새로운 항우울제인 Agomelatine의 임상적 효과

우영섭,박원명 대한우울조울병학회 2012 우울조울병 Vol.10 No.1

Major depression is highly prevalent mental illness and one of the leading causes of premature death and disability. Although current available pharmacological agents are recognized to be effective, delayed onset of action, partial or total resistance to drug treatment and distressing side effects have leaded to continued search for novel antidepressant. Recent understandings of the fundamental links between major depression and disturbed circadian rhythms have led to a renewed focus on this area. Agomelatine is a new agent with a unique pharmacological profile, melatonin receptor agonist and selective antagonist at 5HT2C receptors. Many clinical trials have demonstrated the superior antidepressant efficacy of agomelatine in comparison with placebo in the treatment major depression and similar antidepressant efficacy to venlafaxine, fluoxetine and sertraline. Agomelatine was even effective in severely depressed patients. Agomelatine has less potential for the side effects including serotonin syndrome and sexual dysfunction or discontinuation syndrome than typical to other therapies, such as selective serotonin reuptake inhibitors. These properties give agomelatine a definite clinical advantage in the treatment of depression. 기존의 항우울제인 SSRI, SNRI 등은 우울증이 monoamine 계의 이상이라는 가설에 근거한 약물로, 그 효과는 제한적이다. 최근 우울증의 병태생리에 대한 다양한 가설들이 제시되면서일주기 리듬의 장애가 주요 우울장애의 발생에 주요한 역할을한다는 증거들이 제시되고 있으며 일주기 리듬을 정상화시키는다는 측면에서 agomelatine의 효과를 기대할 수 있다. Agomelatine은 MT1, MT2수용체에 대한 선택적 촉진작용과 5-HT2C 수용체에 대한 길항작용을 통해 항우울 효과, 일주기 리듬 및 수면 구조 개선효과를 나타내는 것으로 생각된다. 많은 임상 연구에서 agomelatine은 주요 우울증 환자에서기존의 항우울제들과 최소 동등한 항우울 효과를 가짐이 입증되었고, 심한 우울 증상 및 불안 증상에도 효과적이었다. Agomelatine은대체로 부작용 측면에서도 안전하였으며 특히 성기능 장애와 중단증후군의 가능성이 낮아 기존의 항우울제의부작용을 상당 부분 개선하였다. 그러나 아직까지 agomelatine의 작용기전은 명확하지 않다. 향후에는 agomelatine의 정확한 작용 기전을 규명하는 연구가 시행되어야 할 것이며 이를 통하여 우울증의 병태생리를 좀더 명확하게 알 수 있을 것이다. 또한 agomelatine의 소아, 노인 등 특정 인구 집단에서의 효과, 인지 기능에 미치는 영향등에 대한 연구가 필요할 것이며, 양극성 우울증, 계절성 기분장애 등 일주기 리듬의 장애와 밀접한 연관이 있는 다른 정신과적 질환에서의 효과 또한 밝혀져야 할 것이다.

우울증에 대한 인지행동적 이론

김원 대한우울조울병학회 2015 우울조울병 Vol.13 No.2

Depressive disorders show various clinical features and prognosis, so we cannot explain depressive disorders by one psychological theory or one biological model. There are many psychological theories and models about depressive disorder. I want to present many significant models based on cognitive-behavioral theory. Cognitive models for depression was originated by Aaron Beck, and developed and studied by many clinicians and researchers. Combined successfully with behavioral model, many cognitive-behavioral model was developed. Understanding about many cognitive-behavioral models for depression with detail will make us develop more appropriate model for depression, and it will be helpful to the treatment of depression.

첫 삽화 이후의 임상적 경과와 치료전략

고영훈 대한우울조울병학회 2009 우울조울병 Vol.7 No.2

The long-term course of depression has been underestimated because it is considered as an episodic disease. A small number of long-term researches suggested that depression would be a life-long disorder and have the various faces of courses. Although pharmacotherapy, psychotherapy and electroconvulsive therapy are effective treatment modalities for depression, those prospective studies showed that depression is a chronic disorder and the individual with depres- sion has a low rate of recovery and a high rate of relapse. Especially, the symptoms are more chronic in the patients who have not accomplished a recovery within one year from a single episode. Therefore clinicians should pay attention to residual symptoms and resolve these symptoms through the use of precisely timed treatment. Moreover, after remis- sion, patients with depression will continue to benefit from maintenance treatment of antidepressant over a period of 6 month to diminish the risk of relapse.

