J Korean Neuropsychiatr Assoc.  2021 Aug;60(3):174-185. 10.4306/jknpa.2021.60.3.174.

Korean Medication Algorithm Project for Depressive Disorder 2021 (I): Treatment Strategies for Major Depressive Episode

  • 1Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea
  • 2Department of Psychiatry, College of Medicine, Chung-Ang University, Seoul, Korea
  • 3Department of Psychiatry, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
  • 4Department of Psychiatry, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
  • 5Department of Psychiatry, Soonchunhyang University Cheonan Hospital, College of Medicine, Soonchunhyang University, Cheonan, Korea
  • 6Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea
  • 7Department of Psychiatry, Wonkwang University Hospital, School of Medicine, Wonkwang University, Iksan, Korea
  • 8Department of Psychiatry, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 9Department of Psychiatry, Soonchunhyang University Gumi Hospital, College of Medicine, Soonchunhyang University, Gumi, Korea
  • 10Department of Neuropsychiatry, College of Medicine, Chosun University, Department of Psychiatry, Chosun University Hospital, Gwangju, Korea
  • 11Department of Psychiatry, Naju National Hospital, Naju, Korea


The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) is a consensus-based medication guideline. To reflect advances in pharmacotherapy for depressive disorders, we have undertaken a fourth revision of the KMAP-DD.
The review committee for the new version of the KMAP-DD (KMAP-DD 2021) included 143 Korean psychiatrists with clinical experience in the field of depressive disorders. Each treatment strategy or treatment option was evaluated with an overall score of nine, and the treatment option was categorized into the three levels of recommendation of primary, secondary, and tertiary.
The first-line pharmacotherapeutic strategy for mild to moderate major depressive episodes (MDE) was antidepressant (AD) monotherapy. For severe MDE without psychotic features, AD monotherapy or the combination of AD and atypical antipsychotics (AAP) was the first-line strategy. The combination of AD and AAP was recommended as the first-line for the MDE with psychotic features as well. When treatment response to initial AD monotherapy was insufficient, a combination of AAP or another AD was recommended. In the case of unsatisfactory response to initial treatment with an AD and AAP combination, switching to another AAP or adding another AD was recommended.
Generally, there were no significant changes in the recommendations for MDE management in the KMAP-DD 2021 compared to previous versions. However, it was notable that the preference for the use of AAP and AD with the novel mechanism of action including vortioxetine and agomelatine increased.


Major depressive disorder; Pharmacotherapy; Algorithm
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