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KMID : 1007420170150010021
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Mood and Emotion
2017 Volume.15 No. 1 p.21 ~ p.26
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Korean Medication Algorithm for Depressive Disorder 2017(III) : Maintenance Treatment
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Kim Won
Wang Hee-Ryung
Woo Young-Sup
Seo Jeong-Seok
Park Young-Min
Jeong Jong-Hyun
Shim Se-Hoon
Lee Jung-Goo
Jon Duk-In
Min Kyung-Joon
Bahk Won-Myong
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Abstract
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Objectives : Pharmacological treatment of depression is common. Novel pharmacological agents are continuously being developed and introduced for use. The Korean Medication Algorithm Project for Depressive Disorder (KMAPDD) developed in 2002 and revised in 2006 and 2012 seeks to manage the burgeoning data to optimally benefit patients.
The latest revision of KMAP-DD reflects new research results and the latest trends in the areas of pharmacological treatment. The current study focused on maintenance treatment.
Methods : A 44-item questionnaire was used to obtain the consensus of experts regarding pharmacological treatment strategies for depressive disorder. The review committee included 144 psychiatrists who have vast clinical experiences in depressive disorder. Of the committee members, 79 psychiatrists responded to the survey. Each treatment strategy or treatment option was evaluated with the overall score of nine and the following 95% confidence interval result treatment options were divided into primary, secondary, and tertiary recommendations. Multiple response sets were used for the statistical analysis.
Results : Most clinicians maintained use of antidepressants and antipsychotics in the treatment of patients with major depressive episodes with psychotic feature during remission. We questioned how to treat the patients in the maintenance phase according to history of depressive episode. For patients in remission from the first depressive episode, most clinicians maintained antidepressants from 19.8 to 46.8 weeks. For patients in remission of the second depressive episode, many clinicians maintained antidepressants from 34.8 to 78.4 weeks. For patients with history of three or more depressive episodes, most clinicians (83.5%) treated continuously and indefinitely. The preferred maintenance dose of antidepressants was about 75% of the acute treatment dose. Maintenance of antipsychotics in patients with psychotic depression in remission was similar to the antidepressants, although the agents were usedfor a shorter time and at a lower dose.
Conclusion : The maintenance treatment strategy of KMAP-DD 2017 is similar to that of KMAP-DD 2012. Most clinicians prefer to maintain antidepressant medications for an extended time after achieving remission. For patients with a history of more depressive episodes, many clinicians prefer to maintain antidepressant therapy continuously. The maintenance of antipsychotics is also preferred, but the duration is shorter than for antidepressants. The dose of antidepressant in maintenance treatment is about 75% of the dose in acute treatment, and the dose of antipsychotics is about 50%.
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KEYWORD
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Korean medication algorithm for depressive disorder 2017, Major depression, Pharmacotherapy, Maintenance
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