성격평가질문지를 이용한 양극성 우울증과 단극성 우울증 환자의 임상양상 비교

이종석,이상열,이귀행,백영석,노승호 대한우울조울병학회 2016 우울조울병 Vol.14 No.3

Objective : We compared the clinical characteristics of patients with bipolar and unipolar depression, using the Personality Assessment Inventory (PAI). Methods : Twenty-seven outpatients with bipolar and 57 outpatients with unipolar depression, who had been diagnosed using the DSM-IV-TR, were enrolled from the department of psychiatry at the university-affiliated general hospital. Using the independent t-test, scores on the PAI and its subscales were compared between patients with bipolar and unipolar depression. Results : There were significant differences in the AGG (Aggression, p<0.01) and MAN (Manic, p<.01) items; and MAM-G (Grandiosity, p<0.01), BOR-N (Negative Relationships, p<0.01), ANT-S (Stimulus-Seeking, p< 0.01), AGG-A (Aggressive Attitude, p <0.01), and AGG-P (Physical Aggression, p<0.01) subscales between patients with bipolar depression and unipolar depression. Conclusion : These findings can contribute to the identification of the discriminating clinical characteristics between patients with bipolar and unipolar depression

여성 우울증 환자에서 Aripiprazole과 Bupropion 부가요법의 우울증상 및안전성에 대한 효과 비교 : 사후분석연구

금무성,천은진,이광헌,구본훈,이영지,박영우,이종훈,이승재,성형모 대한우울조울병학회 2018 우울조울병 Vol.16 No.3

Objectives : The purpose of this study was to examine effects of adjunctive aripiprazole versus bupropion, on depressive symptoms of female depression. Methods : Sixty six female patients with major depressive disorders were enrolled from a six-week, randomized prospective open-label multi-center study. Participants were randomized to receive aripiprazole (2.5-10 mg/day) or bupropion (150-300 mg/day). Montgomery Asberg Depression Rating Scale, 17-item Hamilton Depression Rating scale (HAM-D17), Iowa Fatigue Scale, Drug-Induced Extrapyramidal Symptoms Scale, Psychotropic-Related Sexual Dysfunction Questionnaire scores, and Clinical Global Impression-Severity (CGI-S) were obtained at baseline and after one, two, four, and six weeks. Changes on individual items of HAM-D17 were assessed as well as on composite scales (anxiety, insomnia and drive), and on four core subscales that capture core depression symptoms. Results : Overall, both treatments improved depressive symptoms, without causing serious adverse events. There were significant differences in the HAM-D17 total score (p=0.046) and CGI-S (p=0.004), between aripiprazole and bupropion augmentation, favoring aripiprazole over bupropion. Aripiprazole revealed significantly greater effect size in depressed mood (p=0.006), retardation (p=0.005), anxiety psychic (p=0.032), and general somatic symptom (p=0.01). Conclusion : While both treatments were effective, results of this study suggested that aripiprazole may be preferable, in treating general and core symptoms of female depression.

애도와 복잡성 애도(Complicated Grief) : 새로운 진단과 치료가 필요한가?

송민규,김원 대한우울조울병학회 2016 우울조울병 Vol.14 No.2

Grief processes usually do not make severe symptoms that may impair one’s critical function. A bereaved person may go through some hard time but recovers gradually with time. However, in the case of complicated grief, the symptoms tend to be severe and prolonged. Complicated grief impairs function in important areas of one’s life caused by symptoms such as intense yearning, longing, emotional distress, and having difficulty in planning a meaningful future without the loving one. Complicated grief is more likely to occur in case of one’s child or spouse loss and sudden death by violent means. Many trials support the efficacy of targeted complicated grief therapy which provides an explanation of the disorder, strategies for the acceptance of the loss and moving on to the future. Antidepressant therapy has not yet been studied enough in the case of complicated grief. Despite the fact that complicated grief can cause such debilitating symptoms, it is still not regarded as a disorder according to the DSM-5. Although it shares some symptoms with MDD and PTSD, but the exact symptoms and progress are distinct from that of MDD and PTSD. It implies that Complicated grief needs further researches and more specified therapeutic approach.

자살 시도한 주요 우울 장애 환자의 인구통계학적 특성

허지원,양종철,한상우,심세훈,이분희,김용구 대한우울조울병학회 2008 우울조울병 Vol.6 No.2

Objectives:The purpose of this study was to investigate sociodemographic factors for suicidal attempts in major depressive disorder patients. Methods:We compared the sociodemographic characteristics and clinical history of major depressive disorder (MDD) inpatients who were with suicidal attempts and without suicidal attempts. 314 suicidal attempters who were diagnosed as major depressive disorder by SCID-I interview participated in this study. Besides, 237 patients with major depressive disorder who did not attempt suicide. Results:The MDD patients with suicidal attempts showed younger age, higher education, earlier onset, less frequency of episodes, and shorter duration of illness than patients without suicide attempts. Besides, depressed suicidal attempters showed high proportion of unmarried person than non-suicidal attempters. Conclusion:The most serious outcome of major depression, suicidal attempts is results from the interaction of various factors. This study provides an evidence for distinct sociodemographic and historical factors for suicide attempts in the MDD group.

