한국형 우울장애 약물치료 알고리듬 2017(I) : 정신병적 양상이 없는 주요우울장애

초록

revision of the previous version of the Korean Medication Algorithm Project for Depressive Disorder (KMAPDD). Methods : The KMAP-DD 2017 questionnaire was constructed with 44 questions which asked about overall treatment strategies along with treatment strategies under specific circumstances. This questionnaire was completed by 79 experienced Korean psychiatrists. Results : The first-line strategy for mild to moderate episodes is an antidepressant monotherapy with escitalopram or sertraline. For severe episodes without psychotic features, antidepressant monotherapy (escitalopram, venlafaxine or mirtazapine) or a combination of an antidepressant and an atypical antipsychotic (AAP, aripiprazole or quetiapine) were the first-line strategy. In the case of not responding to the initial treatment, switching to or combining with another class of antidepressants or an AAP were recommended. In the case of partially responding to the initial treatment, adding another antidepressant or combining with an atypical antipsychotic was preferred. Conclusion : If psychotic features are not apparent in a major depressive disorder, SSRIs, SNRIs and mirtazapine monotherapy or these in combination with an AAP are initially considered. There are trends, when the initial treatment is not responded to, of combining an antidepressant and an AAP. This trend has reached the same level of recommendation as antidepressant monotherapy.

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