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KMID : 0368820130520050386
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Journal of the Korean Neuropsychiatr Association
2013 Volume.52 No. 5 p.386 ~ p.401
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Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy
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Han Kyu-Man
Park Seon-Cheol
Won Eun-Soo
Sung Seung-Hwan
Lee Hee-Young
Koo Jae-Woo
Lee Kyung-Min
Lee Hwa-Young
Paik Jong-Woo
Jeon Hong-Jin
Lee Moon-Soo
Shim Se-Hoon
Ko Young-Hoon
Lee Kang-Joon
Han Chang-Su
Ham Byung-Joo
Choi Joon-Ho
Hwang Tae-Yeon
Oh Kang-Seob
Park Yong-Chon
Lee Min-Soo
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Abstract
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Objectives: The aim of this study was to demonstrate the recommendations for antidepressant treatment strategy of dose increment, switching, combination, and augmentation therapy derived from Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition.
Methods: The guideline was developed through adaptation of 12 domestic and foreign clinical guidelines for depression, with key questions concerning pharmacotherapy of depression, and drawing of recommendations.
Results: The guideline strongly recommended dose increment, switching, and combination and augmentation therapy of antidepressant when patients with depression showed inadequate treatment outcomes from initial antidepressant treatment. The dose increment was strongly recommended when the patients had insufficient response from treatment with tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs). Switching from SSRI to non-SSRI was also strongly recommended. The combination of initial medication and other classes of antidepressants could benefit from treatment with TCAs, SSRIs, SNRIs, and noradrenergic and specific serotonergic antidepressants. Combination with norepinephrine and dopamine reuptake inhibitors or serotonin-2 antagonist/reuptake inhibitors was weakly recommended. The guideline strongly recommended use of the augmentation strategy of adding lithium or benzodiazepine to initial antidepressants. Augmentation of lamotrigine, T3, methylphenidate, and modafinil was weakly recommended.
Conclusion: If the initial outcomes of antidepressant therapy are unsatisfactory to the patients the next-step strategies of dose increment, switching, combination and augmentation of antidepressants should be considered after rechecking the patients’ drug compliance, dose, and diagnosis.
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KEYWORD
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Major depressive disorder, Guideline, Antidepressant, Switching, Combination, Augmentation
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