한국형 우울장애 약물치료 알고리듬 2012(I) : 정신병적 양상이 없는 주요우울장애

Abstract

Objectives : Nowadays, the pharmacological method is widely used as the standard treatment for depression. However, as a result of newer agents being introduced, pharmacological treatment strategy continues to develop. To overcome problematic nature in this trend, Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD)had been developed in 2002 and revised in 2006. And we propose the third revision of KMAP-DD reflecting the new research results and the latest trends in the areas of pharmacological treatment. Methods : 123 psychiatrists who had rich clinical experiences in depression were primary selected then surveyed via mail ;67 surveys were retrieved. This survey was constructed with 44 questions which contained overall treatment strategies to specific treatment strategies. Each treatment strategy or treatment option was evaluated with the overall score of nine and the following 95% confidence interval. Results were divided into three phases of recommendation; primary, secondary, tertiary. Results : The initial strategy for pharmacological treatment in major depression disorder without psychotic features is a single treatment of antidepressant which does not take into consideration of the severity of depressive episode. Also, primary recommendations for the mild to moderate episodes are SSRIs except fluvoxamine, SNRIs and mirtazapine. As for the severe episodes, SSRIs except fluvoxamine and flouxetine, SNRIs except milnacipran, and mirtazapine are recommended. In case of no response to the initial treatment, switching to another antidepres-sants or adding another antidepressants are the preferred methods. In case of partial responses to initial treatment, adding another antidepressants or combination of atypical antipsychotics are preferred. As for atypical antipsychot-ics, aripiprazole and quetiapine are selected primarily in the combined pharmacological therapy. Conclusion : If psychotic features are not apparent in major depression disorder, SSRIs, SNRIs and mirtazapine are initially consid-ered for single treatments. There are trends in which if enough response is not obtained in the initial treatment, stra-tegically adding another antidepressants are still preferred as well as combination of atypical antipsychotics. (J of Kor Soc for Dep and Bip Disorders 2013;11:5-11)