• Investigative Magnetic Resonance Imaging
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• v.19 no.1
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• pp.10-18
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• 2015

Background and Purpose: The association between the low emotional regulation and the brain structural change of major depressive disorder (MDD) has been proposed, but the voxel-based morphometry (VBM) studies on female MDD are rare. The purpose of the present study was to show the regional volume changes of gray matter (GM) in female patients with MDD by optimized VBM. Methods: To control subjects homogeneity, twenty female MDD patients and age, sex matched 21 normal controls were included for the VBM analysis. To identify the change of regional gray matter volume (GMV), the optimized VBM was performed with T1 MRIs. The amounts of gray/white matter and intracranial cavity volumes (ICV) were measured. The analysis of covariance (ANCOVA) and partial correlation analyses covariate with age and ICV were applied for VBM. Results: The age and ICV distributions were similar between the two groups. In the ANCOVA, the total GMV of MDD was smaller than that of normal controls. In the VBM, regional GMV was relatively decreased in the limbic system (amygdalae, ambient gyri, hippocampi heads, subiculum, posterior parahippocampal gyri, pulvinar nuclei, dorsal posterior cingulate gyri, and left pregenual cingulate gyrus). The lingual gyri, short insular gyri, right fusiform gyrus, and right inferior frontal gyrus were also showed decreased regional GMV. Conclusion: The results of this study indicate that the female MDD is mainly associated with the structural deficits of the limbic system and limbic system related cortices, which were known to the center of emotions.

• Korean Journal of Biological Psychiatry
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• v.25 no.4
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• pp.89-100
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• 2018

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation method that delivers 1-2 mA of current to the scalp. Several clinical studies have been conducted to confirm the therapeutic effect of major depressive disorder (MDD) patients with tDCS. Some studies have shown tDCS's antidepressant effect, while the others showed conflicting results in antidepressant effects. Our aim of this review is to understand the biological bases of tDCS's antidepressant effect and review the results of studies on tDCS's antidepressant effect. For the review and search process of MDD treatment using tDCS, the US National Library of Medicine search engine PubMed was used. In this review, we discuss the biological mechanism of tDCS's antidepressant effect and the existing published literature including meta-analysis, systematic review, control trial, open studies, and case reports of antidepressant effects and cognitive function improvement in patients with MDD are reviewed. We also discuss the appropriate tDCS protocol for MDD patients, factors predictive of response to tDCS treatment, the disadvantages of tDCS in MDD treatment, and side effects.

• Korean Journal of Biological Psychiatry
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• v.27 no.2
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• pp.74-83
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• 2020

Objectives Psychological resilience plays a significant role in many aspects of mental health. The aim of this study was to find an association between childhood attention deficit hyperactivity disorder (ADHD) features and adulthood psychological resilience in patients with mood disorders. Methods A total of 213 patients with mood disorders including major depressive disorder or bipolar I, II disorder and 909 healthy controls were included. We assessed childhood ADHD features using the Wender Utah Rating Scale (WURS), adulthood psychological resilience using the Connor-Davidson Resilience Scale (CD-RISC), and current depressive mood using the Beck Depression Inventory (BDI). Pearson's correlation, multiple linear regression and a mediation analyses were performed to examine the relationships between three WURS factor (impulsivity, inattention, and mood instability) scores, the BDI score, and the CD-RISC score. Results The CD-RISC score was negatively correlated with the WURS childhood inattention factor score and current BDI score in patients with mood disorders. BDI score mediated the influence of the inattention factor score on CD-RISC score among patients with mood disorders. The CD-RISC score was significantly lower in patients with mood disorders than in controls even after controlling for age, WURS scores, and the BDI score. Conclusions An evaluation of psychological resilience is important for enhancing recovery and quality of life in patients with mood disorders. When assessing psychological resilience, current depression and ADHD features in childhood, particularly inattention, should be considered.

