Clin Psychopharmacol Neurosci.
2018 Feb;16(1):67-87. 10.9758/cpn.2018.16.1.67.
Korean Medication Algorithm for Depressive Disorders 2017: Third Revision
- Affiliations
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- 1Department of Psychiatry, Konkuk University School of Medicine, Cheongju, Korea.
- 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
- 3Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
- 4Department of Psychiatry, Seoul Paik Hospital, Inje University College of Medicine, Seoul, Korea.
- 5Korea/Stress Research Institute, Inje University, Seoul, Korea.
- 6Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea.
- 7Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Korea.
- 8Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan, Korea.
- 9Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea.
- 10Department of Psychiatry, Chung-Ang University College of Medicine, Seoul, Korea. wmbahk@catholic.ac.kr
- KMID: 2405236
- DOI: http://doi.org/10.9758/cpn.2018.16.1.67
Abstract
OBJECTIVE
In 2002, the Korean Society for Affective Disorders developed the guidelines for the treatment of major depressive disorder (MDD), and revised it in 2006 and 2012. The third revision of these guidelines was undertaken to reflect advances in the field.
METHODS
Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically.
RESULTS
AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation but only 31.6% are applying it clinically.
CONCLUSION
The pharmacological treatment strategy in 2017 is similar to that of Korean Medication Algorithm for Depressive Disorder 2012. The preference of AAPs was more increased.
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