J Korean Neuropsychiatr Assoc.
2007 Nov;46(6):610-616.
Korean Medication Algorithm for Depressive Disorder 2006 (IV): The Choice of Antidepressant According to the Subtypes of Depression, Adverse Effects of Antidepressant and Treatment Strategies in Women
- Affiliations
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- 1Department of Psychiatry, Hanmaeum Hospital, Seoul, Korea.
- 2Department of Neuropsychiatry, College of Medicine, Wonkwang University, Iksan, Korea. psysangyeol@hanmail.net
- 3Department of Neuropsychiatry and Stress Research Institute, Inje University College of Medicine, Inje University Seoul Paik Hospital, Seoul, Korea.
- 4Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea.
- 5Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea.
- 6Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea.
- 7Department of Neuropsychiatry, Hallym University College of Medicine, Anyang, Korea.
- 8Department of Psychiatry, St. Andrew's Neuropsychiatry Hospital, Icheon, Korea.
- 9Department of Psychiatry, College of Medicine, University of Ulsan, Seoul, Korea.
- 10Korean College of Neuropsychopharmacology, Korean Society for Depressive and Bipolar Disorders and Korean Academy of Schizophrenia, Seoul, Korea.
Abstract
OBJECTIVES
In 2002, the Korean Medication Algorithm Project for Major depressive Disorder (KMAP-MD) was published, but there has been a need for a guideline about detailed issues of depressive disorder. We revised KMAP-MDD and reestablished Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) in 2006.
METHODS
A questionnaire had been developed by the executive committee for KMAP-DD. The review committee consisted of 101 experienced psychiatrists. From the total of 22 questions in the questionnaire, 7 questions were evaluated for these subjects . We classified the expert opinions to 3 categories according to its confidence interval; first, second and third line.
RESULTS
SSRI and venlafaxine were the first line antidepressants (AD) for atypical and melancholic depression. For dysthymic disorder and minor depressive disorder, SSRI was recommended as the first line medications. Only AD medications was a preferred initial strategy for treating premenstrual dysphoric disorder, mild to moderate and severe non-psychotic postpartum depression. In severe psychotic postpartum depression, combination therapy of AD and atypical antipsychotics was the treatment of choice. SSRI was preferred when considering sedation, anticholinergic and cardiovascular adverse effects. Also, experts recommended mirtazapine against gastrointestinal adverse effects and bupropion in avoiding sexual dysfunction.
CONCLUSION
These results suggest that clinicians have to consider both clinical situations and drug adverse effects in the choice of antidepressant medications.
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