• Korean Journal of Biological Psychiatry
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• v.13 no.4
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• pp.234-243
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• 2006

Objectives : Several factors, such as biological markers, clinical correlates, and course of the depressive disorders with psychotic symptoms differ from those without psychotic symptoms. Therefore, specification of a treatment algorithm for depressive disorder with psychotic symptoms is legitimated. This article provides a systematic review of somatic treatments for depressive disorder with psychotic symptoms. Methods : According to the search strategy of the Clinical Research Center for Depression of Korean Health 21 R & D Project, first, PubMed and EMBASE were searched using terms with regard to the treatment of depressive disorders with psychotic symptoms(until July 2006). Reference lists of related reviews and studies were searched. In addition, relevant practice guidelines were searched using PubMed. All identified clinical literatures were reviewed and summarized in a narrative manner. Results : Treatment options, such as a combination of an antidepressant and an antipsychotic versus an antidepressant or an antipsychotic alone are summarized. In addition, issues regarding the electroconvulsive therapy( ECT), combination therapy, and maintenance treatment are discussed. Conclusion : In former times, the combination of an antidepressant and an antipsychotic or ECT were recommended as the first line treatment for depressive disorder with psychotic symptoms. Recently, however, there was a suggestion that there was no conclusive evidence that the combination of an antidepressant and an antipsychotic drug is more effective than an antidepressant alone. More evidence regarding the pharmacological treatment for depressive disorder with psychotic symptoms is needed.

• Korean Journal of Psychosomatic Medicine
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• v.16 no.1
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• pp.52-58
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• 2008

Objectives : Antidepressants are prescribed by not only psychiatrists but also general practitioners. However, patients' negative attitude and stigma against antidepressants are major obstacles to prescribe antidepressants in nonpsychiatric outpatient departments. We, therefore, examined patients' attitude toward antidepressant in medical and surgical group outpatient in Korea. Methods : Short item questionnaire was applied to medical group and surgical group outpatients who consented to this survey in a Korean university hospital. 100 medical and 100 surgical outpatients were surveyed. The questionnaire contained sociodemographic information, previous recognition of antidepressant, and general attitude toward attidepressants. Results : Of the 212 recipients, exclusive of erroneous and missing ones, we analyzed 200 recipients. 1) We found negative attitude toward antidepressants among both medical and surgical outpatients. 2) Medical group outpatients are answered more' antidepressants cause physically ill. 3) The persons who didn't take previously antidepressants showed more negative attitudes. 4) The most reason why they refuse to take antidepressants is concerns of side effects of antidepressants. Conclusion : There are highly negative attitude toward antidepressants between medical and surgical group outpatients. Study findings suggest the need for an active education on antidepressants to nonpsychiatric outpatients to maximize their therapeutic effect and compliance.

• Korean Journal of Psychosomatic Medicine
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• v.21 no.2
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• pp.81-92
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• 2013

Newer antidepressants are commonly used in clinical practice to treat psychiatric disorder and psychosomatic disorder including chronic pain syndrome, fibromyalgia, headache. However there are many unexpected adverse effects of these drugs such as nausea and vomiting, weight gain, sexual dysfunction. These are 3 most well-recognized common adverse effects of newer antidepressant and are most common causes of treatment failure. I reviewed mechanisms, epidemiology, and pharmacological management of these adverse effects of newer antidepressants. In this paper, newer antidepressants include selective serotonin reuptake inhibitor(fluoxetine, fluvoxamine, citalopram, escitalopram, sertraline, paroxetine), serotonin norepinephrine reuptake inhibitor(venlafaxine, duloxetine), norepinephrine and dopamine reuptake inhibitor(bupropion), noradrenergic and specific serotonergic antidepressant(mirtazapine), and reversible inhibitor of MAO-A(moclobemide). I suggest that psychiatrists and clinicians in the psychosomatic field should know mechanisms, epidemiology, and management of these common and well-recognized adverse effects of newer antidepressants. Therefore it will be helpful to recognize easily and treat well for patients with psychiatric disorder and psychosomatic disorder using newer antidepressants.

