생물정신의학 (Korean Journal of Biological Psychiatry)

  • 제23권2호
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  • Pages.37-40
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  • 2016
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  • 1225-8709(pISSN)
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  • 2005-7571(eISSN)
대한생물정신의학회 (The Korean Society of Biological Psychiatry)
권호 표지

치료저항성 우울증의 연구에서 패러다임의 전환

Paradigm Shift in the Study of Treatment Resistant Depression

  • 김용구 (고려대학교 의과대학 안산병원 정신건강의학교실)
  • Kim, Yong-Ku (Department of Psychiatry, College of Medicine, Korea University Ansan Hospital)
  • 투고 : 2016.04.17
  • 심사 : 2016.04.27
  • 발행 : 2016.05.31
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초록

Treatment-resistant depression (TRD) is a major public health problem. It is estimated that about 30% of patients with major depressive disorder do not show substantial clinical improvement to somatic or psychosocial treatment. Most of studies for TRD have focused on the subjects already known as TRD. Patients with unipolar depressive episodes that do not respond satisfactorily to numerous sequential treatment regimens were included in the TRD studies. Such post hoc experimental design can be regarded only as consequences of having TRD, rather than as causal risk factors for it. Although informative, data derived from such studies often do not allow a distinction to be made between cause and effect. So, we should shift paradigm toward examining the risk for developing TRD in untreated depressed patients. To deal with this problem, untreated depressed patients should be enrolled in the study to identify biological markers for treatment resistance. The peripheral or central biological markers should be explored before starting treatment. Subsequent systematic administration of treatments with appropriate monitoring in the subjects can determine the risk for developing treatment resistance in untreated individuals. Such information could give a cue to improve the initial diagnosis and provide more effective treatment for TRD.

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참고문헌

  1. Ruhe HG, van Rooijen G, Spijker J, Peeters FP, Schene AH. Staging methods for treatment resistant depression. A systematic review. J Affect Disord 2012;137:35-45. https://doi.org/10.1016/j.jad.2011.02.020
  2. Kim YK, Na KS, Myint AM, Leonard BE. The role of pro-inflammatory cytokines in neuroinflammation, neurogenesis and the neuroendocrine system in major depression. Prog Neuropsychopharmacol Biol Psychiatry 2016;64:277-284. https://doi.org/10.1016/j.pnpbp.2015.06.008
  3. Gold PW. The organization of the stress system and its dysregulation in depressive illness. Mol Psychiatry 2015;20:32-47. https://doi.org/10.1038/mp.2014.163
  4. Bauer ME, Papadopoulos A, Poon L, Perks P, Lightman SL, Checkley S, et al. Dexamethasone-induced effects on lymphocyte distribution and expression of adhesion molecules in treatment-resistant depression. Psychiatry Res 2002;113:1-15. https://doi.org/10.1016/S0165-1781(02)00243-3
  5. Bauer ME, Papadopoulos A, Poon L, Perks P, Lightman SL, Checkley S, et al. Altered glucocorticoid immunoregulation in treatment resistant depression. Psychoneuroendocrinology 2003;28:49-65. https://doi.org/10.1016/S0306-4530(02)00009-4
  6. O'Brien SM, Fitzgerald P, Scully P, Landers A, Scott LV, Dinan TG. Impact of gender and menstrual cycle phase on plasma cytokine concentrations. Neuroimmunomodulation 2007;14:84-90. https://doi.org/10.1159/000107423
  7. Raison CL, Rutherford RE, Woolwine BJ, Shuo C, Schettler P, Drake DF, et al. A randomized controlled trial of the tumor necrosis factor antagonist infliximab for treatment-resistant depression: the role of baseline inflammatory biomarkers. JAMA Psychiatry 2013;70:31-41. https://doi.org/10.1001/2013.jamapsychiatry.4
  8. Lee BH, Kim YK. The roles of BDNF in the pathophysiology of major depression and in antidepressant treatment. Psychiatry Investig 2010;7:231-235. https://doi.org/10.4306/pi.2010.7.4.231
  9. Fernandes B, Gama CS, Massuda R, Torres M, Camargo D, Kunz M, et al. Serum brain-derived neurotrophic factor (BDNF) is not associated with response to electroconvulsive therapy (ECT): a pilot study in drug resistant depressed patients. Neurosci Lett 2009;453:195-198. https://doi.org/10.1016/j.neulet.2009.02.032
  10. Anttila S, Huuhka K, Huuhka M, Rontu R, Hurme M, Leinonen E, et al. Interaction between 5-HT1A and BDNF genotypes increases the risk of treatment-resistant depression. J Neural Transm (Vienna) 2007;114:1065-1068. https://doi.org/10.1007/s00702-007-0705-9
  11. Shah PJ, Ebmeier KP, Glabus MF, Goodwin GM. Cortical grey matter reductions associated with treatment-resistant chronic unipolar depression. Controlled magnetic resonance imaging study. Br J Psychiatry 1998;172:527-532. https://doi.org/10.1192/bjp.172.6.527
  12. Shah PJ, Glabus MF, Goodwin GM, Ebmeier KP. Chronic, treatment-resistant depression and right fronto-striatal atrophy. Br J Psychiatry 2002;180:434-440. https://doi.org/10.1192/bjp.180.5.434
  13. Zhang TJ, Wu QZ, Huang XQ, Sun XL, Zou K, Lui S, et al. Magnetization transfer imaging reveals the brain deficit in patients with treatment-refractory depression. J Affect Disord 2009;117:157-161. https://doi.org/10.1016/j.jad.2009.01.003
  14. Liu F, Guo W, Yu D, Gao Q, Gao K, Xue Z, et al. Classification of different therapeutic responses of major depressive disorder with multivariate pattern analysis method based on structural MR scans. PLoS One 2012;7:e40968. https://doi.org/10.1371/journal.pone.0040968
  15. Simpson S, Baldwin RC, Jackson A, Burns AS. Is subcortical disease associated with a poor response to antidepressants? Neurological, neuropsychological and neuroradiological findings in late-life depression. Psychol Med 1998;28:1015-1026. https://doi.org/10.1017/S003329179800693X