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KMID : 1007420170150010005
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Mood and Emotion
2017 Volume.15 No. 1 p.5 ~ p.13
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Korean Medication Algorithm for Depressive Disorder 2017(I) : Major Depressive Disorder without Psychotic Features
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Woo Young-Sup
Seo Jeong-Seok
Wang Hee-Ryung
Park Young-Min
Kim Won
Jeong Jong-Hyun
Shim Se-Hoon
Lee Jung-Goo
Hong Jin-Pyo
Jon Duk-In
Min Kyung-Jun
Bahk Won-Myong
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Abstract
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Objectives : To reflect continuous advances in pharmacological treatment for depression, we have undertaken a revision of the previous version of the Korean Medication Algorithm Project for Depressive Disorder (KMAPDD).
Methods : The KMAP-DD 2017 questionnaire was constructed with 44 questions which asked about overall treatment strategies along with treatment strategies under specific circumstances. This questionnaire was completed by 79 experienced Korean psychiatrists.
Results : The first-line strategy for mild to moderate episodes is an antidepressant monotherapy with escitalopram or sertraline. For severe episodes without psychotic features, antidepressant monotherapy (escitalopram, venlafaxine or mirtazapine) or a combination of an antidepressant and an atypical antipsychotic (AAP, aripiprazole or quetiapine) were the first-line strategy. In the case of not responding to the initial treatment, switching to or combining with another class of antidepressants or an AAP were recommended. In the case of partially responding to the initial treatment, adding another antidepressant or combining with an atypical antipsychotic was preferred.
Conclusion : If psychotic features are not apparent in a major depressive disorder, SSRIs, SNRIs and mirtazapine monotherapy or these in combination with an AAP are initially considered. There are trends, when the initial treatment is not responded to, of combining an antidepressant and an AAP. This trend has reached the same level of recommendation as antidepressant monotherapy.
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KEYWORD
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Major depressive disorder, Non-psychotic features, Medication, Algorithm
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