• Korean Journal of Psychosomatic Medicine
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• v.11 no.1
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• pp.44-51
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• 2003

Objectives: Antidepressants are frequently associated with sexual dysfunction. Especially, there were few report of sexual dysfunction related with venlafaxine and mirtazapine in Korea. The purpose of this survey was to evaluate the frequency and nature of sexual dysfunction related with selective serotonin reuptake inhibitors(SSRIs), venlafaxine and mirtazapine by the use of specific questionaires. Methods: In one hundred twenty two patients, sexual dysfunction was investigated cross-sectionally by using The questionaires for sexual dysfunction, which includes questions about decreased libido, delayed orgasm or ejaculation, premature ejaculation or orgasm, absence of orgasm or ejaculation, erectile dysfunction in men/vaginal lubrication dysfunction in women, sexual pain and patient's tolerance of the sexual dysfunction. BDI was also measured. Sexual dysfunction was analyzed in association with the duration and the dose of medications and the severity of depression. Results: The incidence of sexual dysfunction during antidepressants use in our survey was 37.7%. There were no difference of incidence in sexes(p=.746). In comparison of paroxetine, venlafaxine and mirtazapine, there were no significant differences of the incidence(p=.065) and the severity of any type of sexual dysfunction. Conclusion: Although there were no significant differences of sexual dysfunction in our survey, sexual dysfunction may be closely associated with antidepressants. Further prospective study of sexual dysfunction should be needed.

• Korean Journal of Psychosomatic Medicine
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• v.9 no.2
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• pp.111-132
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• 2001

Depression in the medically ill is a common clinical problem that primary physicians and psychiatric consultants encounter. Treatment of such patients begins with a careful evaluation of the patient's medical and psychiatric conditions. The assessment of depression in the medical patients requires a multidimensional approach. Psychological instruments are also used as a method of assessment in these patients. First of all, what the therapists have to do is to find and remove organic causes. Psychosoical treatment includes dealing with the patient's resistance and despondency relevant to physical diseases. For biological treatment, it is important to select appropriate antidepressants. Therapists should be familiar with the side effects of the antidepressants as well as the patient's primary depressive symptoms, pharmacokinetics and pharmacodynamics of the available agents. In addition, special attention should be paid to the potential for drug-illness and drug-drug interactions. Tricyclic antidepressants can be still effectively used for patients with pain disorder, although a variety of new antidepressants such as selective serotonin reuptake inhibitors (SSRI), bupropion and venlafaxine could have more benefits in depression of the medically ill. However, electroconvulsive therapy can be recommended for refractory cases of depression in patients with medical illness.

• Korean Journal of Biological Psychiatry
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• v.7 no.1
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• pp.21-33
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• 2000

As the clinical practice of using more than one drug at a time increase, the clinician is faced with ever-increasing number of potential drug interactions. Although many interactions have little clinical significances, some may interfere with treatment or even be life-threatening. This review provides a better understanding of drug-drug interactions often encountered in pharmacotherapy of depression. Drug interactions can be grouped into two principal subdivisions : pharmacokinetic and pharmacodynamic. These subgroups serve to focus attention on possible sites of interaction as a drug moves from the site of administration and absorption to its site of action. Pharmacokinetic processes are those that include transport to and from the receptor site and consist of absorption, distribution on body tissue, plasma protein binding, metabolism, and excretion. Pharmacodynamic interactions occur at biologically active sites. In this review, emphasis is placed on antidepressant medications, how they are metabolized by the P450 system, and how they alter the metabolism of other drugs. When prescribing antidepressant medications, the clinician must consider the drug-drug interactions that are potentially problematic.

• Korean Journal of Psychosomatic Medicine
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• v.7 no.2
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• pp.274-280
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• 1999

A variety of mechanism may generate pain resulting from injury to the central and peripheral nervous system. None of these mechanism is disease-specific, and several different pain mechanism may be simultaneously present in anyone patient, independent of diagnosis. Diagnosis of neuropathic pain is often easily made from information gathered on neurologic examination and from patient history. Although treatment of neuropathic pain may be difficult, optimum treatment can be achieved if the neurologist has a complete understanding of therapeutic options, the mainstay of which is pharmacotherapy. Selection of an appropriate rharmacologic agent is by trial and error since individual responses to different agents, doses, and serum levels are highly variable. An adequate trial for each agent tried is key to pharmacologic treatment of neuropathic pain. Tricyclic antidepressants are first-line agents, although other drugs, including anticonvulsants, local anesthetic antiarrhythmics, clonidine, opiates, and certain topical agents, also offer pain relief in some patient populations. The novel antidepressants venlafaxine and nefazodone are potentially useful new drugs that are better tolerated than tricyclic antidepressants. Also Gabapentine seems an interesting and promising drug for the treatment of neuropathic pain.