• Korean Journal of Biological Psychiatry
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• v.21 no.1
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• pp.14-20
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• 2014

Objectives The current study investigated the putative relationship between chronotype and suicidality or bipolarity in patients with major depressive disorder (MDD). Method Nineteen outpatients who met the criteria for MDD according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders-text revision were recruited for the current study. The subjects were divided into two subgroups based on their Basic Language Morningness (BALM) scores (dichotomized according to the median BALM score). The Loudness Dependence of Auditory Evoked Potentials (LDAEP) was evaluated by measuring the auditory event-related potentials before beginning medication with serotonergic agents. In addition, K-Mood Disorder Questionaire (K-MDQ), Beck Scale for Suicidal Ideation (BSS), Beck Hopelessness Scale (BHS), Barratt Impulsiveness Scale (BIS) were applied. Results The K-MDQ, BSS, BHS, BIS score was higher for the eveningness group than for the morningness group. However, the LDAEP, Hamilton Depression Rating Scale, Hamilton Anxiety Scale scores did not differ significantly between them. There were negative correlations between the total BALM score and the total K-MDQ, BSS, and BHS scores (r=-0.64 and p=0.0033, r=-0.61 and p=0.0055, and r=-0.72 and p=0.00056, respectively). Conclusions Depressed patients with eveningness are more vulnerable to the suicidality than those with morningness. Eveningness is also associated with bipolarity.

• Journal of Korean Society of Forest Science
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• v.101 no.4
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• pp.677-685
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• 2012

This study was conducted to evaluate the effect of forest environment and therapeutic program to the patients with major depressive disorder in antidepressant medication. The first group participated the four sessions of therapeutic program in the forest environment ("forest therapy"), the second group did in the program in a hospital environment, the third group did merely walking in the forest ("forest bath"), and the last group was controls. All the participants was diagnosed with major depressive disorder and had been taking antidepressant medication longer than 3 months. Depressive symptoms were measured by the Hamilton Rating Scales for Depression(HRSD), Montgomery-Asberg Depressin Rating Scales(MADRS), Beck Depression Inventory(BDI), and general health perception was measured by Short Form Health Survey Questionnaire(SF-36). Heart rate variability(HRV) were also examined to observe the physiological parameters before and after the program. In the results, HRSD score of forest program group was significantly lower than controls after the program. MADRS score of forest therapy group and hospital program group was also significantly lower than controls after 4 sessions of the program. The remission rate defined as below 7 points in HRSD was higher in the forest therapy group, hospital program group, forest bath group, and controls in order. These results reveals that the therapeutic program performed in forest environment may improve unremitted depressive symptoms of patients with major depressive disorder. Although not significant, the forest therapy program showed better outcome than hosptial program and forest bath.

• Korean Journal of Psychosomatic Medicine
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• v.29 no.1
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• pp.1-10
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• 2021

Objectives : This study was conducted to investigate differences in psychological characteristics between major depressive disorder (MDD) patients with and without suicide attempt using MMPI-2-RF. Methods : Subjects were 107 MDD patients who had visited the department of psychiatry of hallym university hospital and met the DSM-IV diagnostic criteria of MDD by the korean version of MINI-Plus 5.0.0. The patients were divided into suicidal attempters (n=43) and non-suicidal attempters (n=64) using C-SSRS. The one-way ANOVA was used to compare MMPI-2-RF scale scores between two groups. Additionally, ANCOVA was conducted considering the severity of depressive symptom and comorbidity as covariate. Results : Our results showed that Suicide/Death Ideation (SUI), Inefficacy (NFC) and Interpersonal Passivity (IPP) scales were significantly higher in the MDD patients with suicidal attempt compared to MDD patients without suicidal attempt (p<0.05). However, after controlling for the severity of depressive symptom and comorbidity, SUI scale showed a significant tendency (p<0.10). Conclusions : The result suggests that MMPI-2-RF scales could be a useful tool for identifying patients transitioning to actual suicidal attempts in the moderate or severe major depressive disorder group. Limitations of this study and directions for further research are also discussed.

