J Korean Neuropsychiatr Assoc.  2007 Sep;46(5):461-468.

Korean Medication Algorithm for Depressive Disorder 2006 (II): Major Depressive Disorder without Psychotic Features

Affiliations
  • 1Department of Psychiatry, College of Medicine, Hallym University, Hallym University Sacred Heart Hospital, Anyang, Korea. cogni@naver.com
  • 2Department of Psychiatry, Hanmaeum Hospital, Seoul, Korea.
  • 3Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.
  • 4Department of Psychiatry and Stress Research Institute, College of Medicine, Inje University, Seoul, Korea.
  • 5Department of Psychiatry, St. Andrew's Neuropsychiatry Hospital, Icheon, Korea.
  • 6Department of Neuropsychiatry, College of Medicine, Wonkwang University, Iksan, Korea.
  • 7Department of Neuropsychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
  • 8Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
  • 9Department of Psychiatry, College of Medicine, University of Ulsan, Seoul, Korea.
  • 10Korean Society for Depressive and Bipolar Disorders, Korean College of Neuropsychopharmacology and Korean Academy of Schizophrenia, Seoul, Korea.

Abstract


OBJECTIVES
There have been noticeable progresses in the pharmacological management of depressive disorders along with vigorous preclinical and clinical trials of newer antidepressant drugs during the last decade. Since the first development of Korean Medication Algorithm for Major Depressive Disorder (KMAP-MDD) in 2002, there has been a substantial need for the revision of this algorithm. We amended the KMAP-MDD to Korean Medication Algorithm for Depressive Disorders (KMAP-DD) in 2006 and included treatment strategies for other types of depressive disorders. This article is about the treatment of MDD without psychotic features in the KMAP-DD 2006.
METHODS
Questionnaires were developed by the executive committee for KMAP-DD. The first part of this questionnaire is about the treatment strategies of MDD without psychotic features, minor depressive disorder and dysthymic disorder. Seven questions and 10 sub-items were prepared to investigate the experts' opinions about treatment of major depressive disorders without psychotic features. The expert review committee composed of 101 experienced Korean psychiatrists was asked to evaluate the medication strategies for various clinical situations of depressive disorders using a 9-point scale. The scale was slightly modified from the format developed by the RAND corporation. We classified the expert opinions into 3 categories (first-line, high second-line and low second-line) by the 95% confidence interval of response score and evaluated the consensus of opinions of Korean experts using Chi2-test.
RESULTS
For patients with MDD without psychotic features, antidepressant monotherapy was the optimal first-line treat-ment strategy regardless of the severity of an episode. In case of no or partial response to antidepressant monotherapy for severe episode of MDD, combination treatment with another antidepressant drug or augmentation treatment with triiodothyronine or lithium was considered as the second-line treatment. Meanwhile, for mild-to-moderate episode of MDD without psychotic features, switching to another antidepressant as well as augmentation or combination treatment was also considered as the second-line treatment. Selective serotonin reuptake inhibitors, venlafaxine, and mirtazapine were chosen as the 1st-line antidepressant drugs for MDD without psychotic features in Korea.
CONCLUSION
The initial treatment strategy for patients with major depressive disorder without psychotic features is similar to that of the previous medication algorithm (KMAP-MDD). However, combination treatment with two antidepressant drugs and augmentation treatment strategies were considered at a relatively earlier step in this algorithm than in the previous version of Korean medication algorithm (KMAP-MDD) for the severe episode of major depressive disorder. The recent trials of newer antidepressant drugs and the preference of more active treatment strategy in up-to-date clinical psychiatry fields may have affected these changes in Korea.

Keyword

Medication algorithm; Major depressive disorder without psychotic features
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