J Korean Neuropsychiatr Assoc.  2021 Aug;60(3):186-192. 10.4306/jknpa.2021.60.3.186.

Korean Medication Algorithm Project for Depressive Disorder 2021 (II): The Subtypes of Depression

• Park YM
• Seo JS
• Woo YS
• Bahk WM
• Kim W
• Jeong JH
• Shim SH
• Lee JG
• Jang SH
• Wang SM
• Jung MH
• Sung HM
• Choo LH
• Yoon BH
• Lee SY
• Jon DI
• Min KJ

• KMID: 2519853
• DOI: http://doi.org/10.4306/jknpa.2021.60.3.186

Abstract

Objectives
The Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006, 2012, 2017. In 2021, the fifth edition was published. This edition reflected new findings and the latest trends in the areas of pharmacological treatment. The aim of this study is to present strategies and treatment options according to the subtype of depression using data from the KMAP-DD-2021.
Methods
Ninety-seven psychiatrists with clinical experience in depressive disorder were selected. The questionnaires for KMAP-DD 2021 were sent to participants via mail. KMAP-DD 2021 consists of overall treatment strategies and treatment options under specific circumstances. Each treatment strategy or treatment option was evaluated with an overall score of nine and was divided into the three phases of recommendation that include primary, secondary, and tertiary.
Results
For persisting depressive disorder, antidepressant monotherapy including selective serotonin reuptake inhibitor (SSRI) (escitalopram, fluoxetine, sertraline, paroxetine), serotoninnorepinephrine reuptake inhibitor (SNRI) (desvenlafaxine, venlafaxine, duloxetine, milnacipran), vortioxetine, and mirtazapine, was recommended as first-line medications. For melancholia of major depressive disorder, SSRI, SNRI, vortioxetine, and mirtazapine also were recommended as first-line medications. For mixed features, SSRI, bupropion, mirtazapine, SNRI, except for duloxetine, and milnacipran were recommended as first-line medications. For anxious distress, SSRI, mirtazapine, and SNRI, except milnacipran, were recommended as first-line medications.
Conclusion
The preferences of antidepressants by experts differed according to the subtype of depression. These findings suggest that experts treat patients with a major depressive disorder after considering the subtype of depression involved.

Keyword

Korean Medication Algorithm Project; Major depressive disorder; Persisting depressive disorder; Subtype