J Korean Med Assoc.  2020 Apr;63(4):216-226. 10.5124/jkma.2020.63.4.216.

Symptom-based selection of antidepressants

  • 1Department of Psychiatry, Inje University Haeundae Paik Hospital, Busan, Korea


Most evidence-based pharmacological guidelines recommend selective serotonin reuptake inhibitors, serotoninnorepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors or norepinephrine and specific serotonin antidepressants as the first-line treatment for major depression. Since the clinical factors associated with treating patients with depression are relatively complex, it can be challenging to apply the recommendations of evidence-based medicine verbatim. Furthermore, the diagnostic criteria of major depressive disorders, which are defined in a polythetic and operational manner, inevitably result in their heterogeneity. Studies have inferred that depressive syndrome may be connected with “family resemblance” rather than being shared with a neurobiological essence. Therefore, the symptom-based selection of antidepressants can be supported by a network analysis that provides a novel perspective on the symptom structure of major depression. The symptom-based treatment algorithm suggests treatment options that can be applied to the symptoms that are included in and excluded from the diagnosis criteria of major depressive disorder. The symptom-based selection of antidepressants and other psychotropic agents involves matching the deconstructed symptoms of depression to the specific neuroanatomical regions and neurotransmitters. This ensures timely and optimized treatment options for patients with depression.


Antidepressive agents; Depression; Psychopathology; Drug therapy; Algorithms; 항우울제; 우울증; 정신병리학; 약물치료; 알고리듬
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