J Korean Neuropsychiatr Assoc.  2021 Nov;60(4):267-274. 10.4306/jknpa.2021.60.4.267.

Korean Medication Algorithm Project for Depressive Disorder 2021 (V): Antidepressant Choices According to Safety, Adverse Effect, Comorbid Physical Illnesses and Clinical Definition of Treatment Resistant Depression

  • 1Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 2Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
  • 3Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, 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, College of Medicine, Chung-Ang University, Seoul, Korea
  • 7Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
  • 8Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, 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


To revise Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, adverse effects, comorbid physical illnesses, and the clinical definition of treatment-resistant depression (TRD).
A 33-item questionnaire comprised of six parts was developed. A 65-expert consensus (65/97, 67.0%) was obtained on pharmacological treatment strategies regarding antidepressant choice with respect to safety, adverse effects, and comorbid physical illnesses. Multiple response sets were subjected to statistical analysis.
The results obtained showed that first-line pharmacotherapeutic strategies based on various clinical considerations were as follows: mirtazapine (for patients with increased suicidality, Gastrointestinal discomfort, and insomnia), bupropion (for patients with orthostatic hypotension, history of a safety accident, serotonin syndrome, sedation, sexual dysfunction, and weight gain), and escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, duloxetine was the first line pharmacotherapeutic strategy for chronic pain, escitalopram was the first-line pharmacotherapeutic strategy for diabetes, hypertension, liver disease, Parkinson’s disease, renal disease, epilepsy, and thyroid disease, and sertraline was a first-line pharmacotherapeutic strategy for arrhythmia and cardiovascular disease.
Pharmacological treatment strategy of KMAP-DD 2021 is similar to that of KMAPDD 2017. Additional study is required to determine antidepressant choices for TRD and cancer patients with depression.


Depressive disorder; Safety; Adverse effect; Comorbid physical iIlness; Treatment resistant depression
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