J Korean Neuropsychiatr Assoc.  2007 Nov;46(6):603-609.

Korean Medication Algorithm for Depressive Disorder 2006 (III): Major Depressive Episode with Psychotic Feature

• Kim W
• Bahk WM
• Seo JS
• Min KJ
• Seok JH
• Jon DI
• Jeon HT
• Lee SY
• Song HC
• Hong JP
• Study Group of Korean Medication Algorithm Project for Depressive Disorder 2006

Abstract

OBJECTIVES
Since the publication of Korean Medication Algorithm Project for Major Depressive Disorder (KMAP-MD) in 2002, there has been a substantial need for a revision due to rapid progress in the pharmacological management of depressive disorder. We revised KMAP-MD 2002 and developed the Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) 2006.
METHODS
We developed a questionniare for surveying the opinion of experts on pharmacotherapy of depressive disorder. The questionnaire consisted of 4 parts; 1) treatment of non-psychotic depressive disorder, 2) treatment of psychotic depressive disorder, 3) treatment according to clinical subtypes and drugs choice considering adverse effects, and 4) treatment of depressive disorder in women. The questionnaire was completed by the review committee consisting of 101 experienced Korean psychiatrists. It is composed of 22 questions, and each question includes 54 sub-items. We classified the expert opinion to 3 categories (the first-line, the second-line, or the third-line) by Chi2-test.
RESULTS
For depressive disorder with psychotic features, most reviewers prefer the combination of antidepressant and atypical antipsychotics. Electroconvulsive therapy and the combination of antidepressant and typical antipsychotics were the second-line treatment. Among antidepressants, venlafaxine was the most preferred, and SSRI and mirtazapine followed. Among atypical antipsychotics, quetiapine, risperidone and olanzapine were the most preferred, in this order. In patients who have no response to the first-line treatment, many reviewers recommended switching to another antidepressant or adding another atypical antipsychotics.
CONCLUSION
For severe depressive disorder with psychotic features, the combination of antidepressant and atypical antipsychotics was preferred for the first-line treatment. These results suggest that the medication strategies of depressive disorder are rapidly changing and reflects the recent studies and clinical experiences.

Keyword

Depressive disorder; Psychotic features; Korean medication algorithm

MeSH Terms

Advisory Committees
Antidepressive Agents
Antipsychotic Agents
Depressive Disorder*
Depressive Disorder, Major
Drug Therapy
Electroconvulsive Therapy
Expert Testimony
Female
Humans
Psychiatry
Publications
Surveys and Questionnaires
Risperidone
Quetiapine Fumarate
Venlafaxine Hydrochloride
Antidepressive Agents
Antipsychotic Agents
Risperidone