우울증의 최신 약물요법

함병주,정인과 대한의사협회 2009 대한의사협회지 Vol.52 No.5

Currently, pharmacotherapy is the primary treatment modality for depression. Various classes of antidepressants have been developed and are widely used at present. Although the antidepressant effects of these drugs are thought to be similar, there are numerous differences between drugs in pharmacologic characteristics, side effects, and tolerabilities. Furthermore, 40~50% of patients may not respond sufficiently to the first-line antidepressants they take. As the response rates are substantially insufficient, and the side effects are not uncommon, the optimal treatment of antidepressants is somewhat difficult. Therefore, the clinicians treating depression should understand the characteristics of various antidepressants and also the optimal treatment strategy. In this review, we introduce various antidepressants and optimal treatment strategies for the treatment of depression.

불면증과 성격유형

함병주,김린,Ham, Byung-Joo,Kim, Leen 대한수면의학회 2002 수면·정신생리 Vol.9 No.2

Personality traits in insomniac patients have been a subject of many studies. A number of these studies have used the MMPI and have demonstrated elevated scores on several clinical scales reflecting somatic concerns, somatization, depression, anxiety, worry and social alienation. And it was suggested that insomnia was due to a process of internalization of psychological distress. Another hypothesis about psychological mechanisms has focused upon worry. Excessive and uncontrollable cognitive activity seem to be a characteristic feature of many insomniacs. One author emphasized the role of the dependency need and found a characteristic pattern among insomniacs. The central feature of this pattern is frustration of dependency need. The purpose of this paper was to review possible personality variable that may be predisposing causal factors of insomnia. Several factors are suggested by many studies, but in order to explore their causal importance other experimental and longitudinal studies are needed.

우울장애의 신경생물학적 최신 지견 : 세로토닌 전달체에 대한 영상 유전학적 연구를 중심으로

함병주,Ham, Byung-Joo 대한생물정신의학회 2011 생물정신의학 Vol.18 No.4

Depressive disorders have strong genetic components. However, conventional linkage and association studies have not yielded definitive results. These might be due to the absence of objective diagnostic tests, the complex nature of human behavior or the incomplete penetrance of psychiatric traits. Imaging genetics explores the influences of genetic variation on the brain function or structure. This technique could provide a more sensitive assessment than traditional behavioral measures in psychiatric studies. Imaging genetics is a relatively new field of psychiatric researches, and may improve our understanding on neurobiology of psychiatric disorders. In this review, current understanding in neurobiology of depressive disorders, especially imaging genetic studies on serotonin transporter will be discussed.

외적 환경을 고려한 최적의 항우울제 치료

함병주,한창환 大韓神經精神醫學會 2008 신경정신의학 Vol.47 No.1

Depressive illness is a major public health problem with important medical, social and economic implications. The effcacy of various antidepressants in treating depression has been demonstrated in randomized controlled trials (RCTs). However, these studies do not adequately address the complexities of clinical practice. Although most of RCTs assumed there was no difference in effcacy between the tncyclic antidepressants (TCAs) and serotonin specific reuptake inhibitors (SSRIs), natumlistic studies show that patients who take TCAs often receive subtherapeutic doses for inadequate duration than those with SSRIs. Because the benefits of the implementation of current guidelines are limited, the optimal choice of medication must be guided by detailed history and careful consideration ofthe real-world efficacy of antidepressants and long-term health care costs.

우울증의 약물유전체학

함병주,이민수,Ham, Byung-Joo,Lee, Min-Soo 대한생물정신의학회 2001 생물정신의학 Vol.8 No.2

The pharmacotherapy of depression has reduced morbidity and improved outcome for many depressive patients. A wide range of classical and new antidepressants are available for their treatment. However, 30-40% of all patients do not respond sufficiently to the initial treatment and present adverse effects. Pharmacogenetics studies the genetic basis of an individual's ability to respond to pharmacotherapy. Recently, some reports on serotonin transporter gene polymorphisms and their influence on the response to antidepressive therapy provide an interesting diagnostic tool in assessing the chances of response to antidepressants. We also investigated the relationship between serotonin transprter polymorphisms(5-HTTLPR) and the long-term effect of the antidepressant treatment. 128 depressive patients were enrolled into 2nd year study. The therapeutic response of each subset was not different at 8th, 16th week, but the subset with homozygote(l/l) of long variant showed a better therapeutic response to antidepressant than the heterozygote(l/s) of long and short variant, which showed a better therapeutic response than the subset with homozygote (s/s) of short variant at 1st year and 2nd year after the antidepressant treatment. This result shows that the serotonin transporter polymorphisms may be related to the long-term effect of antidepressant treatment. The potential for pharmacogenomics, the use of genetic information to guide pharmacotherapy and improve outcome by providing individualized treatment decisions, has gained increasing attention. pharmacogenomics will contribute to individualize drug choice by using genotype to predict positive clinical outcomes, adverse reactions, and levels of drug metabolism. Personalized medicine, the use of marker-assisted diagnosis and targeted therapies derived from an individual molecular profile, will impact the antidepressant therapy and this approach will replace the traditional trial-and-error practice of medicine.

