Treatment with Selective Serotonin Reuptake Inhibitors and Mirtapazine Results in Differential Brain Activation by Visual Erotic Stimuli in Patients with Major Depressive Disorder

OBJECTIVE: The objective of this study was to identify patterns of brain activation elicited by erotic visual stimuli in patients treated with either Selective Serotonin Reuptake Inhibitors (SSRIs) or mirtazipine. METHODS: Nine middle-aged men with major depressive disorder treated with an SSRI and ten middle-aged men with major depressive disorder treated with mirtazapine completed the trial. Ten subjects with no psychiatric illness were included as a control group. We conducted functional brain magnetic resonance imaging (fMRI) while a film alternatively played erotic and non-erotic contents for 14 minutes and 9 seconds. RESULTS: The control group showed activation in the occipitotemporal area, anterior cingulate gyrus, insula, orbitofrontal cortex, and caudate nucleus. For subjects treated with SSRIs, the intensity of activity in these regions was much lower compared to the control group. Intensity of activation in the group treated with mirtazapine was less than the control group but grea-ter than those treated with SSRIs. Using subtraction analysis, the SSRI group showed significantly lower activation than the mirtazapine group in the anterior cingulate gyrus and the caudate nucleus. CONCLUSION: Our study suggests that the different rates of sexual side effects between the patients in the SSRI-treated group and the mirtazapine-treated group may be due to different effects on brain activation.

A Provoked Bradycardia Associated with a Combination Treatment of Paroxetine and Carvedilol / 신경정신의학

Selective serotonin reuptake inhibitors (SSRIs) have been used for patients with depressive disorder because of their favorable side effect profiles. However, SSRIs have variable drug interactions because of the inhibitory action on the Cytochrome-P 450 system (CYP450), especially in combination with antipsychotic and antiarrhythmic drugs. We hereupon present the first case report of bradycardia associated with the use of paroxetine and carvedilol combination in a patient with depressive disorder.

Depression and the Frontal Lobe

OBJECTIVES: Abnormalities in the frontal lobe have been consistently suggested in the pathophysiology of depression. The purpose of this review is to discuss the relationship between the frontal lobe and depression. METHODS: Recent researches on the frontal lobe in depression were reviewed and abnormalities in this region were considered within the context of modern functional neuroanatomy. RESULTS: This paper reviewed evidence strongly implicating the frontal lobe as a key brain structure in depression. CONCLUSION: Taken together, these abnormalities in the function of the frontal lobe implicate interconnected neural circuits in depression and offer suggestions for the themes of future research and treatment. Further research is needed to investigate the association between emotion and the brain in the paradigm of "affective neuroscience".

USE OF LASER DOPPLER FLOWMETRY FOR ESTIMATION OF BURN DEPTH

The main trend moves towards early excision and skin grafting as treatment for the deep second degree burns and the third degree burns. The ability to excision & skin grafting. This study prospectively evaluated the ability of laser doppler flow measurements obtained within 72 hours after burn injury to predict the depth of burn wounds. A Periflux system 4001 laser doppler flowmetry had been used to measure cutaneous microflow circulation of 100 selected points of burn wounds in 44 admitted patients from March 1993 to February 1994. The mean value of superficial second degree burn checked by laser doppler was 194.6 perfusion unit(PU). The deep second degree burn was 59.7 PU and third degree burn was 5.1 PU. The blood flow of more than 100 PU reliably predicted the superficial second degree burn with 90.2 percents accuracy. The blood flow between 100 PU and 10 PU predict the deep second degree dermal burn with 96.2 percents accuracy. That of less than 10 PU predict the third degree burn with 100 percents accuracy. There was also a significant correlation between initial flow measurements and the depth of burn wounds. We conclude that laser doppler flow measurements performed early after burn injury are useful in predicting the depth of burn wounds. The laser doppler flowmetry has the advantage of being easy to use, noninvasive, provide immediate result for early determination of burn depth. The laser doppler flowmetry is useful in selecting patients for early excision and grafting of burn wounds.