한국형 우울장애 약물치료 알고리듬 2012(VI) : 비약물학적 생물치료

Abstract

Objectives: Pharmacological treatment of depression is widely used. As new medication for depression has been introduced continuously, pharmacological treatment strategy is also changing. To overcome problematic nature this trend, Korean Medication Algorithm Project for Depressive Disorder (KMAP-DD) was developed in 2002 and revised in 2006. Since the last revision six years ago, this revision reflected the new research result and the latest trends in the areas of pharmacological treatment. Methods: 123 psychiatrists who have vast clinical experiences in depressive disorder are primary selected then survey was sent to them via mail, 67 surveys were retried. This survey is constructed with 44 questionnaires in which contained from overall treatment strategies to treatment strategies under the specific circumstances. Each treatment strategy or treatment option is evaluated with the overall score of nine and the following 95% confidence interval result treatment option were divided into three phases of recommendation; primary, secondary, tertiary. Results: Electroconvulsive therapy(ECT) was recommended as an initial strategy for major depressive disorder, severe without psychotic features with urgent suicidal risk, and as a second strategy for non-responders on antidepressant combination therapy and combined with physical illness. In the patient of major depressive disorder, severe with psychotic features, ECT was preferred as an initial strategy for urgent suicidal risk patients, but as a second strategy for non-responders on antipsychotics and antidepressants combination therapy and combid with physical illness. Many experts have considered ECT (84.4%) as a good treatment strategy, and 53% of experts have execute ECT. TMS was not recommended as a initial treatment strategy for major depressive disorder, but could be a second strategy for non-responder on antidepressants combination therapy in severe episodes without psychotic features and non-responders on pharmacotherapy in moderate episodes. Light therapy, omega-3 and megavitamine combination therapy could be a second strategies for treatment refractory patients. Conclusions: ECT was an initial strategy in severe episode with/without psychotic features who has an urgent suicidal risks, and secondarily preferred in case of non-responders, comorbid with physical illness and pregnants. Combination with complementary therapy was a second strategy for treatment refractory patients.