J Korean Neuropsychiatr Assoc.  2021 Nov;60(4):267-274. 10.4306/jknpa.2021.60.4.267.

Korean Medication Algorithm Project for Depressive Disorder 2021 (V): Antidepressant Choices According to Safety, Adverse Effect, Comorbid Physical Illnesses and Clinical Definition of Treatment Resistant Depression

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

• KMID: 2523096
• DOI: http://doi.org/10.4306/jknpa.2021.60.4.267

Abstract

Objectives
To revise Korean Medication Algorithm Project for Depressive Disorder 2017 (KMAPDD 2017) guidelines by revising antidepressant choices based on their safety, adverse effects, comorbid physical illnesses, and the clinical definition of treatment-resistant depression (TRD).
Methods
A 33-item questionnaire comprised of six parts was developed. A 65-expert consensus (65/97, 67.0%) was obtained on pharmacological treatment strategies regarding antidepressant choice with respect to safety, adverse effects, and comorbid physical illnesses. Multiple response sets were subjected to statistical analysis.
Results
The results obtained showed that first-line pharmacotherapeutic strategies based on various clinical considerations were as follows: mirtazapine (for patients with increased suicidality, Gastrointestinal discomfort, and insomnia), bupropion (for patients with orthostatic hypotension, history of a safety accident, serotonin syndrome, sedation, sexual dysfunction, and weight gain), and escitalopram (for patients with anticholinergic side effects). For patients exhibiting comorbid conditions, duloxetine was the first line pharmacotherapeutic strategy for chronic pain, escitalopram was the first-line pharmacotherapeutic strategy for diabetes, hypertension, liver disease, Parkinson’s disease, renal disease, epilepsy, and thyroid disease, and sertraline was a first-line pharmacotherapeutic strategy for arrhythmia and cardiovascular disease.
Conclusion
Pharmacological treatment strategy of KMAP-DD 2021 is similar to that of KMAPDD 2017. Additional study is required to determine antidepressant choices for TRD and cancer patients with depression.

Keyword

Depressive disorder; Safety; Adverse effect; Comorbid physical iIlness; Treatment resistant depression