J Korean Neuropsychiatr Assoc.  2021 Nov;60(4):275-283. 10.4306/jknpa.2021.60.4.275.

Korean Medication Algorithm Project for Depressive Disorder 2021 (VI): Non-Pharmacological Biological Treatments

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

• KMID: 2523097
• DOI: http://doi.org/10.4306/jknpa.2021.60.4.275

Abstract

Objectives
The Korean Medication Algorithm Project for Depressive Disorder 2021 (KMAP-DD 2021) was made to update new researches and data. This study focused on non-pharmacological biological treatments.
Methods
Ninety-seven psychiatrists with extensive clinical experience in the non-pharmacological biological treatment of depressive disorder were primary selected and a questionnaire was sent to each of them by mail, 65 of the 97 replied.
Results
Electroconvulsive therapy (ECT) was recommended as an initial strategy for major depressive disorder, severe depressive disorder with/without psychotic features with urgent suicidal risk, or a severe depressive episode with psychotic features in pregnant patients, for non-responders on pharmacotherapy for a moderate depressive episode, and as a second strategy for non-responders on antidepressant monotherapy or combination therapy combined with physical illness. For pregnant women with a severe episode of major depressive disorder, repetitive transcranial magnetic stimulation (rTMS) was preferred as a first-line strategy, and as a second strategy for non-responders on combined antipsychotic and antidepressant therapy and non-responders with comorbidity and physical illness. Complementary or novel treatment was not recommended as the first-line treatment strategy for depressive disorder, but transcranial direct current stimulation (tDCS), vagus nerve stimulation (VNS), deep brain stimulation (DBS), light therapy, and omega-3 fatty acid nutritional therapy were second-line treatment strategies.
Conclusion
ECT and rTMS are initial strategies in specific clinical situations. Preferences for complementary or novel treatments such as tDCS, light therapy, and omega-3 fatty acid nutritional therapy have increased gradually, but in practice, their usages are still limited.

Keyword

Korean Medication Algorithm Project for Depressive Disorder 2021; Major depressive disorder; Non-pharmacological biological treatments