Korean J Psychopharmacol.
2013 Jan;24(1):25-34.
Korean Medication Algorithm for Depressive Disorder (IV): Child and Adolescent/The Elderly/Female
- Affiliations
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- 1Department of Psychiatry, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. wmbahk@catholic.ac.kr
- 2Department of Psychiatry, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea.
- 3Department of Psychiatry, Seoul National Hospital, Seoul, Korea.
- 4Department of Psychiatry, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea.
- 5Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.
- 6Shinsegae Hospital, Gimje, Korea.
- 7Namwon Sungil Mental Hospital, Namwon, Korea.
- 8Department of Psychiatry, Stress Research Institute, Seoul Paik Hospital, College of Medicine, Inje University, Seoul, Korea.
- 9Department of Psychiatry, College of Medicine, Hallym University, Anyang, Korea.
- 10Department of Psychiatry, College of Medicine, University of Ulsan, Seoul, Korea.
- 11Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
Abstract
OBJECTIVE
Since the introduction of selective serotonin reuptake inhibitor in 1980s, there have been many changes in the treatment strategies for depressive disorders. To be of help for clinicians to select appropriate treatment strategies, Korean Medication Algorithm Project for Major Depressive Disorder was developed in 2002 and revised in 2006. To reflect changes in treatment pattern for depressive disorders since 2006, we revised the previous algorithm and developed Korean Medication Algorithm Project for Depressive Disorder 2012 (KMAP-DD 2012).
METHODS
123 psychiatrists who have vast clinical experiences in treating depressive disorders are primarily selected, and the survey was sent to them via mails. Among them, 67 psychiatrists answered the survey. This survey was composed of 44 questionnaires of which the contents covered from overall treatment strategies to treatment strategies under the specific circumstances. Based on 95% confidence interval and overall scores, each treatment of option was classified into three categories of recommendation; first-line, second-line, and third-line treatment option.
RESULTS
In child and adolescent, antidepressant monotherapy was selected as first-line treatment option for mild, moderate, and severe episode without psychotic features. The combination of antidepressant and atypical antipsychotics was advocated as first-line treatment option for severe episode with psychotic features. In geriatric depression, antidepressant monotherapy was advocated as treatment of choice for mild to moderate episode. For severe episode without psychotic features, antidepressant monotherapy was selected as first-line treatment option. For severe episode with psychotic features, combination of antidepressant and atypical antipsychotics was selected as treatment of choice. In premenstrual dysphoric disorder, antidepressant monotherapy was advocated as first-line treatment option. In postpartum depression, antidepressant monotherapy was selected as first-line treatment option for mild to moderate episode. For severe episode without psychotic features, both antidepressant monotherapy and combination of antidepressant and atypical antipsychotics were selected as first-line treatment option. For severe episode with psychotic features, both combination of antidepressant and atypical antipsychotics and combination of mood stabilizer and atypical antipsychotics were advocated as first-line treatment option.
CONCLUSION
In KMAP-DD 2012, the recommendations for treatment options in Child and Adolescent Depressive Disorder and Geriatric Depression were newly introduced. In aspects of treatment options for Female Depression, KMAP-DD 2006 and KMAP-DD 2012 had some similarities. But there were some changes of the treatment strategies in KMAP-DD 2012 which seemed to reflect recent study results.
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