J Korean Neuropsychiatr Assoc.  2013 Sep;52(5):386-401.

Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition (III) : Dose Increment, Switching, Combination, and Augmentation Strategy in Antidepressant Therapy

• Han KM
• Park SC
• Won ES
• Sung SH
• Lee H
• Koo JW
• Lee K
• Lee HY
• Paik JW
• Jeon HJ
• Lee MS
• Shim SH
• Ko YH
• Lee KJ
• Han C
• Ham BJ
• Choi J
• Hwang TY
• Oh KS
• Hahn SW
• Park YC
• Lee MS

Abstract

OBJECTIVES
The aim of this study was to demonstrate the recommendations for antidepressant treatment strategy of dose increment, switching, combination, and augmentation therapy derived from Evidence-Based Korean Pharmacological Treatment Guideline for Depression, Revised Edition.
METHODS
The guideline was developed through adaptation of 12 domestic and foreign clinical guidelines for depression, with key questions concerning pharmacotherapy of depression, and drawing of recommendations.
RESULTS
The guideline strongly recommended dose increment, switching, and combination and augmentation therapy of antidepressant when patients with depression showed inadequate treatment outcomes from initial antidepressant treatment. The dose increment was strongly recommended when the patients had insufficient response from treatment with tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, selective serotonin reuptake inhibitors (SSRIs), and serotonin and norepinephrine reuptake inhibitors (SNRIs). Switching from SSRI to non-SSRI was also strongly recommended. The combination of initial medication and other classes of antidepressants could benefit from treatment with TCAs, SSRIs, SNRIs, and noradrenergic and specific serotonergic antidepressants. Combination with norepinephrine and dopamine reuptake inhibitors or serotonin-2 antagonist/reuptake inhibitors was weakly recommended. The guideline strongly recommended use of the augmentation strategy of adding lithium or benzodiazepine to initial antidepressants. Augmentation of lamotrigine, T3, methylphenidate, and modafinil was weakly recommended.
CONCLUSION
If the initial outcomes of antidepressant therapy are unsatisfactory to the patients the next-step strategies of dose increment, switching, combination and augmentation of antidepressants should be considered after rechecking the patients' drug compliance, dose, and diagnosis.

Keyword

Major depressive disorder; Guideline; Antidepressant; Switching; Combination; Augmentation

MeSH Terms

Antidepressive Agents
Antidepressive Agents, Tricyclic
Benzhydryl Compounds
Benzodiazepines
Compliance
Depression*
Depressive Disorder, Major
Dopamine Uptake Inhibitors
Drug Therapy
Humans
Lithium
Methylphenidate
Monoamine Oxidase Inhibitors
Norepinephrine
Serotonin
Serotonin Uptake Inhibitors
Triazines
Antidepressive Agents
Antidepressive Agents, Tricyclic
Benzhydryl Compounds
Benzodiazepines
Dopamine Uptake Inhibitors
Lithium
Methylphenidate
Monoamine Oxidase Inhibitors
Norepinephrine
Serotonin
Serotonin Uptake Inhibitors
Triazines

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