J Korean Neuropsychiatr Assoc.  2021 Nov;60(4):258-266. 10.4306/jknpa.2021.60.4.258.

Korean Medication Algorithm Project for Depressive Disorder 2021 (IV): Female and Elderly

Affiliations
  • 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea
  • 3Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 4Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
  • 5Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
  • 6Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
  • 7Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
  • 8Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 9Department of Psychiatry, Soonchunhyang University Gumi Hospital, College of Medicine, Soonchunhyang University, Gumi, Korea
  • 10Department of Neuropsychiatry, College of Medicine, Chosun University, Department of Psychiatry, Chosun University Hospital, Gwangju, Korea
  • 11Department of Psychiatry, Naju National Hospital, Naju, Korea

Abstract


Objectives
An expert consensus guideline for the treatment of depressive disorder, the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD), was first established in 2002 and updated in 2017. To provide an up-to-date treatment guideline, KMAP-DD 2021 was recently completed. This study was undertaken to provide a guideline for the treatment of depressive disorder in a selected population that included females and elderly.
Methods
The survey conducted consisted of 7 questionnaires for each population, females and elderly, with depressive disorder. A total of 65 of 97 experienced psychiatrists answered the survey.
Results
For the treatment of premenstrual dysphoric disorder, the selective serotonin reuptake inhibitors, venlafaxine, and desvenlafaxine were recommended as first-line therapies. For major depressive disorder (MDD) during pregnancy, antidepressant (AD) monotherapy was recommended as a first-line therapy for mild to moderate and severe depression, and combined electroconvulsive therapy and AD with atypical antipsychotics (AAP) were recommended as a first-line therapy for severe depression with psychotic features. AD plus AAP was generally recommended for post-partum depression. In elderly with depression, AD monotherapy was recommended as the treatment of choice for mild to moderate episodes, and AD monotherapy and AD plus AAP were recommended as a first-line therapy for severe depression without psychotic features. Lastly, AD plus AAP was chosen as the treatment of choice for psychotic depression.
Conclusion
Present study provides an updated algorithm for the treatment of females and elderly with depressive disorders. This algorithm provides a practical aid to clinicians for the treatment of females and elderly with MDD.

Keyword

Depressive disorder; Korean Medication Algorithm; Female and elderly
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