First-line therapy of depression is a pharmacological treatment. Many prescribed antidepressants modulate monoamine neurotransmitters including serotonin, norepinephrine and dopamine. Recently, Ketamine, an N-methyl-D-aspartate receptor antagonist, has received attention and has been investigated for clinical trials and neurobiological studies. Here, I introduce ketamine as a rapid-acting antidepressant.

The geriatric patients with chronic physical diseases are frequently associated with the continuous clusters of depression including nonpathological sadness, subsyndromal depression, minor depressive disorder, and major depressive disorder. Because of the complex and reciprocal relationships among depression, elderly, and chronic physical diseases, screening approaches with specific nosological methods should be needed in the realm of early detection of depression. Cognitive decline is frequently manifested in geriatric depression with medical or neurological diseases. Also, somatic symptoms of depression or emotional symptoms of physical diseases can play a role as a hampering factor in the early detection of depression. Furthermore, after-care has been regarded as an essential factor of depression screening in the geriatric patients with chronic physical diseases. We reviewed the most popular examples of integrated medicine for depression in primary care. Thus, we propose a general hospital-based model for early detection of depression which includes favorable response loop between screening and therapeutic intervention. Our model can be a basis for evidence-based detection and after-care for depression in the geriatric patients with chronic medical diseases.

Objectives The purpose of this study was to examine the differences according to depressive symptom-related difficulty status. Methods 2828 participants were a divided into depressive symptom-related difficulty group (difficult group, n = 774), and a non-depressive symptom-related difficulty group (not difficult group, n = 2054). The psychological character of the participants were assessed using the Korean version of the Patient Health Questionnaire-9 (PHQ-9), Satisfaction with Life Scale (SWLS), the 12-item General Health Questionnaire (GHQ-12), and Conner-Davidson Resilience Scale (CD-RISC). Statistical analyses were done using t-test, chi-square, and analysis of covariance (ANCOVA). Results Compared with the no difficulty group, the difficulty group reported significantly higher score in all items of PHQ-9. The score of "feeling tired" was the highest and the score of "suicidal ideation" is the lowest in both groups. ANCOVA analysis that is adjusted with the total score of PHQ-9 showed the differences in SWLS, GHQ-12, and CD-RISC scores between the difficulty group and the no difficulty group. Conclusions The findings suggest that there are different characters on PHQ-9, SWLS, GHQ-12, and CD-RISC according to depressive symptom-related difficulty. Therefore, it is required not only to evaluate depressive symptoms in patients with depression, but also the depressive symptom-related difficulty to understand these differences.

Objectives Non-major depression with fewer symptoms than required for a Diagnostic and Statistical Manual of Mental Disorders-4th edition diagnosis of major depressive disorder (MDD) has consistently been found to be associated with functional impairment. In this study, we aim to estimate the cognitive impairment and the quality of life in elderly patients with subsyndromal depression (SSD) compared with non-depressive elderly (NDE). Methods The Korean version of Mini International Neuropsychiatric Interview was administered to 194 outpatients with depression and 108 normal controls. SSD is defined as having five or more current depressive symptoms with core depressive symptoms (depressive mood or loss of interest or pleasure) during more than half a day and more than seven days over two weeks. Depression was evaluated by the Korean form of Geriatric Depression Scale of a 15-item short version. Global cognition was assessed by Mini-Mental State Examination in the Korean version of CERAD assessment packet (MMSE-KC). Subjective cognitive impairment was assessed by the Subjective Memory Complaint Questionnaire. Quality of life was evaluated by the Korean Version of Short-Form 36-Item Health Survey. Results The mean score of the MMSE-KC in the SSD group was lower than that in the NDE group with adjustment for age, gender, and education [F = 4.270, p = 0.04, analysis of covariance (ANCOVA)]. If we defined those having Z-score of MMSE-KC < -1.5 as a high risk group of cognitive impairment, the odds ratio for the high risk group of cognitive impairment was 1.86 [95% confidence intervals (CI) 1.04-3.34] in SSD and 7.57 (95% CI 3.50-16.40) in MDD compared to NDE. The scores of physical component summary (F = 9.274, p = 0.003, ANCOVA) and mental component summary (F = 53.166, p < 0.001, ANCOVA) in the SSD group were lower than those in the NDE group with adjustment for age, gender, and education. Conclusions The subjects with SSD, as well as those with MDD, showed impairment of global cognition and also experienced low quality of life in both physical and mental aspects, compared to the NDE group.

Objectives The purpose of this study is to find the influential clinical and physical characteristics which affect apnea-hypopnea index (AHI) in suspected obstructive sleep apnea (OSA) patients. Methods We evaluated the comprehensive factors including sleep related symptoms, clinical scales, medical history, substance use, and anthropometric data of the 119 participants who complained of the symptoms of OSA. All the participants underwent attended-full night laboratory polysomnography. The correlation and multiple regression analysis were conducted to find the influential and predictive factors of AHI. Results A multiple linear regression model 1 showed that higher AHI was associated with higher body mass index (BMI)(p < 0.001) and higher frequency of observed apnea (p = 0.002). In multiple linear regression model 2, AHI was associated with higher BMI (p < 0.001) and loudness of snoring (p = 0.018). Conclusions The present preliminary results suggest that BMI and observed apnea are most influential factors that affect AHI in suspected OSA patients. In the future study we will design the prediction formula for the OSA and AHI, which is useful in the clinical medical field.