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KMID : 1007420130110010012
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Mood and Emotion
2013 Volume.11 No. 1 p.12 ~ p.19
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Korean Medication Algorithm for Depressive Disorder (II) : Psychotic Depression
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Lee Hwang-Bin
Jeong Jong-Hyun
Song Hoo-Rim
Seo Jeong-Seok
Park Young-Min
Hong Jeong-Wan
Kim Won
Wang Hee-Ryung
Lim Eun-Sung
Min Kyung-Jun
Bahk Won-Myong
Hong Jin-Pyo
Jon Duk-In
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Abstract
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OBJECTIVE: To update treatment strategies for psychotic depression, we revised Korean medication algorithm for depressive disorder based on the expert clinical consensus.
METHODS: We developed the 44-item questionnaire consisted of six parts, including treatment strategies for psychotic depression. The questionnaire was sent to the review committee consisting of 123 experienced korean psychiatrists. They were asked to rate their preference for various treatment options and treatment medications on a 1-9 point scale. We classified expert opinions to 3 categories (the first, the second, or the third choice).
RESULTS: The combination of antidepressant and atypical antipsychotic medication is preferred for the initial treatment strategy for psychotic depression. For patients who fail to respond fully to the initial treatment strategy, switching or adding an antidepressant or atypical antipsychotic medication is the most likely chosen for the subsequent treatment strategy. To allow sufficient time for treatment effects to take place, it is recommended to wait 2-5 weeks before changing the treatment regimen when the initial treatment strategy is not responsive, whereas 3-7 weeks is recommended when the initial treatment strategy is partially responsive. Mirtazapine, SSRIs, and SNRIs are the most preferred antidepressants. Quetiapine, aripiprazole, olanzapine, and risperidone are preferred antipsychotics.
CONCLUSIONS: For psychotic depression, the combination of antidepressant and atypical antipsychotic medication is the treatment-of-choice. Mirtazapine, SSRIs, SNRIs, quetiapine, aripiprazole, olanzapine, and risperidone are preferred drugs.
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KEYWORD
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Psychotic depression, Medication, Algorithm, Depressive disorder
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