• Psychiatry investigation
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• v.15 no.11
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• pp.1009-1010
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• 2018

• Korean Journal of Biological Psychiatry
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• v.21 no.2
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• pp.74-80
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• 2014

Objectives More than half of the elders suffer from chronic sleep disturbances. Moreover, sleep disturbances are more prevalent in patients with depressive disorder than in community dwelling elderly. In this study, we aim to estimate the risk factors of poor sleep quality and its effect on quality of life in patients with late life depression. Methods This study included 159 depressive patients aged 65 years or older who completed Pittsburgh Sleep Quality Index (PSQI). A global PSQI score of 5 or greater indicates a poor sleeper. Structural diagnostic interviews were performed using the Korean version of Mini International Neuropsychiatric Interview (MINI). Depression was evaluated by the Korean form of Geriatric Depression Scale (KGDS). Global cognition was assessed by Mini-Mental State Examination in the Korean version of the Consortium to Establish a Registry for Alzheimer's Disease assessment packet. Quality of life was evaluated by the Korean version of Short-Form 36-Item Health Survey (SF-36). Results The frequencies of poor sleepers were 90.5% in major depressive disorder, 71.8% in minor depressive disorder, 47.1% in subsyndromal depressive disorder, and 73.0% in all types of depressive disorders. Multivariate logistic regression analysis indicated that female [odds ratio (OR) = 2.83, 95% confidence interval (CI) = 1.20-6.67] and higher KGDS score (OR = 1.13, 95% CI = 1.05-1.21) were risk factors of poor sleep quality in patients with late life depression. In the analysis of ANCOVA adjusted for age, gender, education and KGDS score, the mean scores of vitality mental health and mental component summary of SF-36 were lower in poor sleepers than in good sleepers. Conclusions Poor sleepers among patients with late life depression are very common and are associated with female and higher KGDS scores. Poor sleep quality causes a significant negative effect on mental health quality. So researchers and clinicians should be more vigilant in the evaluation and treatment of sleep disturbances in patients with late life depression.

• Anxiety and mood
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• v.9 no.2
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• pp.140-146
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• 2013

Objective : There have been few comprehensive studies on the analysis of 24-hour HRV of major depressive disorder (MDD). The purpose of this study was to compare the autonomic nerve system of patients with a MDD with healthy patients and to examine the physiologic and clinical effects of 24-hour HRV by analyzing whether the HRV demonstrates the level of depressive symptoms after improving the symptoms in patients with a MDD. Methods : The 24-hour HRV was measured in patient groups with a MDD (n=16) and control groups (n=16). The patients with a MDD received the follow up test for two months after the treatment. Results : There were significant differences among the indexes (SDNN, rMSSD, SDNN index, and pNN50) of time-domain analysis and the indexes (TP, VLF, LF, HF, and ULF) of frequency-domain analysis of HRV between patient and control groups. The means of RR, SDNN, SDANN, and TP increased after two month of the treatment, comparing them with before the treatment, but there were no statistical significance. Conclusion : The results of 24-hour HRV analysis indicated significant decrease of HRV indexes among MDD patients which may suggest decrease of parasympathetic nervous functions.

• YAKHAK HOEJI
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• v.57 no.2
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• pp.101-109
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• 2013

Depressive disorders are the most common psychiatric problem in the elderly. Most depression treatment guidelines emphasize treatment with antidepressant medication and recommend that benzodiazepine use be minimized for limited period, particularly to elderly patients. In order to evaluate appropriate use of antidepressants and benzodiazepine, retrospective review of prescriptions was performed. The study population are older than 65 years who had been newly diagnosed with major depressive disorder in specialty mental health at a community general hospital from January $1^{st}$, 2007 to October $31^{th}$, 2012 (N=373). Initial antidepressant accounted for 89.5% with SSRI, and escitalopram accounted for 60.9% of SSRI group. 79% or more of the patients were prescribed the recommended dosage. The maintenance rate for 4 weeks of initial antidepressant was 48% and 6 weeks was 39%. Treatment-discontinuation rate was 68% at 3 month. Alprazolam (short acting benzodiazepine) was prescribed the most, followed by clonazepam (long acting benzodiazepine) and then diazepam. 55% of patients received a duplicated prescription for short acting plus long acting benzodiazepine. 61% of patients used long acting benzodiazepines. Prescribed dosages of benzodiazepines were commonly within a recommended range, while no one was prescribed a appropriate period (up to 2 weeks) except for the early discontinued patients. Appropriate use of zolpidem was only 16.2%. The depressed elderly treated in specialty mental health mostly received long-term treatment with benzodiazepines in combination with antidepressants, guideline recommendations was not followed. Multidisciplinary interventions like audit and feedback of benzodiazepine use are needed and education for the elderly is needed to properly maintain antidepressant treatment.