Brain-Derived Neurotrophic Factor(BNDF) Val66Met 유전자 다형성과 성격 특성에 대한 연합연구

함병주,안희범,조수민,류성곤,최명진,이민수,최인근,Ham, Byung-Joo,An, Hwei-Beom,Cho, Su-Min,Ryu, Sung-Gon,Choi, Myoung-Jin,Lee, Min-Soo,Choi, Ihn-Geun 대한생물정신의학회 2005 생물정신의학 Vol.12 No.2

Background:Brain-derived neurotrophic factor(BDNF) genes are thought to be important factors in some personality traits. The goal of this study was to determine the role of these genes in personality traits. Method:The participants included 170 healthy adults with no history of psychiatric disorders and other physical illnesses for the last 6 months. All participants were tested by the Temperament and Character Inventory (TCI). BDNF Val64Met gene polymorphisms were analyzed with PCR(Polymerase Chain Reaction). Differences on TCI dimensions and sub-scales among groups were examined with ANOVA. Result:There was a significant correlation between BDNF Val64Met and Persistence(PS)(p=0.036) in female subjects, but none with the other TCI dimensions. A post-hoc comparison revealed significant a difference between Val/Val and Met/Met (p=0.031). Conclusion:Our study suggests that the BDNF Val64Met gene polymorphism is associated with persistence in Korean female subjects, but the small number of subjects limits generalization of our results. Further studies with a larger number of homogenous subjects are needed to confirm whether the BDNF gene is related to personality traits.

감정표현불능증 : 그 개념과 치료적 함의

함병주,김린,Ham, Byung-Joo,Kim, Leen 대한수면의학회 2002 수면·정신생리 Vol.9 No.1

Alexithymia represents deficits in the cognitive processing and regulation of emotions. It is observed in many cases of psychosomatic disease, anorexia nervosa, panic disorder, depression etc. Many studies have shown that alexithymia is associated with maladaptive styles of emotion regulation, low emotional intelligence, interhemispheric transfer deficit, and reduced rapid eye movement density. Psychotherapies that enhance emotional awareness may be effective in alleviating the difficulties of alexithymic individuals. Aexithymia is useful for constructing the role of personality and emotions in the pathogenesis of psychiatric disorders. It may serve as a bridge between neurobiology and psychology. We review recent alexithymia theory and research and their implications for treatment of psychosomatic disorders.

수면 무호흡증이 있는 양극성 장애 환자에서 급속 정온요법으로 인해 발생한 급성 호흡 장애

함병주,서용진,김린,Ham, Byung-Joo,Seo, Yong-Jin,Kim, Leen 대한수면의학회 2001 수면·정신생리 Vol.8 No.2

Chemical restraint or "rapid tranquilization" is another option in treating patients who are a danger to themselves or others and struggle violently once physically restrained. The most commonly used drugs are benzodiazepines and antipsychotics. The use of benzodiazepines, either alone or in combination with high potency neuroleptics, has increased in recent years. Benzodiazepines are extremely safe but may cause respiratory depression and hypotension. Respiratory depression is more likely with intravenous administration, therefore these medications should be given slowly and titrated to the desired effect. Special care should be taken when sedating patients who are under the influence of alcohol or narcotics and are sleep apneic patients. This report deals with a case of respiratory distress in a patient with sleep apnea syndrome after the rapid tranqulization. All patients receiving chemical restraint must be carefully monitored. For critically ill patients who require sedation or chemical restraint, the constant attendance of a physician may be warranted.

우울증 치료에서 보다 더 우울한 항우울제가 있는가?

함병주 대한우울조울병학회 2008 우울조울병 Vol.6 No.2

The efficacy of antidepressants has been demonstrated in various study including randomized controlled trials (RCTs), and most of them assumed there was no difference in efficacy among antidepressants. Recently, several studies have suggested that some antidepressants such as clomipramine, venlafaxine, and escitalopram have superior efficacy over other antidepressants. In this debate, I discussed these studies and my opinion.

항우울제와 우울증 환자의 삶의 질 - 삼환계 항우울제와 Sertraline을 중심으로 -

함병주,이민수,Ham, Byung-Joo,Lee, Min-Soo 대한생물정신의학회 1997 생물정신의학 Vol.4 No.1

This study investigated the antidepressant efficacy and it's impact on the quality of life of depressed patients. We performed Hamilton Depression Rating Scale(HDRS), and Montgomery-Asberg Depression Rating Scale(MADRS), and Health-related Quality of Life Questionnaire(HQLQ) to both tricyclic antidepressant(TCA) and sertraline groups. There were 16 subjects in this study. The tricyclic group had 9 subjects and the sertraline group had 7. The TCA and sertraline produced a similar degree of response. Both groups experienced a reduction of 70% or more in mean HDRS and MADRS total score after 6wks. In HQLQ, the TCAs group also showed improved bed disability days, alertness behavior, and social interaction, the sertraline group showed improved health perception, alertness behavior, home management, and social interaction. We suggested that the improvement of "Quality of life" were not in proportion to the clinical symptom's improvement. Therefore, clinicians should consider the benefit of antidepressant treatment in terms of quality of life.