주요우울장애로 처음 정신건강의학과 입원 후 퇴원 한 환자에서 외래 치료 유지에 영향을 주는 요인

임대창,김상훈,박상학,김승곤,장현,추일한 대한우울조울병학회 2014 우울조울병 Vol.12 No.3

Objectives : This study aims to identify clinical factors associated with outpatient maintenance treatment for major depressive disorder patients who discharged after first psychiatric admission. Methods : Ninety-three patients who discharged after first psychiatric admission from June 2008 to May 2011 were selected. Until Nov. 2013, we examined outpatient follow-up rate. And univariate logistic regression was applied to find influencing clinical factors on outpatient maintenance treatment. Results : Fifty-two patients (55.9%) maintained outpatient treatment more than 6 months and 42 patients (45.2%) did more than 12 months. Outpatient maintenance treatment over 6 months was significantly related to major depressive disorder treatment history, outpatient clinical treatment in prior 30 days before admission, no suicide attempt history, inpatient stays more than 7 days, augmentation of antianxiety drugs, discharge with medical advice, kept first outpatient appointment. Outpatient maintenance treatment over 12 months was significantly related to female, major depressive disorder treatment history, no suicide attempt history, augmentation of antianxiety drugs, discharge with medical advice, kept first outpatient appointment. Conclusion : Our research suggest that outpatient maintenance treatment after first time hospitalization with major depressive disorder is related to psychiatric histories of previous outpatient treatment and suicide before admission, inpatient duration, and keeping first outpatient appointment after discharge.

정신병적 증상을 동반한 주요우울장애의 진단변화 양상

오승영,김종우,강원섭,백종우,반건호,송지영 대한우울조울병학회 2014 우울조울병 Vol.12 No.3

Objectives : Several studies suggested that major depressive disorder (MDD) with psychotic features might be a distinct disease in several clinical features. Therefore, we investigated the clinical features of the inpatients with MDD with psychotic features at a university hospital in Korea. Method : We performed a retrospective analysis of 79 patients who had ever been hospitalized as DSM-IV-TR MDD with psychotic features in a University Hospital from 2002 to 2012. We investigated and analyzed several clinical aspects, such as diagnostic changes, concomitant psychotic symptoms, family histories, and suicidal attempts from the medical records of the patients. Results : Among 79 patients whose initial diagnoses were MDD, 70 (88.6%) were not changed, 6 (7.6%) shifted to Bipolar disorder and 3 (3.8%) shifted to Schizophrenia. In the two groups, persisting MDD and shifting to other diagnoses, significant differences were found in the follow-up duration and the number of hospitalization. In the whole patients, 35 patients (44.3%) had hallucinations, 70 patients (88.6%) had delusions, 25 patients (31.6%) had family histories and 38 patients (48.1%) had suicidal ideations. Conclusion : The diagnostic stability of MDD with psychotic features was slightly higher than previous researches. The follow-up duration and the number of hospitalization were significant predictors associated with diagnostic shift.

의과대학생들의 우울 증상 : 유병율, 관련요인 및 긍정심리의 조절효과

김상훈,김정호,정형식,박종철,김영심 대한우울조울병학회 2014 우울조울병 Vol.12 No.2

Objectives : This study was undertaken to investigate the prevalence of depressive symptoms and their related factors among a group of medical students. Method : A total of 874 (529 male and 345 female) medical students were randomly selected to participate in a survey. Depressive symptoms, satisfaction with life, health behavior including alcohol use, stress, sleep disturbance and happiness were collected using self-reported questionnaires. Results : The prevalence of depressive symptoms was 10.8%. In stepwise multiple regression analysis, lower satisfaction of life, daytime dysfunction due to sleepiness, history of suicidal attempt, stress, sleep disturbance were found to be significant relating factors of depressive symptoms. In moderated regression analysis, the result showed that the impact of life stress were moderated by satisfaction of life on depressive symptoms, but the moderating effect of happiness was not significant. Conclusion : This study showed considerably high prevalence of depressive symptoms and BDI score in medical students. The findings suggest that early detection of depressive symptoms and intensive mental health promotion program is needed in order to improve medical student’s mental health status.