한국형 우울장애 약물치료 알고리듬 2012(II) : 정신병적 양상을 동반한 우울장애

Abstract

OBJECTIVE: To update treatment strategies for psychotic depression, we revised Korean medication algorithm for depressive disorder based on the expert clinical consensus.

METHODS: We developed the 44-item questionnaire consisted of six parts, including treatment strategies for psychotic depression. The questionnaire was sent to the review committee consisting of 123 experienced korean psychiatrists. They were asked to rate their preference for various treatment options and treatment medications on a 1-9 point scale. We classified expert opinions to 3 categories (the first, the second, or the third choice).

RESULTS: The combination of antidepressant and atypical antipsychotic medication is preferred for the initial treatment strategy for psychotic depression. For patients who fail to respond fully to the initial treatment strategy, switching or adding an antidepressant or atypical antipsychotic medication is the most likely chosen for the subsequent treatment strategy. To allow sufficient time for treatment effects to take place, it is recommended to wait 2-5 weeks before changing the treatment regimen when the initial treatment strategy is not responsive, whereas 3-7 weeks is recommended when the initial treatment strategy is partially responsive. Mirtazapine, SSRIs, and SNRIs are the most preferred antidepressants. Quetiapine, aripiprazole, olanzapine, and risperidone are preferred antipsychotics.

CONCLUSIONS: For psychotic depression, the combination of antidepressant and atypical antipsychotic medication is the treatment-of-choice. Mirtazapine, SSRIs, SNRIs, quetiapine, aripiprazole, olanzapine, and risperidone are preferred drugs.