Korean Medication Algorithm for Depressive Disorders 2017: Third Revision

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.

Keywords: Algorithms; Depressive disorder; Drug therapy; Guideline.

Fig. 1

Korean Medication Algorithm for Depressive Disorder 2017: Non-psychotic depression. AD, antidepressant; AAP, atypical antipsychotics; AD′, another antidepressant; AD″, other antidepressant; AAP′, another atypical antipsychotics; AAP″, other atypical antipsychotics.

Fig. 2

Korean Medication Algorithm for Depressive Disorder 2017: Psychotic depression. AD, antidepressant; AAP, atypical antipsychotics; AD′, another antidepressant; AD″, other antidepressant; AAP′, another atypical antipsychotics; AAP″, other atypical antipsychotics.

Fig. 3

Indications of electro-convulsive therapy. 95% CI, 95% confidential interval; SD, standard deviation; ADs, antidepressants; APs, antipsychotics. *Treatment of choice.

Fig. 4

Indications of repetitive transcranial magnetic stimulation. 95% CI, 95% confidential interval; SD, standard deviation; ADs, antidepressants; APs, antipsychotics.