• Korean Journal of Psychosomatic Medicine
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• v.15 no.1
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• pp.7-13
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• 2007

Antidepressants are used by substantial number of physicians as well as psychiatrists. Antidepressants are the mainstay of treatment of depression combined with physical illness, neuropathic pain, and various psychosomatic disorders. Antidepressants, especially TCA and SSRI, are superior to placebo in treating comorbid depression and pain of physical illness. Although it has been controversial whether the influence of depression on the risk and outcome of physical illness is true, antidepressants would provide more favorable prognosis and better quality of life for the patients with physical illness.

• Korean Journal of Biological Psychiatry
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• v.9 no.1
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• pp.25-33
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• 2002

Serotonin transporter(5-HTT) is one of the major action site of antidepressants in neuronal cells. According to the recent studies, it is known that the functional polymorphism in the promoter region of the 5-HTT gene(5-HTT linked polymorphism repetitive element in promoter region, 5-HTTLPR) is associated with antidepressant responsiveness, and the distributions of 5-HTTLPR is various among the different populations. Our preliminary study suggested that it is possible to measure the endophenotype of 5-HTTLPR genotype by examining the pharmacodynamic research of the 5-HTT in platelet membranes. However, there are limitations to predicting the antidepressant responsiveness only from the endophenotypic characteristics of 5-HTT gene promoter polymorphism, and therefore we propose to use the pharmacogenomic methods for overcoming these limitations. We found that the significant correlations existed among the genetic polymorphisms of biogenic amine transporters whose structure and characteristics are similar to the 5-HTT, and the predictable odds ratio of antidepressant responsiveness are increased significantly by combining the effect with other associated polymorphisms, compared to the effect of 5-HTT promoter polymorphism only. These results support the hypothesis that antidepressant treatment has to be individualized according to the genetic and ethnic background of depressed patients. It would be possible to develope the evaluation tools to predict the antidepressant responsiveness and its side effect profile, if scientists reveal the genes related to the action mechanism as well as the metabolism of antidepressants so as to discover the interaction of those genes and contribution of endogenotypes toward antidepressant responsiveness.

• Journal of the Korean Academy of Child and Adolescent Psychiatry
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• v.14 no.1
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• pp.12-25
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• 2003

Objectives：As increasing number of new antidepressants have been being introduced in clinical practice, pharmacological understanding has been broadened. These changes mandate new information and theories to be incorporated into the treatment process of children with depressive disorders. In light of newly coming knowledge, this review intended to recapitulate the characteristics of new antidepressants and to consider the pivotal issues to develope guidelines for the treatment of depression in childhood and adolescence. Methods：Searching the Pub-Med online database for the articles with the key words of 'new', 'antidepressants' and 'children' ninety-seven headings of review articles were obtained. The author selected the articles of pertinent subjects in terms of either treatment guideline or psychopharmacology of new antidepressants. When required, articles about the clinical effectiveness of individual antidepressants were separatedly searched. In addition, the safety information of new antidepressants was acquired by browsing the official sites of the United States Food and Drugs Administration and Department of Health and Human Services. Results：1) For the clinical course, treatment phase, and treatment outcome, the reviews or treatment guidelines adopted the information from adult treatment guidelines. 2) Systematic and critical reviews unambiguously concluded that selective serotonin reuptake inhibitors(SSRIs) excelled tricyclic antidepressants( TCAs) for both efficacy and side effect profiles, and were recommend for the first-line choice for the treatment of children with depressive disorders. 3) New antidepressants generally lacked treatment experiences and randomized controlled clinical trials. 4) SSRIs and other new antidepressants, when used together, might result in pharmacokinetic and/or pharmacodynamic drug-to-drug interaction. 5) The difference of the clinical effectiveness of antidepressants between children and adults should be addressed from developmental aspects, which required further evidence. Conclusion：Treatment guidelines for the pharmacological treatment of childhood and adolescence depression could be constructed on the basis of clinical trial findings and practical experiences. Treatment guidelines are to best serve as the frame of reference for a clinician to make reasonable decisions for a particular therapeutic situation. In order to fulfill this role, guidelines should be updated as soon as new research data become available.