Korean medication algorithm for depressive disorders 2017: Third revision
Jeong Seok Seo , Won-Myong Bahk *, Hee Ryung Wang , Young Sup Woo , Young-Min Park , Jong-Hyun Jeong , Won Kim , Se-Hoon Shim , Jung Goo Lee , Duk-In Jon , Kyung Joon Min
1Department of Psychiatry, School of Medicine, Konkuk University, Chungju, Korea, 2Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea, 3Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea, 4Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea, 5Department of Psychiatry, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea, 6Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Korea, 7Department of Psychiatry, Seoul Paik Hospital, School of Medicine, Inje University, Seoul, Korea/Stress Research Institute, Inje University, Seoul, Korea, 8Department of Psychiatry, Soonchunhyang University Cheonan Hospital, Soonchunhyang University, Cheonan, Korea, 9Department of Psychiatry, Haeundae Paik Hospital, College of Medicine, Inje University and Paik Institute for Clinical Research, Department of Health Science and Technology, Graduate School of Inje University, Busan, Korea
Received: July 12, 2017; Accepted: August 1, 2017; Published online: August 1, 2017.
© The Korean College of Neuropsychopharmacology. All rights reserved.

Abstract
Background: Here, we revised the guidelines for treating major depressive disorder (MDD), which was developed in 2002.
Methods: Using a 44-item questionnaire, an expert consensus was obtained on pharmacological treatment strategies for MDD 1) without or 2) with psychotic features, 3) depression subtypes, 4) maintenance, 5) special populations, 6) the choice of an antidepressant (AD) regarding safety and adverse effects, and 7) non-pharmacological biological therapies. Recommended first, second, and third-line strategies were derived statistically.
Results: AD monotherapy is recommended as the first-line strategy for non-psychotic depression in adults, children/adolescents, elderly adults, patient with persistent depressive disorder, and pregnant women or patients with postpartum depression or premenstrual dysphoric disorder. The combination of AD and atypical antipsychotics (AAP) was recommended for psychotic depression in adult, child/adolescent, postpartum depression, and mixed features or anxious distress. Most experts recommended stopping the ongoing initial AD and AAP after a certain period in patients with one or two depressive episodes. As an MDD treatment modality, 92% of experts are considering electroconvulsive therapy (ECT) and 46.8% are applying it clinically, while 86% of experts are considering repetitive transcranial magnetic stimulation (rTMS) but only 31.6% are applying it clinically.
Limitations: Study was based on a consensus of Korean experts rather than on evidence.
Conclusion: The pharmacological treatment strategy in 2017 is similar to that of KMAP-DD 2012. The preference of AAPs was more increased.
Keywords: algorithm, depressiive disorder, guideline, drug therapy


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