J Korean Neuropsychiatr Assoc.  2021 Nov;60(4):275-283. 10.4306/jknpa.2021.60.4.275.

Korean Medication Algorithm Project for Depressive Disorder 2021 (VI): Non-Pharmacological Biological Treatments

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
The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was made to update new researches and data. This study focused on non-pharmacological biological treatments.
Methods
Ninety-seven psychiatrists with extensive clinical experience in the non-pharmacological biological treatment of depressive disorder were primary selected and a questionnaire was sent to each of them by mail, 65 of the 97 replied.
Results
Electroconvulsive therapy (ECT) was recommended as an initial strategy for major depressive disorder, severe depressive disorder with/without psychotic features with urgent suicidal risk, or a severe depressive episode with psychotic features in pregnant patients, for non-responders on pharmacotherapy for a moderate depressive episode, and as a second strategy for non-responders on antidepressant monotherapy or combination therapy combined with physical illness. For pregnant women with a severe episode of major depressive disorder, repetitive transcranial magnetic stimulation (rTMS) was preferred as a first-line strategy, and as a second strategy for non-responders on combined antipsychotic and antidepressant therapy and non-responders with comorbidity and physical illness. Complementary or novel treatment was not recommended as the first-line treatment strategy for depressive disorder, but transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), light therapy, and omega-3 fatty acid nutritional therapy were second-line treatment strategies.
Conclusion
ECT and rTMS are initial strategies in specific clinical situations. Preferences for complementary or novel treatments such as tDCS, light therapy, and omega-3 fatty acid nutritional therapy have increased gradually, but in practice, their usages are still limited.

Keyword

Korean Medication Algorithm Project for Depressive Disorder 2021; Major depressive disorder; Non-pharmacological biological treatments
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