J Korean Neuropsychiatr Assoc.
2007 Sep;46(5):453-460.
Korean Medication Algorithm for Depressive Disorder 2006 (I)
- Affiliations
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- 1Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.
- 2Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea. kjmin@cau.ac.kr
- 3Department of Psychiatry and Stress Research Institute, College of Medicine, Inje University, Seoul, Korea.
- 4Department of Psychiatry, College of Medicine, Hallym University, Sacred Heart Hospital, Anyang, Korea.
- 5Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- 6Department of Psychiatry, St. Andrew's Neuropsychiatry Hospital, Icheon, Korea.
- 7Department of Neuropsychiatry, College of Medicine, Wonkwang University, Iksan, Korea.
- 8Department of Psychiatry, Hanmaeum Hospital, Seoul, Korea.
- 9Department of Psychiatry, College of Medicine, University of Ulsan, Seoul, Korea.
- 10Korean College of Neuropsychopharmacology, Korean Society for Depressive and Bipolar Disorders and Korean Academy of Schizophrenia, Seoul, Korea.
Abstract
OBJECTIVES
Since the publication of Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management for depressive disorder. We revised KMAP-MD to Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006. This paper is one of the following 4 papers consisting of Korean pharmacological algorithm for depressive disorder.
METHODS
The questionnaire consisted of 4 parts; initial treatment of 1) non-psychotic depressive disorder, 2) psychotic depressive disorder, 3) treatment strategy for clinical subtypes and drug choice considering adverse effects, and 4) treatment for depressive disorder in women. It was composed of 22 questions, and each question had 54 sub-items. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line).
RESULTS
For non-psychotic major depression, regardless of the severity of an episode, the antidepressant (AD) monotherapy was the optimal first-line treatment. SSRI, venlafaxine, and mirtazapine were the 1st-line AD. In case of a partial or no response to initial strategy, adding another AD was recommended. For psychotic major depression, combination of an AD and an atypical antipsychotic (AAP) was the treatment of choice. Among AAPs, quetiapine, risperidone, olanzapine were preferred. For non-responder to initial strategy, the next step was adding or changing AD before changing AAP. For women with premenstrual dysphoric syndrome or postpartum depression without psychotic features, AD monotherapty was a preferred strategy while for psychotic postpartum depression, combination of AD and AAP was recommended. Experts recommended various ADs according to adverse effect.
CONCLUSION
These results suggest that the medication strategies for depressive disorder are rapidly changing and reflect the recent studies and clinical experiences.
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