among cancer patients. The aim of this study is to investigate the characteristics of psychiatric consultations and antidepressant use for cancer patients. METHODS: Participants in the study included cancer patients who had been referred for psychiatric consultation. A total of 488 patients were recruited from nine general hospitals in Korea. Questionnaires based on medical records, including antidepressants prescribed, were investigated by psychiatrists. RESULTS: The most common psychiatric diagnosis of subjects was depressive disorders (72.4%), followed by anxiety disorders (13.0%), and adjustment disorders (7.3%). Antidepressants were prescribed for 96.3% of subjects and escitalopram, mirtazapine, and paroxetine were prescribed frequently, in order. Anxiolytics and hypnotics were used for 58.2% of the subjects, for which lorazepam and alprozolam were preferred. During the study period, 226 (46.8%) subjects discontinued treatment and the most common cause was improvement of symptoms (123, 54.4%). CONCLUSION: Our results showed a tendency of prescription of antidepressants and anxiolytics and common psychiatric problems in Korean cancer patients. We suppose that these data would be helpful to clinicians who manage psychiatric symptoms of cancer patients.
Adjustment Disorders ; Anti-Anxiety Agents ; Antidepressive Agents ; Anxiety Disorders ; Citalopram ; Depressive Disorder ; Hospitals, General ; Humans ; Hypnotics and Sedatives ; Korea ; Lorazepam ; Medical Records ; Mental Disorders ; Mianserin ; Paroxetine ; Prescriptions ; Surveys and Questionnaires ; Referral and Consultation

OBJECTIVE: Prescription patterns have changed rapidly due to development of new drugs, results of new researches, and increment of clinician's experience. The goal of this study was to examine and compare the trend of prescription patterns for major depressive disorder at a university hospital among year 2001, 2006, and 2010. METHODS: We reviewed the medication usage of inpatients with major depressive disorder in 2001, 2006 and 2010, including antidepressants used as first choice, switching, and combination, and various augmentation agents. And we investigated the time to switching and combination of antidepressant in 2001, 2006 and 2010. RESULTS: The antidepressants used as first line drug were selective serotonin reuptake inhibitor (SSRI) (49.7%), mirtazapine (24.5%), and tricyclic antidepressant (TCA) (4.9%) in 2001, and SSRI (49.4%), mirtazapine (25.6%) and serotonin-norepinephrine reuptake inhibitor (SNRI) (20.2%) in 2006, SSRI (42.7%), mirtazapine (19.5%) and SNRI (18.3%) in 2010 in frequency order. The antidepressants used as switching drug were TCA (33.3%), mirtazapine (25.0%), and nefazodone (16.7%) in 2001, SSRI (35.0%), mirtazapine (35.0%), and SNRI (20.0%) in 2006, and SSRI (50.0%), SNRI (30.0%) and mirtazapine (20.0%) in 2010. As combination treatment, SSRI and TCA combination was used mostly by far in 2001 (51.1%), but in 2006 and 2010, various combination were used. In 2010 year, SNRI and mirtazapine, SSRI and TCA, SSRI and mirtazapine (42.1%, 21.1%, 15.8%, respectively) combination treatment were used in frequency order. The use of typical antipsychotics as augmentation agent decreased and the use of atypical antipsychotics increased significantly in 2010. Most frequently used atypical antipsychotic was quetiapine in 2010. The use of thyroid hormone was significantly decreased after 2006, but the use of mood stabilizer was increased between 2001 and 2010 (p=0.001). CONCLUSION: The results of the present study suggested that there were lots of change in prescription patterns for major depressive disorder between 2001 and 2010. Especially, these changes could be seen in use of various antidepressants, increment in use of atypical antipsychotics and lamotrigine. It can reflect not only the current progress of psychopharmacology and clinical experience, but also the clinical complexity of treatment of depression.
Antidepressive Agents ; Antipsychotic Agents ; Depression ; Depressive Disorder, Major ; Dibenzothiazepines ; Humans ; Inpatients ; Mianserin ; Prescriptions ; Psychopharmacology ; Serotonin ; Thyroid Gland ; Triazines ; Triazoles ; Quetiapine Fumarate